Definite surfacing signal or distortion on only one image represents a possible tear. Tear between 1-4 cm vertical tear red-red meniscal root <40 yo Maybe concominant ACL surgery . sagittal magnetic resonance (MR) images. The prevalence of a medial discoid meniscus in patients with AIMM De Smet A. appearance.12 It is now believed that the knee develops from a Sagittal proton density-weighted image (8A) through the medial meniscus demonstrates signal extending to the tibial surface (arrow). with mechanical features of clicking and locking. meniscal diameter. Materials and methods . Sagittal proton density-weighted image (9A) demonstrates no high signal abnormality. What are the findings? Am J Sports Med 2010; 38:15421548, LaPrade RF, Matheny LM, Moulton SG, James EW, Dean CS. Considered a feature of knee osteoarthritis. ADVERTISEMENT: Supporters see fewer/no ads. Repair devices including arrows, darts and sutures are used to approximate the torn edges of the meniscus. These are like large radial tears and can destabilize a large portion of the meniscus. He presented after a few months with symptoms of instability. The incidence was calculated based on arthroscopic findings, and the potential secondary signs of meniscal ramp tears were evaluated on MRI. Following partial meniscectomy, the knee is at increased risk for osteoarthritis. 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. medial meniscus, and not be confined to the ACL as seen in an ACL tear. diagnostic dilemma, as the AIMM band will be seen to extend to the Figure 7: Meniscofemoral ligament. Meniscus tears, indicated by MRI, are classified in three grades. Lee S, Jee W, Kim J. Normal Source: Shepard MF, et al. AJR Am J Roentgenol. When it involves the posterior root, medial root tears are easier to diagnose than lateral root tears. There was no evidence of meniscal extrusion or a meniscal ghost sign (Fig. At 1 year, 5 of 6 were completely asymptomatic with the remaining patient minimally painful with no suggestion of meniscal symptoms. discoid lateral meniscus is a relatively uncommon developmental variant Bucket Handle Meniscal Tear - Diagnosis - MRI Online The MFL was not observed in five (19%) of 26 studies of an LMRT. trials, alternative billing arrangements or group and site discounts please call Their conclusion that one should not perform surgery unless clinical correlation exists with effusions, mechanical catching or locking, or the failure to respond to nonoperative measures I believe is a good recommendation that we can all follow. These include looking for a After failing conservative management with NSAIDs, PT, and activity modification, he underwent an MRI. Another MRI was later performed due to worsening symptoms, and demonstrated a bucket-handle tear with complete anterior luxation of the posterior horn of the left lateral meniscus (Figs. Comparison of Medial and Lateral Meniscus Root Tears - PLOS Sagittal T2-weighted image (18A) demonstrates high T2 fluid signal in the medial meniscus posterior horn consistent with a recurrent tear (arrow). Media community. Examination of the knee showed a mild effusion, 1+ Lachman, positive Pivot shift, and mild tenderness to both medial and lateral joint lines. The Journal of bone and joint surgery American volume. mesenchymal mass that differentiates into the tibia, femur, and FSE T2-weighted images, with a slab-like appearance on coronal images. Healed peripheral medial meniscus posterior horn repair and new longitudinal tear in a different location. ISAKOS: 2023 Congress in Boston, USA : Abstract Analysis of Risk medial meniscus are extremely uncommon and should not be a diagnostic Surgery Needed?? : r/MeniscusInjuries of the distal femur and proximal tibia, and in the case report of A tear of the lateral meniscus can occur from a sudden injury, or from chronic wear and overload. Anterior horn of the lateral meniscus: another potential pitfall in MR imaging of the knee. 2006; 187:W565568. On MR arthrography, (12B), gadolinium extends through the repair site indicating a tear. Methods Eighteen patients who had arthroscopically confirmed partial MMPRTs were included. Stein T, Mehling AP, Welsch F, von EisenhartRothe R, Jger A. Meniscal root tears are defined as radial tears located within 1 cm from the meniscal attachment or a bony rootavulsion. Meniscal Tear Patterns - Radsource Normal shape and signal of the horns of the medial meniscus, with no evidence of tears or degenerations seen. Knee Examination - Samarpan Physio 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. Anatomic variability and increased signal change in this area are commonly mistaken for tears. The meniscus is two crescent-shaped, thick pieces of cartilage that sit in the knee between the tibia and the femur. Lateral meniscus tears of the posterior root are a common concomitant injury to anterior cruciate ligament (ACL) tears [6, 16, 20]. For DSR inquiries or complaints, please reach out to Wes Vaux, Data Privacy Officer, Klingele KE, Kocher MS, Hresko MT, et al. {"url":"/signup-modal-props.json?lang=us"}, El-Feky M, Flipped meniscus - anterior horn lateral meniscus. You have reached your article limit for the month. On the fat-supressed proton density-weighted coronal (17A) and axial (17B) images, notice the trapazoidal shaped bone bridge (arrow) placed in the tibial slot with menscal allograft attached at the anterior and posterior roots. 2002;30(2):189-192. The meniscal repair is intact. The lateral . A 510, 210-pound 16-year-old male injured his left knee while kicking a football. This scan showed a radial MMT. The anterior horn inserts on the tibia and continues laterally to the anterior horn of the lateral meniscus via the transverse intermeniscal ligament. meniscal injury. View Mostafa El-Feky's current disclosures, see full revision history and disclosures, Flipped meniscus - anterior horn lateral meniscus, Disproportionate posterior horn sign (meniscal tear). Case study, Radiopaedia.org (Accessed on 04 Mar 2023) https://doi.org/10.53347/rID-75066. 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. Repair of posterior root tears are being performed with increased frequency over the past several years. 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. In the U.S., intraarticular injection of gadolinium-based contrast is off label. Type 1: A complete slab of meniscal tissue with complete tibial coverage. History of a longitudinal medial meniscus tear managed by repair and concurrent ACL reconstruction. The lateral meniscus is one of two fibrocartilaginous menisci of the knee. When interpreting MR images of the knee, it is important to assess for any change from the expected shape of the menisci. 2008; 32:212219, Magee T. Accuracy of 3-Tesla MR and MR arthrography in diagnosis of meniscal retear in the post-operative knee. Because there is less pressure on the meniscus there, it is difficult to evaluate the anterior region of the meniscus. They divide the meniscus into superior and inferior halves (Fig. In these cases, surfacing meniscal signal on low TE series may represent recurrent tear, granulation tissue or residual grade 2 degenerative signal that contacts the meniscal surface after debridement. ligaments and menisci causing severe knee dysplasia in TAR syndrome. They often tend to be radial tears extending into the meniscal root. 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 Magnetic resonance imaging (MRI) revealed an elongated free edge of the diffusely enlarged lateral meniscus extending toward the intercondylar region on coronal T1-weighted images (Figure 1A). The lateral meniscus is more circular, and its anterior and posterior horns are nearly equivalent in size in cross section. Efficacy of Arthroscopic Treatment for Concurrent Medial Meniscus Bilateral Hypoplasia of the Medial and Lateral Menisci - PMC Lateral Meniscus Root Tear and Meniscus Extrusion with Anterior 2012;20(10):2098-103. posterior horn of the medial meniscus include a triangular hypointense The anterior and posterior meniscofemoral ligaments (Humphrey and Wrisberg respectively) are commonly present with one or both found in 93-100% of patients.9 The lateral meniscus is more loosely attached than the medial and can translate approximately 11mm with normal knee motion.10. There is no telling how much this error rate will change for radiologists less experienced with MRI. To provide the highest quality clinical and technology services to customers and patients, in the spirit of continuous improvement and innovation. slab-like configuration on sagittal MR images, with > 3 bowties . In this case the roots remained intact at the bone bridge, but the meniscal allograft detached from the joint capsule at the posterior and middle third with displacement into the central weightbearing surface (arrowheads) on sagittal T2-weighted (17C) and fat-suppressed axial proton density-weighted (17D) images. Horizontal (degenerative) tears run relatively parallel the tibial plateau. Both horns of the medial meniscus are triangular with sharp points. However, many clinicians opt to use conventional MRI as the initial postoperative imaging study and reserve MR arthrography for equivocal cases. 1). High signal close to fluid intensity contacts the tibial surface on the sagittal T2-weighted image (11B) and is equivocal. morphology. American Board of Orthopaedic Surgery Practice of the Orthopaedic Surgeon: Part-II, certification examination case mix. The examiner can test the entire posterior horn up to the middle segment of the meniscus using the IR of the tibia followed by an extension. The medial compartment articular cartilage is preserved, and the meniscal body is not significantly extruded (16D). Special thanks to David Rubin, MD for providing several cases used in this web clinic. We will review the common meniscal variants, which Brody J, Lin H, Hulstyn M, Tung G. Lateral Meniscus Root Tear and Meniscus Extrusion with Anterior Cruciate Ligament Tear. Collagen fibers are arranged for transferring compressive loads into circumferential hoop stresses, secured by radially oriented tie fibers. The congenitally absent meniscus appears to influence the development Skeletal radiology. A slightly overweight 44-year-old male sought evaluation for medial knee pain that persisted for months after running on the beach. Magnetic resonance imaging of the postoperative meniscus: resection, repair, and replacement. to tear. Anterior tibial marrow edema and organized trabecular fracture measuring 16 mm AP, 18 mm transverse. Renew or update your current subscription to Applied Radiology. History of medial meniscus posterior horn and body partial meniscectomy. structure on sagittal images on T1, proton density, and fat-saturated 1991;7(3):297-300. This is a critical differentiation because the latter represents meniscal tears that can be Meniscal Roots: Current Concepts Review Knee Surg Sports Traumatol Arthrosc 2011; 19:147157, Gwathmey F.W., Golish S.R., Diduch D.R., et al: Complications in brief: meniscus repair. Is sport activity possible after arthroscopic meniscal allograft transplantation? This is because most tears occur in the posterior horns [, Whether a torn meniscus is reparable depends on the type or pattern of tear, its location, and the quality of the meniscal tissue. A tear of the anterior horn of the lateral meniscus is damage to the front part of one of the two structures that act as shock absorbers between the thigh bone and the lower leg, explains The Steadman Clinic. The reported prevalence is 0.06% to 0.3%.25 Am J Sports Med 2017; 45:4249, ElAttar M, Dhollander A, Verdonk R, Almqvist KF, Verdonk P. Twenty six years of meniscal allograft transplantation: is it still experimental? If a horizontal tear involves a long segment of the meniscus, the central fragment may displace centrally from the peripheral portion of the meniscus [, Bucket handle tears (BHT) often cause pain and mechanical symptoms, such as locking, catching, and giving way [. If missing on MR images, a posterior root tear is present. Grades 1 and 2 are not considered serious. 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 . Menisci ensure normal function of the 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. Meniscal tears are common and often associated with knee pain. These features constitute O'Donoghue unhappy triad. of the transverse ligament is comparable to the general population.5. This injury is biomechanically comparable to a total meniscectomy, leading to compromised hoop stressesresulting in decreased tibiofemoral contact area and increased contact pressures in the involved compartment.These changes are detrimental to the articular cartilage and . AJR Am J Roentgenol 2009;193:515-523. 6 months post-operative she had increased pain prompting follow-up MRI. Pain is typically medial and activity-related (e.g. 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. 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. 9 The lateral meniscus is more loosely attached than the medial and can translate approximately 11mm with normal knee motion. Sagittal T2-weighted (18B) and fat-suppressed sagittal proton density-weighted sagittal (18C) images demonstrate fluid-like signal in the posterior horn suggestive of a recurrent tear. to the base of the ACL or the intercondylar notch. That reported case was also associated with In the above case there is no gross chondral defect although the articular cartilage is noticeably thinner compared to the baseline study despite the patients young age. A new longitudinal tear has occurred more centrally in the meniscus (arrowhead) with linear high signal extending to the tibial and femoral surfaces as well as fluid signal and gadolinium contrast in the defect. A meniscus. They are usually due to an acute injury [. The same imaging criteria (as for the case of greater than 25% partial meniscectomy), the presence of fluid signal on T2-weighted or contrast extending into the meniscal substance is used to diagnose a recurrent tear. AJR American journal of roentgenology. The superior, middle and inferior geniculate arteries are the main vascular supply to the menisci. Mild irregularities of the meniscal contour may be present, particularly in the first 6-9 months after surgery which tend to smooth out and remodel over time.15 For partial meniscectomies involving less than 25% of the meniscus, conventional MRI is used with the same imaging criteria for evaluating a tear as the native meniscus linear intrasubstance increased signal extending to the articular surface, visualized on 2 images, either consecutively in the same orientation or in the same region in 2 different planes or displaced meniscal fragment (based on the assumption that imaging is spaced at 3 mm intervals). Clinical Examination in the Diagnosis of Anterior Cruciate : JAAOS 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. Dr. Michael Gabor answered Diagnostic Radiology 35 years experience No,: It doesn't sound like a bucket handle tear Posterior meniscal root repairs: outcomes of an anatomic transtibial pull-out technique. does not normally occur.13. The Postoperative Meniscus - Radsource Factors affecting meniscal extrusion: correlation with MRI, clinical 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. A previous study by De Smet et al. Youderian A, Chmell S, Stull MA. Controlling Blood Pressure During Pregnancy Could Lower Dementia Risk, Researchers Address HIV Treatment Gap Among Underserved Population, HHS Announces Reorganization of Office for Civil Rights, FDA Adopts Flu-Like Plan for an Annual COVID Vaccine. 2019: Factors associated with bilateral discoid lateral meniscus tear in patients with symptomatic discoid lateral meniscus tear using MRi and X-ray Orthopaedics and Traumatology Surgery and Research: Otsr 105(7): 1389-1394 Coronal extrusion of the lateral meniscus does not increase after At the time the article was last revised Yahya Baba had ligament will help to exclude these conditions.5 In the first On MRI, they resemble radial tears, with a linear cleft of abnormal signal seen at the free edge. The location of meniscal tears or signal alterations (anterior/posterior horn or body of the medial/lateral meniscus) and the grade (normal/intra-substance signal abnormality = 0 and tear = 1) were determined on 2D . 2020;49(1):42-49. Type 2: An incomplete slab of meniscal tissue with 80% coverage of the lateral tibial plateau. It is often explained by fibers of the anterior cruciate ligament and the covering synovium . Suprapatellar plica noticed, with no related cartilaginous erosions. Lateral Meniscus - ProScan Education - MRI Online : Complications in brief: arthroscopic partial meniscectomy. A recurrent tear was proved at second look arthroscopy. Findings indicate an intact meniscus following partial meniscectomy with normal intrameniscal signal.