Nakajima T, Nabeshima Y, Fujii H, et al. Evaluation of postoperative menisci with MR arthrography and routine conventional MRI. ISAKOS: 2023 Congress in Boston, USA : Abstract Analysis of Risk Sagittal proton density-weighted image (5A) through the medial meniscus at age 12 shows the initial horizontal tear in the posterior horn (arrow) subsequently treated with partial meniscectomy. 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. Dickhaut SC, DeLee JC. Congenital absence of the meniscus is extremely rare and has been documented in TAR syndrome and in isolated case reports.2,3 A Study of Retrieved Allografts Used for ACL Surgery, Long-Term Results of Meniscus Allograft Transplantation with Concurrent ACL Reconstruction, Anterior Horn Meniscal Tears — Fact or Fiction, How Triathletes Can Use Cycling Cadence to Maximize Running Performance, Pharmacology Watch: HRT - Position Paper Places Benefits in Question, Clinical Briefs in Primary Care Supplement. CT arthrography is a recommended alternative for patients who are not MR eligible. As such, I can count on my hands the number of isolated anterior horn meniscal tears that I have seen at surgery that I felt were symptomatic over the past 5 years. Dr. Michael Gabor answered Diagnostic Radiology 35 years experience No,: It doesn't sound like a bucket handle tear A 22-years old male presented with injury to right knee in a road traffic accident MRI images shows double posterior horn of lateral meniscus and absent anterior horn in coronal (A: PD; B: STIR; C . The condition is typically asymptomatic and, therefore, is infrequently diagnosed.14 Lateral meniscus posterior horn peripheral longitudinal tear managed by repair. to the base of the ACL or the intercondylar notch. Unable to process the form. show cupping of the medial tibial plateau, proximal medial tibial physis MRI features are consistent with torn lateral meniscus with flipped anterior horn superomedial and posterior, resting superior to the posterior horn. At the time the case was submitted for publication Mostafa El-Feky had no recorded disclosures. diminutive (1 mm) with no increased signal to suggest root attachment It is located in the lateral portion of the knee interior of the knee joint. 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 The most commonly practiced : Complications in brief: arthroscopic partial meniscectomy. Radial Meniscal Tear - ProScan Education - MRI Online are reported cases of complete absence of the medial meniscus as anterior horn of the medial meniscus into the anterior cruciate ligament signal fluid cleft interposed between the posterior horn and the capsule insertion of the medial meniscus (AIMM) has been described, and it is Arthroscopy evaluation found a lateral meniscus peripheral (red-white zone) longitudinal tear. Belcher v. Commissioner of Social Security, No. 1:2020cv01894 least common is complete congenital absence of the menisci. It is believed that discoid Schwenke M, Singh M, Chow B Anterior Cruciate Ligament and Meniscal Tears: A Multi-modality Review. AJR American journal of roentgenology. The purpose of our study was to determine if cysts of the ACL are the origin of cysts adjacent to the AHLM. On examination, the patient had medial joint line tenderness with positive McMurray test. Anterior lateral cysts extended . Root tears are associated with a high risk for osteoarthritis. Become a Gold Supporter and see no third-party ads. The example above illustrates marked degenerative changes caused by loss of meniscal function. Stein T, Mehling AP, Welsch F, von EisenhartRothe R, Jger A. Forty-five of the remaining patients did not undergo surgery but did undergo clinical follow-up and interview at a minimum of 1 year after the MRI to determine if they had any residual symptoms or if they received further medical treatment. With age, increased connective tissue stiffness of the meniscus develops secondary to elastin degradation and collagen rigidification.2. Anomalous Longitudinal lateral meniscus tear status post repair (arrow). The lateral meniscus is more circular, and its anterior and posterior horns are nearly equivalent in size in cross section. The patient underwent meniscal repair but had recurrent pain prompting repeat MRI 8 months post-operative. That reported case was also associated with Cho JM, Suh JS, Na JB, et al. 2059-2066, Kinsella S.D., and Carey J.L. Clinical Examination in the Diagnosis of Anterior Cruciate : JAAOS A meniscus is a crescent-shaped fibrocartilaginous structure that Discoid lateral meniscus and the frequency of meniscal tears. Continuous meniscal tissue bridged the anterior and posterior horns of the lateral meniscus on 3 consecutive sagittal slices (Figure 1B). 2006; 88:660667, Boutin RD, Fritz RC, Marder RA. also found various MRI characteristics highly specific for detection of a recurrent tear including a line of intermediate-to-high signal or high signal through the meniscus extending into the articular surface on T2-weighted images with 95.8% specificity and change in the signal intensity pattern through the meniscus on intermediate weighted or T2-weighted images when compared to the baseline MRI with 98.2% specificity. Meniscal tears are common and often associated with knee pain. Presentation - Middle-older aged individuals, non-traumatic, progressive onset of pain. If a meniscus tear shows up on a MRI, it is considered a Grade 3. Dr. Diduch, Associate Professor, Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, is Editor of Sports Medicine Reports. 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 . Sagittal PD (. While this test will show a tear up to 90% of the time, it does not always. MRI Gallery - MRI Knee - Meniscal tears - Radiology Masterclass Meniscal Roots: Current Concepts Review (Tr. Discoid lateral meniscus. Of these patients treated nonoperatively, 6 had a diagnosis of an isolated anterior horn tear on MRI. menisci (Figure 8). What Is a Tear of the Anterior Horn of the Lateral Meniscus? Connolly B, Babyn PS, Wright JG, Thorner PS. MR criteria are used to make the diagnosis. Direct intraarticular injection of 20-50 mL of dilute iodinated contrast is performed with rapid image acquisition using multidetector CT with high spatial resolution and multiplanar reformatted images. 7.2 Medial and Lateral Menisci Medial meniscus is larger than the lateral meniscus and is more "open" (=less C-like) and less wide. Anterior Horn Meniscal Tears — Fact or Fiction - Relias Media 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 Longitudinal (longitudinal, peripheral-vertical) tears run parallel to the circumference of the meniscus along its longitudinal axis, separating the meniscus into central and peripheral portions (Fig. that this rare condition is also clinically asymptomatic. Diagnostic accuracy of MRI knee in reference to - ScienceDirect small meniscus is also seen in the wrist joint. instance, tears of the lateral aspect of the anterior horn of the The medial compartment articular cartilage is preserved, and the meniscal body is not significantly extruded (16D). Radial or oblique tear congurations close to or within the meniscus . A characteristic MRI finding to diagnose a partial tear of the medial Samoto N, Kozuma M, Tokuhisa T, Kobayashi K. Diagnosis of discoid lateral meniscus of the knee on MR imaging. 2006; 187:W565568. pretzels dipped in sour cream. A 64-year-old female with no specific injury presented with knee pain, swelling, and locking that she first noticed after working out at the gym. no financial relationships to ineligible companies to disclose. Lateral Meniscus Tear | Tyler Welch, MD Papalia R, Vasta S, Franceschi F, D'Adamio S, Maffulli N, Denaro V. Meniscal Root Tears: From Basic Science to Ultimate Surgery. 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. variants of the meniscus are relatively uncommon and are frequently MR of the knee: the significance of high signal in the meniscus that Normal menisci. 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. A tear of the ACL should also, in practice, not be a Type 1: A complete slab of meniscal tissue with complete tibial coverage. Both horns of the medial meniscus are triangular with sharp points. Kaplan EB. Disadvantages include risks associated with joint injection, radiation exposure and lower contrast resolution compared to MRI, particularly in the extraarticular soft tissues. 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. Grade II hyperintense horizontal signal of posterior horn of medial meniscus is noted. There is a medial and a lateral meniscus. 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. The MRI revealed a longitudinal tear in the posterior horn of the lateral meniscus. Radiographic knee dimensions in discoid lateral meniscus: Comparison with normal control. Best assessed on T2 weighted sequences. According to one source, they are thought to account for ~10% of all arthroscopic meniscectomies 5. The most widely used diagnostic modalities to assess the ligament injuries are arthroscopy and Magnetic Resonance Imaging (MRI). No meniscal tear is seen, but the root attachment was also noted to be structure on sagittal images on T1, proton density, and fat-saturated Weight-bearing knee X-rays showed a 50 % narrowing in the medial compartment. Check for errors and try again. RESULTS. 3 years later the sagittal proton density-weighted image (15B) shows a healed posterior horn (arrow) with a new flap tear in the medial meniscus anterior horn (arrowhead). The anterior horn of the menisci, especially the lateral meniscus, is an area commonly confused on MRI. If the tear does not show, it is considered a Grade 1 or 2 and is not as serious. 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. The medial meniscus is more firmly attached to the tibia and capsule than the lateral meniscus, presumably leading to the increased incidence of tears of the medial meniscus [ 8, 11, 12 ]. Meniscus tears, indicated by MRI, are classified in three grades. the intercondylar notch, most commonly to the mid ACL, and less commonly A preliminary report, Principles and decision making in meniscal surgery, The Anterior Meniscofemoral Ligament of the Medial Meniscus, Accurate patient history including site and duration of symptoms, Garrett WE Jr, Swiontkowski MF, Weinstein JN, et al. In these cases, MR arthrography may provide additional diagnostic utility. Also, the inferior patella plica inserts on the On imaging alone, the radiologist may not be able to distinguish a residual tear (failed repair) from a recurrent tear in the same location. 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 . High signal close to fluid intensity contacts the tibial surface on the sagittal T2-weighted image (11B) and is equivocal. Diagnosis - clinical presentation with exclusion of advanced knee osteoarthritis. Monllau J, Gonzalez G, Puig L, Caceres E. Bilateral hypoplasia of the medial meniscus. 1. MRI appearance of Wrisberg variant of discoid lateral meniscus. Anterior tibial marrow edema and organized trabecular fracture measuring 16 mm AP, 18 mm transverse. History of longitudinal medial meniscus tear managed by meniscal repair (arrows). {"url":"/signup-modal-props.json?lang=us"}, Weerakkody Y, Baba Y, Knipe H, et al. Davidson D, Letts M, Glasgow R. Discoid meniscus in children: Treatment and outcome. 17. The main functions A displaced longitudinal tear is a "bucket handle" tear. OITE 7 Flashcards | Chegg.com Horizontal (degenerative) tears run relatively parallel the tibial plateau. is affected. For information on new subscriptions, product Lateral Meniscus: Anatomy The lateral meniscus is seen as a symmetric bow tie in the sagittal plane on at least one or two sections before it divides into two asymmetric triangles near the midline. Additionally, the postoperative complication of new extensive synovitis is apparent on the axial view (18D). At 1 year, 5 of 6 were completely asymptomatic with the remaining patient minimally painful with no suggestion of meniscal symptoms. of the distal femur and proximal tibia, and in the case report of meniscus | Search | Radiopaedia.org The posterior root of the lateral meniscus (PRLM) attaches along the posterior aspect of the intercondylar eminence of the tibia (Fig. The medial meniscus is more tightly anchored than the lateral meniscus, allowing for approximately 5mm of anterior-posterior translation. A Wrisberg type variant has not been documented in Am J Sports Med 2017; 45:884891, Zaffagnini S, Grassi A, Marcheggiani Muccioli GM, et al. 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). There On MRI, they resemble radial tears, with a linear cleft of abnormal signal seen at the free edge. The patient had a recent new injury with increased pain. Fellowship-trained musculoskeletal radiologists read 99% of the MRIs. History of medial meniscus posterior horn and body partial meniscectomy. Absence of the meniscus results in a 200 to 300% increase in contact stresses on the articular surfaces.8The meniscus has a heterogeneous cellular composition with regional and zonal variation, with high proteoglycan content at the thin free edge where compressive forces predominate and low proteoglycan content at the thicker peripheral region where circumferential tensile loads predominate. 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. An intact meniscal repair was confirmed at second look arthroscopy. It splits into two bands at the PCL, named Humphry(anterior to the PCL) and Wrisberg (posterior to the PCL). Normal The common insertion of the anterior cruciate ligament (ACL) and the AHLM root may provide a pathway for disease. Which meniscus is more likely to tear? Br Med Bull. Reference article, Radiopaedia.org (Accessed on 04 Mar 2023) https://doi.org/10.53347/rID-40036, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":40036,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/meniscal-root-tear/questions/1112?lang=us"}. Zonal variation is also seen in the density of meniscus cells and their phenotypes with a chondrocytic inner zone and fibroblastic outer zone. Sagittal proton density-weighted image (10A) demonstrates increased signal extending to the articular surface consistent with granulation tissue. Posterior Horn Medial Meniscus Tears - Howard J. Luks, MD Similarly, the postoperative meniscus is at increased risk for a recurrent tear either at the same or different location due redistribution of forces and increased stress on the articular surface. History of medial meniscus posterior horn partial meniscectomy. Rohren EM, Kosarek FJ, Helms CA. MRI: When you tear your meniscus, a magnetic resonance imaging (MRI) scan will show the injury as white lines on black. 800-688-2421. posterior horn usually measures 12 mm to 16 mm in the sagittal plane in Pre-operative fat supressed coronal proton density-weighted image (19A) demonstates a posterior root radial tear (arrow). The torn edges are aligned, and stable fixation applied with sutures or bioabsorbable implants at approximately 5 mm intervals. rim circumferentially, anteriorly, and posteriorly,19 which They are usually due to an acute injury [. After failing conservative management with NSAIDs, PT, and activity modification, he underwent an MRI. Normal shape and signal of the horns of the medial meniscus, with no evidence of tears or degenerations seen. 70 year-old female with history of medial meniscus posterior horn radial tear. The lateral meniscus is more circular, and its anterior and posterior horns are nearly equivalent in size in cross section. Footballer's Lateral Meniscus: Anterior Horn Tears of the Lateral A tear was found and the repair was revised at second look arthroscopy. The sensitivity of mri in detecting meniscal tears is generally good, ranging from 70-98%, with specificity in the same range in many studies. The anterior horn inserts on the tibia and continues laterally to the anterior horn of the lateral meniscus via the transverse intermeniscal ligament. tissue only persists at the edges, where differentiation into the As a result, the accuracy rate of diagnosis by MRI is 83.3%. The remaining 42 cases were located in the red zone (19 cases) or the red-white zone. Report Sagittal proton density-weighted image (6A) through the medial meniscus following partial meniscectomy and debridement of the inferior articular surface shows increased PD signal contacting the inferior articular surface (arrow) but no T2 fluid signal at the surgical site (6B) and no gadolinium signal in the meniscus (6C). 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. The anomalous insertion These tears are usually degenerative in nature and usually not associated with a discrete injury [. They were first described by M J Pagnaniet al. The meniscus root plays an essential role in maintaining the circumferential hoop tension and preventing meniscal displacement. The medial meniscus covers 60% of the medial compartment. Kim EY, Choi SH, Ahn JH, Kwon JW. The anterior and posterior meniscofemoral ligaments (Humphrey and Wrisberg respectively) are commonly present with one or both found in 93-100% of patients. The MRI also demonstrated moderate degenerative spurring at the lateral joint compartment, a large knee joint effusion with . MRI has high sensitivity and specificity for detecting meniscus tears in patients without prior knee surgery. Lateral meniscal variant with absence of the posterior coronary ligament. Am J Sports Med 2016; 44:625632, De Smet AA, Horak DM, Davis KW, Choi JJ. (PubMed: 17114506), BakerJC, FriedmanMV, RubinDA (2018) Imaging the postoperative knee meniscus: an evidence-based review. Lee S, Jee W, Kim J. 6. It can be divided into five segments: anterior horn, anterior, middle and posterior segments, and posterior horn. However, this conjecture and others pre- highest.13,27,34,42 Tear locations, such as the posterior sented in literature are mostly speculative. discoid meniscus, although discoid medial menisci can occur much less When it involves the posterior root, medial root tears are easier to diagnose than lateral root tears. 1). 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. Association of Parameniscal Cysts With Underlying Meniscal Tears as Surgical Outcomes Lysholm Score treatment for stable complete or incomplete types of discoid lateral Arthroscopy revealed a horizontal tear of PHMM, and a partial medial meniscectomy was performed. Efficacy of Arthroscopic Treatment for Concurrent Medial Meniscus The patient subsequently underwent successful partial medial meniscectomy. The most frequent symptom is pain that usually begins with a minor Conventional MRI is the least invasive modality for evaluation of a meniscal repair but has lower sensitivity, specificity and accuracy than direct or indirect arthrographic MRI. normal knee. Disadvantages include increased cost, increased patient time, potential for adverse reactions to contrast agent compared to conventional MRI and lack of joint distention. Sagittal T2-weighted (8B) and fat-suppressed coronal T2-weighted (8C) images reveal fluid signal (arrows) extending into the meniscal substance indicating a recurrent tear which was confirmed at second look arthroscopy. Normal course and intensity of both cruciate ligaments. Heron, D, Bonnard C, Moraine C,Toutain A. Agenesis of cruciate The LaPrade classification systemof meniscal root tears has become commonly used in arthroscopy, and there is evidence that this system can be to some extent translated to MRI assessment of these tears ref. Magnetic resonance imaging (MRI) of both knee joints showed an almost complete absence of the anterior and posterior horns of the medial meniscus, except for the peripheral portion, hypoplastic anterior horns and tears in the posterior horns of the lateral meniscus in both knees (Fig. By continuing to use our site, you consent to the use of cookies outlined in our Privacy Policy. On MR images of the knee it is sometimes impossible to determine with confidence if a focus of high signal in the meniscus is confined to the substance of the meniscus or if it extends to involve the surface. On the proton density-weighted image (12A) persistent high signal extends to the tibial and femoral surfaces (arrow). Meniscus | Radiology Key Pseudotear Sign of the Anterior Horn of the Meniscus This arises from the posterior horn of the lateral meniscus and attaches to the lateral aspect of the medial femoral condyle. Special thanks to David Rubin, MD for providing several cases used in this web clinic. Bucket Handle Tear of Lateral Meniscus on MRI - A Case Report Longitudinal medial meniscus tear managed by repair (arrow). As DLM is a congenital anomaly, the ultrastructural features and morphology differ from those of the normal meniscus, potentially leading to meniscal tears. Anomalous insertion of anterior and posterior horns of medial meniscus The example above demonstrates the importance of baseline MRI comparison when evaluating the postoperative meniscus. On this page: Article: Epidemiology Pathology Radiographic features History and etymology Kocher MS, Klingele K, Rassman SO. 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 . (PDF) Sensitivity and Specificity of MRI in Diagnosing Concomitant The meniscus may also become hypertrophic. Increased signal intensity at the anterior horn of the lateral meniscus was seen on the images of seven of the 11 MR studies of the volunteers. St. Louis County's newspaper of politics and culture Fukuta S, Masaki K, Korai F. Prevalence of abnormal findings in magnetic resonance images of asymptomatic knees. However, recognizing these variants is important, as they can The ends of the anterior and posterior horns are firmly attached to the tibia at their roots. Fat suppressed sagittal T1-weighted MR arthrogram (5C) demonstrates gadolinium within the tear (arrow). of the menisci can be summarized as providing: Clark and Ogden studied the natural development of the menisci in the An algorithm for computing tear meniscus profile Discoid medial meniscus. Thompson WO, Thaete FL, Fu FH, Dye SF. . On sagittal proton-density and T2-weighted images, this lesion was demonstrated by sensitive but nonspecific signs, such as the flipped meniscus . AJR Am J Roentgenol. At the time the article was last revised Yahya Baba had continued knee pain after meniscus surgery
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