If the tear does not show, it is considered a Grade 1 or 2 and is not as serious. Meniscal root tears are a form of radial tear that involves the central attachment of the meniscus (12a). By continuing to use our site, you consent to the use of cookies outlined in our Privacy Policy. A mimicking an anterior horn tear. Examination showed lateral joint line tenderness and a positive McMurray sign. A classification system developed by the International Society of Arthroscopy, Knee Surgery, and Orthopedic Sports Medicine [, Longitudinal-vertical tear. If a meniscus tear shows up on a MRI, it is considered a Grade 3. Clinical History: An 18 year-old male with a history of a posterior horn medial meniscus peripheral longitudinal tear treated with meniscal repair at age 16 presents for MR imaging. Clin Orthop Relat Res 2012; 470: pp. Irrespective of the repair approach or repair devices used, diagnostic criteria for a recurrent tear remains the same fluid signal or contrast extending into the meniscal substance. immediatly lateral to the anterior horn of lateral meniscus and posterior to the tubercle of anteriro horn of medial meniscus . incomplete breakdown of the central meniscus, but this is now disputed, both enjoyable and insightful. Of the anterior horn tears read on MRI, 85% involved the lateral meniscus anterior horn and about one half were judged to extend into the middle or body of the same meniscus. joint: Morphologic changes and their potential role in childhood Meniscus repair is superior to partial meniscectomy in preventing osteoarthritis and facilitating return to athletic activity.11 However, the period of postoperative immobilization and activity restriction associated with meniscus repair is longer than that associated with partial meniscectomy and requires a compliant, motivated patient to be successful. Long-term outcome after arthroscopic meniscal repair versus arthroscopic partial meniscectomy for traumatic meniscal tears. 3. They are most frequently seen at the posterior horn of the medial meniscus. was saddle shaped. variant, and discoid medial meniscus. One of the most frequent indications for arthroscopic knee surgery is a meniscal tear.1 It is estimated that 1 million meniscus surgeries are performed in the U.S. annually with 4 billion dollars in associated direct medical expenditures.2 Meniscal surgeries include partial meniscectomy, meniscal repair and meniscal replacement. We use cookies to create a better experience. Of the 14 athletes, 8 repairs were performed, 5 patients . 15 year old patient with prior extensive lateral partial meniscectomy was treated with lateral chondroplasty and lateral meniscal allograft transplant with continued pain and clicking 6 weeks post-operative. Medial meniscus bucket handle tears can result in a double PCL sign. be misinterpreted for more significant pathology on MRI. Suprapatellar plica noticed, with no related cartilaginous erosions. On MRI, longitudinal tears appear as a vertical line of abnormal signal contacting articular surface. In children, sometimes an increased signal is seen within meniscus due to increased vascularity, but usually the signal does not contact articular surface. What are the findings? These tears are usually degenerative in nature and usually not associated with a discrete injury [. Ross JA,Tough ICK, English TA. Illustration of the transtibial pullout repair for a tear of the posterior horn medial meniscal root (arrow). The posterior cruciate ligament is intact. Of these 45 patients, there was an average of 3.74 additional pathological conditions noted on the MRI scan, mainly including degenerative arthrosis or patellar chondromalacia to explain the patients continued pain. 2002;30(2):189-192. Radial or oblique tear congurations close to or within the meniscus . A slightly overweight 44-year-old male sought evaluation for medial knee pain that persisted for months after running on the beach. Rao PS, Rao SK, Paul R. Clinical, radiologic, and arthroscopic assessment of discoid lateral meniscus. Sagittal proton density (PD) images through normal medial (, The medial meniscus is larger, more oblong, and normally has a larger posterior horn than anterior horn in cross section. On examination, the patient had medial joint line tenderness with positive McMurray test. When evaluating a portion of the meniscus that is in a different location than the repair, criteria for evaluating a virgin meniscus may be used for that area. Objectives: Low-field MRI at 0.55 Tesla (T) with deep learning image reconstruction has recently become commercially available. 1). Generally, One important reason for such discrepancies is a failure to understand the transverse geniculate ligament of the knee (TGL). insertion of the medial meniscus (AIMM) has been described, and it is The symptoms Sagittal T2-weighted image (10B) reveals no fluid at the repair site. Grade II hyperintense horizontal signal of posterior horn of medial meniscus is noted. Magnetic resonance imaging (MRI) is the most accurate imaging technique in the diagnosis of meniscal lesions and represents a standard tool in knee evaluation. In this case, having the prior MRI exam is useful for showing the location of the initial tear and the new tear in a different location. Note the symmetrical shape of the lateral meniscus (left) with similar size of the anterior and posterior horns. The anterior and posterior meniscofemoral ligaments (Humphrey and Wrisberg respectively) are commonly present with one or both found in 93-100% of patients. The medial meniscus is asymmetrical with a larger posterior horn. History of a longitudinal medial meniscus tear managed by repair and concurrent ACL reconstruction. of these meniscal variants is the discoid lateral meniscus, and the Meniscal root tears are a type of meniscal tear in the knee where the tear extends to either the anterior or posterior meniscal root attachment to the central tibial plateau. Problems encountered in a discoid medial meniscus are the same as a Anterior horn lateral meniscus tear A female asked: Mri: "macerated anterior horn lateral meniscus with inferiorly surfacing tear. There are Tachibana Y, Yamazaki Y, Ninomiya S. Discoid medial meniscus. Grades 1 and 2 are not considered serious. The most commonly practiced 2013;106(1):91-115. Sagittal PD (. The congenitally absent meniscus appears to influence the development An athletic 52-year-old male, who was an avid runner all his adult life, presented with medial pain and a popping sensation in knee. This is a well-done study with clinical correlation and adequate follow-up. Best assessed on T2 weighted sequences. Lateral meniscus tears of the posterior root are a common concomitant injury to anterior cruciate ligament (ACL) tears [6, 16, 20]. Pain is typically medial and activity-related (e.g. The sagittal proton density-weighted image (13A) demonstrates linear high signal extending to the femoral and tibial surfaces (arrow). MRI Knee - Sagittal PDFS - Displaced meniscus Part of a torn meniscus can be displaced into another part of the knee joint In this image the anterior part of the meniscus (the anterior horn) is correctly located The posterior horn is displaced such that it is located next to the anterior horn The correct position of the posterior horn is shown Root tears are associated with a high risk for osteoarthritis. Choi S, Bae S, Ji S, Chang M. The MRI Findings of Meniscal Root Tear of the Medial Meniscus: Emphasis on Coronal, Sagittal and Axial Images. {"url":"/signup-modal-props.json?lang=us"}, El-Feky M, Flipped meniscus - anterior horn lateral meniscus. Medial meniscus posterior horn peripheral longitudinal tear treated with repair. 2006; 88:660667, Boutin RD, Fritz RC, Marder RA. A detached posterior root is functionally equivalent to a total meniscectomy with loss of its ability to withstand hoop stress. Conventional MRI imaging correlates well with arthroscopic evaluation of the transplants for tears of the posterior and middle thirds of the meniscus allograft with a high sensitivity, specificity and accuracy, but results were poor for evaluation of the anterior third with a low specificity and accuracy.16 Allograft shrinkage and meniscus extrusion are common findings on postoperative MRI but do not always correlate with patient pain and function. Papalia R, Vasta S, Franceschi F, D'Adamio S, Maffulli N, Denaro V. Meniscal Root Tears: From Basic Science to Ultimate Surgery. In these cases, thin-section or well-placed axial images confirm that the tear is not a simple radial tear but rather a vertical flap tear (Fig. Am J Sports Med 2010; 38:15421548, LaPrade RF, Matheny LM, Moulton SG, James EW, Dean CS. MRI: When you tear your meniscus, a magnetic resonance imaging (MRI) scan will show the injury as white lines on black. After preparing the recipient knee by creating a matching keyhole trough in the tibia, the surgeon slides the allograft bone plug into its matching tibial slot and sutures the periphery of the allograft meniscus to the capsule. This case is almost identical to the previous case with a different clinical history. seen on standard 4- to 5-mm slices.21 The Wrisberg ligament may also be thick and high in patients with a complete discoid lateral meniscus.22 Other criteria used to diagnose lateral discoid meniscus include the following: In the If missing on MR images, a posterior root tear is present. Arthroscopy is considered gold standard in the diagnosis of knee ligament injuries, with diagnostic accuracy up to 94% [1], [2]; and can be used therapeutically as well. A Wrisberg type variant has not been documented in The sutures are tied over a cortical fixation device or Endobutton (short arrow) with the knee flexed at 90 to secure the root repair. An abnormal shape may indicate a meniscal tear or a partial meniscectomy. Meniscal root tears are defined as radial tears located within 1 cm from the meniscal attachment or a bony rootavulsion. is in fact reducing the volume of the meniscus and restoring a normal It is usually seen near the lateral meniscus central attachment site. joint, and they also protect the hyaline cartilage. the intercondylar notch, most commonly to the mid ACL, and less commonly MRI failed to detect anterior horn injury of lateral meniscus in six (16.7%) cases, all of which were longitudinal fissure in the red zone. 5. Discoid lateral meniscus. The anterior horn of the menisci, especially the lateral meniscus, is an area commonly confused on MRI. Both ligaments attach distally to the posterior horn of the lateral meniscus and contribute to posterior drawer stability . Skeletal radiology. of a case of discoid medial cartilage, with an embryological note. Check for errors and try again. MR criteria for discoid lateral menisci are used for discoid medial Case study, Radiopaedia.org (Accessed on 04 Mar 2023) https://doi.org/10.53347/rID-75066. The lateral meniscus is produced by the varus tension and tibial IR. collapse and widening of the medial joint space (Figure 7). Normal Disadvantages include increased cost, increased patient time, potential for adverse reactions to contrast agent compared to conventional MRI and lack of joint distention. The common insertion of the anterior cruciate ligament (ACL) and the AHLM root may provide a pathway for disease. Become a Gold Supporter and see no third-party ads. The lateral meniscus is one of two fibrocartilaginous menisci of the knee. 1427-143. At the time the article was last revised Yahya Baba had Lee, J.W. this may extend to to the mid body." is this a bucket tear? Meniscal transplants can fail at the implantation site by avulsion, failure of bone plug incorporation or bone bridge fracture. Again, this emphasizes the importance of accurate history, prior imaging and operative reports. Diagnosis of recurrent meniscal tears: prospective evaluation of conventional MR imaging, indirect MR arthrography, and direct MR arthrography. This high rate of success, however, may not apply to anterior horn tears, which occur much less commonly than posterior horn and meniscal body tears. The incidence of lateral meniscus posterior root tears was approximately 4 times higher than of medial meniscus posterior root tears in both primary (12.2% vs 3.2%) and revision (20.5% vs 5.6%) ACLRs. However, this conjecture and others pre- highest.13,27,34,42 Tear locations, such as the posterior sented in literature are mostly speculative. History of medial meniscus posterior horn partial meniscectomy. Indirect MR arthrography is less commonly used and relies on excretion of intravascular gadolinium into the joint through synovial cells after intravenous administration of gadolinium contrast 20-90 minutes prior to the MRI exam. You can use Radiopaedia cases in a variety of ways to help you learn and teach. posterior horn usually measures 12 mm to 16 mm in the sagittal plane in Kim SJ, Choi CH. Conventional MRI is useful for evaluation of posterior root morphology at the tibial tunnel fixation site, meniscal extrusion and articular cartilage. St. Louis County's newspaper of politics and culture Anterior horn tear of the lateral meniscus in footballers with a stable knee is characterized by pain at the anterolateral aspect of the knee during knee extension, especially when kicking. They maintain a relatively constant distance from the periphery of the meniscus [. Of these patients treated nonoperatively, 6 had a diagnosis of an isolated anterior horn tear on MRI. Arthroscopy for Medial Meniscus Tears The decision to repair or remove the torn portion is made at the time of surgery. does not normally occur.13. Meniscus tears are either degenerative or acute. The aim of this study was to evaluate diagnostic values involved in conventional magnetic resonance imaging (MRI) features of MM posterior root tears (MMPRTs) and find other MRI-based findings in patients with partial MMPRTs. On MRI, they exhibit abnormal horizontal linear signal contacting the inferior articular surface near the free edge or less commonly the superior surface. Learn more. pretzels dipped in sour cream. There is no telling how much this error rate will change for radiologists less experienced with MRI. the example shown (Figures 1 and 2), the entire medial meniscus is Brody J, Lin H, Hulstyn M, Tung G. Lateral Meniscus Root Tear and Meniscus Extrusion with Anterior Cruciate Ligament Tear. Meniscal root tearsare a type of meniscal tearin the knee where the tear extends to either the anterior or posterior meniscal root attachment to the central tibial plateau. The posterior root of the medial meniscus attaches to the tibia, just anterior and medial to the posterior cruciate ligament (PCL). MRI c spine / head jxn - they can have stenosis of foramen magnum . treatment for stable complete or incomplete types of discoid lateral Objective Parameniscal cysts have a very high association with meniscal tears in all locations except the anterior horn lateral meniscus (AHLM). Complex or deep radial tears were found in three of five cases of lateral meniscus extrusion and normal root. has shown that 41% of patients with a surgically confirmed torn post-operative meniscus had signal intensity within the meniscus extending into the articular surface which was lower than the signal intensity of gadolinium contrast.14 Like the presence of a line of intermediate T2 signal extending into the articular surface on conventional MRI, diagnosis of a torn post-operative meniscus on MRI arthrography is challenging when the intra-meniscal signal intensity is not as bright as gadolinium contrast. The patient underwent partial medial meniscectomy and ACL reconstruction. Congenital absence of the meniscus is extremely rare and has been documented in TAR syndrome and in isolated case reports.2,3 This has also been described as grade 2 signal [, Sagittal fat-suppressed T2 image of a 14-year-old patient showing a grade 2 signal in the posterior horn of the medial meniscus (PHMM). Evaluation of postoperative menisci with MR arthrography and routine conventional MRI. An intact meniscal repair was confirmed at second look arthroscopy. horn of the lateral meniscus, and oblique tear orientation In the present study, the patients analyzed came from the have been the most difficult for imaging planes to visualize same geographical area . Kaplan EB. Kelly BT, Green DW. In the U.S., intraarticular injection of gadolinium-based contrast is off label. diminutive (1 mm) with no increased signal to suggest root attachment Normal The posterior root lies anterior to the posterior cruciate ligament. The articular cartilage is well seen on the pre-operative sagittal proton density-weighted image (19B). The intrameniscal ligament where it diverges from the back of the anterior horn of the lateral meniscus is also a common area misinterpreted as a tear. The medial meniscus is more tightly anchored than the lateral meniscus, allowing for approximately 5mm of anterior-posterior translation. MR arthrogram fat-suppressed sagittal T1-weighted image (11C) shows no gadolinium in the repair. Knee Surg Sports Traumatol Arthrosc 2011; 19:147157, Gwathmey F.W., Golish S.R., Diduch D.R., et al: Complications in brief: meniscus repair. The anterior horn inserts on the tibia and continues laterally to the anterior horn of the lateral meniscus via the transverse intermeniscal ligament. Unable to process the form. Among these 26 studies of an LMRT . Report proximal medial tibia was convex and the distal medial femoral condyle They found that 76 (8%) of these indicated a tear of the anterior horn of either the medial or lateral meniscus. At the time the article was created Yuranga Weerakkody had no recorded disclosures. The shape of the meniscus is formed at the eighth week of Note that signal does not contact articular surface, The most common criterion for diagnosing meniscus tear on MRI is an increased signal extending in a line or band to the articular surface. It is located in the lateral portion of the knee interior of the knee joint. Of those 31 patients who underwent arthroscopic examination, there were only 8 true anterior horn tears (26% true positive rate) and 18 had normal or intact menisci in all zones. 1 ). Both horns of the medial meniscus are triangular with sharp points. The purpose of our study was to determine if cysts of the ACL are the origin of cysts adjacent to the AHLM. On imaging alone, the radiologist may not be able to distinguish a residual tear (failed repair) from a recurrent tear in the same location. Analytical, Diagnostic and Therapeutic Techniques and Equipment 13. However, clinically significant tears that can mechanically impinge were unlikely to have been missed. small meniscus is also seen in the wrist joint. A Surgical Outcomes Lysholm Score The most important clinical concern at the time of MRI imaging is often high-grade articular cartilage loss. In this section, the major patterns of tears are described and depicted in MRIs and arthroscopy images. Surgery is useful if they are unstable and flipping in and out of the joint causing pain. Posterior root repair (Figure 16) is being performed with increasing frequency and has been shown to have better outcomes and decreased risk of osteoarthritis compared to posterior root tears treated non-operatively. medial meniscus, and not be confined to the ACL as seen in an ACL tear. (Tr. After failing conservative management with NSAIDs, PT, and activity modification, he underwent an MRI. The discoid lateral-meniscus syndrome. 3 is least common. anterior horn of the medial meniscus into the anterior cruciate ligament Posterior meniscal root repairs: outcomes of an anatomic transtibial pull-out technique. found that the absence of a line of increased signal through the meniscus extending to the articular surface on proton density and T2-weighted images was a reliable MRI finding for an untorn post-operative meniscus with 100% sensitivity. from AIMM. The tear was treated by partial meniscectomy at second surgery. Description. Damaged meniscal tissue is removed with arthroscopic instruments including scissors, baskets and mechanical shavers until a solid tissue rim is reached with the meniscal remnant contoured, preserving of as much meniscal tissue as possible. discoid meniscus, although discoid medial menisci can occur much less Ideal for residents, practicing radiologists, and fellows alike, this updated reference offers easy-to-understand guidance on how to approach musculoskeletal MRI and recognize abnormalities. congenital anomalies affect the lateral meniscus, most commonly a A 2003 systematic review of the literature, in which 29 publications met strict inclusion criteria, demonstrated pooled weighted sensitivity and specificity of 93.3 % and 88.4 % for the medial meniscus and 79.3 % and 95.7 % for the lateral meniscus, respectively [, Most meniscal tears are visible and best seen on sagittal images. On medial posterior root tears there is often 2: On posterior root radial tears of the lateral meniscus, the appearance may be similar to radial tears in other locations. Discoid lateral meniscus and the frequency of meniscal tears. The prevalence of a medial discoid meniscus in patients with AIMM The clinical significance of anterior horn meniscal tears diagnosed on magnetic resonance images. Each meniscus attaches to the tibia bone in the back and front via the "meniscal roots." The primary role of the meniscus is to serve as a shock-absorber and protect the underlying articular cartilage and bone. . The posterior horn is always larger than the anterior horn. Is sport activity possible after arthroscopic meniscal allograft transplantation? may simulate a peripheral tear (Figure 6).23 The only When interpreting MR images of the knee, it is important to assess for any change from the expected shape of the menisci. There is a medial and a lateral meniscus. Semin Musculoskelet Radiol 2005;9(2):11624, Chung KS, Ha JK, Ra HJ, Nam GW, Kim JG. {"url":"/signup-modal-props.json?lang=us"}, Weerakkody Y, Baba Y, Knipe H, et al. 5 In the first instance, tears of the lateral aspect of the anterior horn of the medial meniscus are extremely uncommon and should not be a diagnostic When the cruciate Anterior horn of the lateral meniscus: another potential pitfall in MR imaging of the knee. CT arthrography may be used to evaluate the postoperative meniscus when MRI is contraindicated. mesenchymal mass that differentiates into the tibia, femur, and medial meniscus, discoid lateral meniscus, including the Wrisberg It splits into two bands at the PCL, named Humphry(anterior to the PCL) and Wrisberg (posterior to the PCL). Tear between 1-4 cm vertical tear red-red meniscal root <40 yo Maybe concominant ACL surgery . There was no history of a specific knee injury. of the menisci can be summarized as providing: Clark and Ogden studied the natural development of the menisci in the Direct and indirect MR arthrography have been shown to be superior to conventional MRI for detection of recurrent meniscal tears in greater than 25% partial meniscectomies and meniscal repairs; however, conventional MRI is commonly used for initial evaluation of the postoperative meniscus with MR arthrography reserved for equivocal cases. The camera can visualize the meniscus and other structures within the knee. Knee Surg Sports Traumatol Arthrosc. high fibula head and a widened lateral joint space.20 Several At least one meniscofemoral ligament is present in 7093 % Of knees The avulsed anterior horn of the lateral meniscus is flipped over and situated above the posterior horn. Sagittal proton density-weighted image (10A) demonstrates increased signal extending to the articular surface consistent with granulation tissue. The intrameniscal ligament where it diverges from the back of the anterior horn of the lateral meniscus is also a common area misinterpreted as a tear. [emailprotected]. 300). Heron, D, Bonnard C, Moraine C,Toutain A. Agenesis of cruciate The meniscus can separate from the joint capsule or tear through the allograft. The lateral meniscus is more circular, and its anterior and posterior horns are nearly equivalent in size in cross section. There are 3 main types, according to the Watanabe classification:18. Meniscal disorders: Normal, discoid, and cysts. The most common location is the anterior horn-body junction of the lateral meniscus and less commonly in the mid posterior horn or root of the medial meniscus. in 19916. ligament and meniscal fascicles. It is believed that discoid The patient subsequently underwent successful partial medial meniscectomy. Shepard and colleagues at UCLA specifically analyzed this by reviewing 947 consecutive MRIs. mobility, and a giving-way sensation.11, 15, 16 A high percentage of cases present with an associated meniscal tear and peripheral rim instability.9,16,17 Although discoid lateral meniscus is commonly bilateral, symptoms tend to occur on one side.15 It is characterized by an excess of meniscal tissue with a slab-like configuration in the 2 most common forms (Figure 5).
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