Become a Gold Supporter and see no third-party ads. Renew or update your current subscription to Applied Radiology. Complex or deep radial tears were found in three of five cases of lateral meniscus extrusion and normal root. Anomalous MRI features are consistent with torn lateral meniscus with flipped anterior horn superomedial and posterior, resting superior to the posterior horn. Br Med Bull. Check for errors and try again. Lee, J.W. Magnetic resonance imaging of the postoperative meniscus: resection, repair, and replacement. pivoting). sagittal magnetic resonance (MR) images. Am J Sports Med 2010; 38:15421548, LaPrade RF, Matheny LM, Moulton SG, James EW, Dean CS. Lateral Meniscus Tear | New Health Advisor 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. Clinical imaging. The lateral . diagnostic dilemma, as the AIMM band will be seen to extend to the Tears of the anterior horn of the medial meniscus, an inferior patella plica, and ACL tears can be mistaken for AIMM, but carefully tracing the ligament will help to exclude these conditions. Materials and methods . menisci (Figure 8). Results: Arthroscopic examination of the anterior horn of the lateral meniscus in all 22 patients was normal. Type The ideal technique for imaging the postoperative meniscus is a matter of active controversy and depends on the operation performed, surgeon preference and clinical question (concern for recurrent meniscal tear versus articular cartilage). 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. The anterior root of the medial meniscus attaches to the anterior midline of the tibial plateau or sometimes the anterior surface of the tibia just below the plateau. MRIs of BHT may have several characteristic appearances including (1) fragment in the notch sign; (2) double anterior horn sign, in which there is an additional meniscal fragment in the anterior joint on top of the native anterior horn; (3) the absent bow tie sign; (4) the double PCL sign, in which the centrally displaced fragment lies just anterior and parallel to the PCL giving the appearance of two PCLs; and (5) the coronal truncation sign, in which the free edge of the meniscal body appears clipped off on coronal images (Fig. This case is almost identical to the previous case with a different clinical history. At the time the case was submitted for publication Mostafa El-Feky had no recorded disclosures. in 19916. By continuing to use our site, you consent to the use of cookies outlined in our Privacy Policy. One important reason for such discrepancies is a failure to understand the transverse geniculate ligament of the knee (TGL). Download Musculoskeletal MRI by Nancy Major, Mark Anderson Close clinical correlation is advised before recommending surgery based on this finding alone. described in thrombocytopenia absent radius syndrome (TAR syndrome).2,3 Bilateral hypoplasia of the medial meniscus has also been reported.4. Clinical Examination in the Diagnosis of Anterior Cruciate : JAAOS The MRI showed complete ACL tear with displaced bucket handle medial meniscus tear. published a case series of anterior horn tears of the lateral meniscus in 14 soccer players (mean age 20.2 years). 2002; 222:421429, Ciliz D, Ciliz A, Elverici E, Sakman B, Yuksel E, Akbulut O. Belcher v. Commissioner of Social Security, No. 1:2020cv01894 snapping knee due to hypermobility. 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. trials, alternative billing arrangements or group and site discounts please call mimicking an anterior horn tear. 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. 3 is least common. Magnetic resonance imaging (MRI) and computed tomography (CT) arthrography are both well suited for evaluation of these lesions though somewhat limited by cost and access for MRI and by invasiveness for CT arthrography . Acute partial interstitial to near complete anterior cruciate ligament tear is noted at its posterior end with femoral deep lateral sulcus sign. The anterior horn of the menisci, especially the lateral meniscus, is an area commonly confused on MRI. Meniscal extrusion. Medical search. Web Sagittal proton density-weighted image (10A) demonstrates increased signal extending to the articular surface consistent with granulation tissue. Fat supressed coronal proton density-weighted (19C, D) and sagittal proton density-weighted (19E) images demonstrate postoperative changes from interval posterior horn partial meniscectomy with a thin rim of posterior horn remaining (arrow) and subchondral fractures in the medial femoral condyle and medial tibial plateau (arrowheads) with marked progression of full-thickness chondral loss in the medial compartment and extruded meniscal tissue. This is a critical differentiation because the latter represents meniscal tears that can be (PubMed: 17114506), BakerJC, FriedmanMV, RubinDA (2018) Imaging the postoperative knee meniscus: an evidence-based review. 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 ]. Surgical Outcomes Lysholm Score The clinical significance of anterior horn meniscal tears diagnosed on magnetic resonance images. The condition is typically asymptomatic and, therefore, is infrequently diagnosed.14 Kaplan EB. They are usually due to an acute injury [. He presented after a few months with symptoms of instability. 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 ]. What Is a Tear of the Anterior Horn of the Lateral Meniscus? The Knee Resource | Degenerative Meniscus Tear varus deformity (Figure 3). meniscus is partial meniscal excision, leaving a 6- to 7-mm peripheral Dickhaut SC, DeLee JC. 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. Posterior meniscal root repairs: outcomes of an anatomic transtibial pull-out technique. Another finding is the abnormal size or shape of the meniscus, which would indicate damaged surfaces [, To provide a greater degree of accuracy, De Smet advocated the two-slice-touch rule. To call a definite tear, one should see increased signal contacting the articular surface of the menisci on at least two images (sagittal or coronal). Congenital discoid cartilage. Medial meniscus posterior horn peripheral longitudinal tear treated with repair. The medial compartment articular cartilage is preserved, and the meniscal body is not significantly extruded (16D). The trusted source for healthcare information and CONTINUING EDUCATION. MRI of the knee is commonly indicated for evaluation of unresolved or recurrent knee pain following meniscal surgery. Each meniscus has three main parts, the back (posterior horn), middle (body), and front (anterior horn). Menisci are present in the knees and the The Journal of bone and joint surgery American volume. Meniscus tears are either degenerative or acute. The reported prevalence is 0.06% to 0.3%.25 The patient failed conservative management of aspiration and cortisone injection. The tear was treated by partial meniscectomy at second surgery. 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. 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 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. Sagittal proton density-weighted image (9A) demonstrates no high signal abnormality. During an arthroscopy, we have the choice of either repairing the meniscus tear or removing the torn piece. The patient underwent a successful partial medial meniscectomy and was encouraged to seek low-impact exercise. Bilateral hypoplasia of the medial meniscus has also been structure on sagittal images on T1, proton density, and fat-saturated Lateral meniscus posterior horn peripheral longitudinal tear managed by repair. At surgery, the torn part of the meniscus was in the intercondylar notch and chewed up and not amenable to repair. Radial Tear of the Medial Meniscal Root: Reliability and Accuracy of MRI for Diagnosis. Radiology. An abnormal shape may indicate a meniscal tear or a partial meniscectomy. Both ligaments attach distally to the posterior horn of the lateral meniscus and contribute to posterior drawer stability . from AIMM. It is located in the lateral portion of the knee interior of the knee joint. For DSR inquiries or complaints, please reach out to Wes Vaux, Data Privacy Officer, ligament and meniscal fascicles. Klingele KE, Kocher MS, Hresko MT, et al. It is believed that discoid Pathology - a tear that has developed gradually in the meniscus. The Postoperative Meniscus - Radsource Of the 45 patients who were interviewed and evaluated clinically without surgery at a minimum of 1 year, 32 reported continued pain but no mechanical symptoms suggestive of a meniscal tear. 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 Tears in the red zone have the potential to heal and are more amenable to repair. Knee Examination - Samarpan Physio This article focuses on These are like large radial tears and can destabilize a large portion of the meniscus. There is no telling how much this error rate will change for radiologists less experienced with MRI. diminutive (1 mm) with no increased signal to suggest root attachment Case 9: posterior root of medial meniscus, View Yuranga Weerakkody's current disclosures, see full revision history and disclosures, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, Ahlback classification system in assessing osteoarthritis of the knee joint, Kellgren and Lawrence system for classification of osteoarthritis, anterior cruciate ligament mucoid degeneration, MRI grading system for meniscal signal intensity, shortening or absence of the root on sagittal images, vertical fluid cleft on coronal fluid-sensitive (T2) images. A meniscal allograft transplant frequently leads to significant improvements in pain and activity level and hastens the return to sport for most amateur and professional athletes.13 A common method of meniscal allograft transplant includes a cadaveric meniscus (fresh or frozen) attached by its anterior and posterior roots to a bone bridge with a trapezoidal shape harvested from a donor tibia. Diagnostic Image Quality of a Low-Field (0.55T) Knee MRI Protocol Using Objectives: Low-field MRI at 0.55 Tesla (T) with deep learning image reconstruction has recently become commercially available. A characteristic MRI finding to diagnose a partial tear of the medial MRI Findings: Medial meniscus: Tear of the posterior horn seen to the inferior articular surface continuing into the posterior body and becoming more vertical. Variations in meniscofemoral ligaments at anatomical study and MR imaging. 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. MRI Gallery - MRI Knee - Meniscal tears - Radiology Masterclass Fellowship-trained musculoskeletal radiologists read 99% of the MRIs. [emailprotected]. In these cases, MR arthrography may provide additional diagnostic utility. The anterior horn of the menisci, especially the lateral meniscus, is an area commonly confused on MRI. The anterior root of the lateral meniscus attaches to the tibia, just lateral to the midline and posterior to fibers of the anterior cruciate ligament (ACL). It is important to know the age of the patient when interpreting the MRI. Repair of posterior root tears are being performed with increased frequency over the past several years. is much greater than in a discoid lateral meniscus, and the prevalence 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. 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. Discoid lateral meniscus in children. Because there is less pressure on the meniscus there, it is difficult to evaluate the anterior region of the meniscus. Radiology. an adult), and approximately twice the size of the anterior horn on Radiographs are usually not diagnostic, but they may show a The knee is a complex synovial joint that can be affected by a range of pathologies: ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. They were first described by M J Pagnaniet al. If missing on MR images, a posterior root tear is present. However, many clinicians opt to use conventional MRI as the initial postoperative imaging study and reserve MR arthrography for equivocal cases. History of longitudinal medial meniscus tear managed by meniscal repair (arrows). When the cruciate Knee Surg Sports Traumatol Arthrosc. At least one meniscofemoral ligament is present in 7093 % Of knees A meniscus is a crescent-shaped fibrocartilaginous structure that 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. Resnick D, Goergen TG, Kaye JJ, et al. Am J Sports Med 2017; 45:884891, Zaffagnini S, Grassi A, Marcheggiani Muccioli GM, et al. An alternative way of fastening the allograft to the donor knee involves harvesting the meniscus with a small bone plug attached to each root and then securing the plugs within osseous tunnels drilled in the recipient tibia. is in fact reducing the volume of the meniscus and restoring a normal Sagittal T2-weighted image (10B) reveals no fluid at the repair site. Discoid medial menisci are much less common than discoid lateral menisci,24 and they may be bilateral. It is usually seen near the lateral meniscus central attachment site. 2006;239(3):805-10. (Figure 1). Tears can be characterized by length, depth, shape, gap, displacement, stability, dysplasia (discoid) Most studies have shown increased accuracy for direct and indirect MR arthrography compared to conventional MRI for partial meniscectomies of 25% or more.16. It is often explained by fibers of the anterior cruciate ligament and the covering synovium . 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. Of the 54 participants, 5 had PHLM tears and 49 were normal. acromioclavicular, sternoclavicular, and temporomandibular joints. A 510, 210-pound 16-year-old male injured his left knee while kicking a football. 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. medial meniscus, and not be confined to the ACL as seen in an ACL tear. Coronal extrusion of the lateral meniscus does not increase after 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. Efficacy of Arthroscopic Treatment for Concurrent Medial Meniscus 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. Magn Reson Imaging Clin N Am 2014;22(4): 517555, White LM, Schweitzer ME, Weishaupt D, Kramer J, Davis A, Marks PH. immediatly lateral to the anterior horn of lateral meniscus and posterior to the tubercle of anteriro horn of medial meniscus . Is sport activity possible after arthroscopic meniscal allograft transplantation? no specific MR criteria for classifying discoid medial menisci, and the AJR American journal of roentgenology. tissue only persists at the edges, where differentiation into the RESULTS. Extrusion is commonly seen following root repair. 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. 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). Considered a feature of knee osteoarthritis. Pagnani M, Cooper D, Warren R. Extrusion of the Medial Meniscus. However, clinically significant tears that can mechanically impinge were unlikely to have been missed. anterior horn of the medial meniscus into the anterior cruciate ligament Lateral meniscus tears of the posterior root are a common concomitant injury to anterior cruciate ligament (ACL) tears [6, 16, 20]. On the sagittal proton density-weighted image (11A), signal contacts the tibial surface. Bucket Handle Meniscal Tear - Diagnosis - MRI Online 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. MR imaging is useful for evaluation of many possible complications following meniscal surgery. ligaments and menisci causing severe knee dysplasia in TAR syndrome. Intensity of signal contacting meniscal surface in recurrent tears on MR arthrography compared with that of contrast material. Discoid lateral meniscus: Prevalence of peripheral rim instability. Monllau J, Gonzalez G, Puig L, Caceres E. Bilateral hypoplasia of the medial meniscus. American Board of Orthopaedic Surgery Practice of the Orthopaedic Surgeon: Part-II, certification examination case mix. Note the symmetrical shape of the lateral meniscus (left) with similar size of the anterior and posterior horns. Coronal extrusion of the lateral meniscus does not increase after 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. Anterior tibial marrow edema and organized trabecular fracture measuring 16 mm AP, 18 mm transverse. Sagittal proton density-weighted image (8A) through the medial meniscus demonstrates signal extending to the tibial surface (arrow). least common is complete congenital absence of the menisci. posterior fascicles and meniscotibial ligament are absent and a high discoid lateral meniscus, including a propensity for tears to occur and
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