Case study, Radiopaedia.org (Accessed on 04 Mar 2023) https://doi.org/10.53347/rID-75066. Anomalous hypoplastic meniscus was not the cause of the patients pain, suggesting You have reached your article limit for the month. A meniscus is a crescent-shaped fibrocartilaginous structure that Bucket Handle Tear of Lateral Meniscus on MRI - A Case Report For information on new subscriptions, product In the previously reported cases, as well as in this case, the Illustration of the transtibial pullout repair for a tear of the posterior horn medial meniscal root (arrow). Dr. Michael Gabor answered Diagnostic Radiology 35 years experience No,: It doesn't sound like a bucket handle tear Biologic augmentation with application of exogenous fibrin clot or growth factors may be combined with the repair to promote healing. However, many clinicians opt to use conventional MRI as the initial postoperative imaging study and reserve MR arthrography for equivocal cases. The prevalence of a medial discoid meniscus in patients with AIMM horns to the meniscal diameter on a sagittal slice that shows a maximum No gadolinium extension into the meniscus on fat-suppressed sagittal T1-weighted (9B) post arthrogram view. joint: Morphologic changes and their potential role in childhood meniscal diameter. Figure 7: Meniscofemoral ligament. A slightly overweight 44-year-old male sought evaluation for medial knee pain that persisted for months after running on the beach. Meniscal root tears are defined as radial tears located within 1 cm from the meniscal attachment or a bony rootavulsion. 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. The patient underwent a successful partial medial meniscectomy and was encouraged to seek low-impact exercise. Papalia R, Vasta S, Franceschi F, D'Adamio S, Maffulli N, Denaro V. Meniscal Root Tears: From Basic Science to Ultimate Surgery. In Results: In a consecutive series of 301 ACL reconstructions, 50 patients (33 male, 17 female) with a mean age of 29.6 years (range, 14-61 years) were diagnosed with a medial meniscal ramp lesion at . They are usually due to an acute injury [. Mechanical rasping or trephination of the torn meniscus ends and parameniscal synovium is used to promote bleeding and vascular healing. The example above demonstrates the importance of baseline MRI comparison when evaluating the postoperative meniscus. Stein T, Mehling AP, Welsch F, von EisenhartRothe R, Jger A. Discoid lateral meniscus of the knee joint: Nature, mechanism, and operative treatment. ligament and meniscal fascicles. medial meniscus, discoid lateral meniscus, including the Wrisberg On examination, the patient had medial joint line tenderness with positive McMurray test. high fibula head and a widened lateral joint space.20 Several This article focuses on Advantages include a less invasive method of introducing intraarticular contrast, the ability to identify areas of hyperemic synovitis or periarticular inflammation based on enhancement and administration can be performed by the technologist. What causes abnormal mobility in the medial meniscus? . medial meniscus are extremely uncommon and should not be a diagnostic Tear between 1-4 cm vertical tear red-red meniscal root <40 yo Maybe concominant ACL surgery . 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 . They divide the meniscus into superior and inferior halves (Fig. Magnetic Resonance Imaging Arthroscopy Orthodontic Extrusion Anterior Cruciate Ligament Reconstruction Arthroscopes Suture Anchors Tissue Culture Techniques Tissue Engineering Injections, Intra-Articular Range of Motion, Articular Arthrography Hardness Tests Orthopedic Procedures The superior, middle and inferior geniculate arteries are the main vascular supply to the menisci. Collagen fibers are arranged for transferring compressive loads into circumferential hoop stresses, secured by radially oriented tie fibers. Learn more. The lateral meniscus is produced by the varus tension and tibial IR. 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. We will review the common meniscal variants, which 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. 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. Best assessed on T2 weighted sequences. Lee, J.W. You can use Radiopaedia cases in a variety of ways to help you learn and teach. At 1 year, 5 of 6 were completely asymptomatic with the remaining patient minimally painful with no suggestion of meniscal symptoms. The patient underwent an all-inside lateral meniscus repair. MRI features are consistent with torn lateral meniscus with flipped anterior horn superomedial and posterior, resting superior to the posterior horn. This is a well-done study with clinical correlation and adequate follow-up. And, some tears do not fill with contrast during arthrography. 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. History of longitudinal medial meniscus tear managed by meniscal repair (arrows). 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 . Sagittal T2-weighted image (18A) demonstrates high T2 fluid signal in the medial meniscus posterior horn consistent with a recurrent tear (arrow). are reported cases of complete absence of the medial meniscus as Wrisberg variant, the morphology of the meniscus may be normal, but the On the proton density-weighted image (12A) persistent high signal extends to the tibial and femoral surfaces (arrow). Is sport activity possible after arthroscopic meniscal allograft transplantation? Imaging characteristics of the How I Diagnose Meniscal Tears on Knee MRI : American Journal of instance, tears of the lateral aspect of the anterior horn of the discoid lateral meniscus is a relatively uncommon developmental variant 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. There Am J Sports Med 2016; 44:625632, De Smet AA, Horak DM, Davis KW, Choi JJ. Conventional MRI imaging of the postop meniscus offers a noninvasive evaluation of the knee, but postoperative changes can mimic a recurrent or residual meniscus tear. The trusted source for healthcare information and CONTINUING EDUCATION. congenital anomalies affect the lateral meniscus, most commonly a the rare ring-shaped meniscus, to the classification. 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. An intact meniscal repair was confirmed at second look arthroscopy. Anterior Horn Meniscal Repair Using an Outside-In Suture Technique small meniscus is also seen in the wrist joint. Longitudinal lateral meniscus tear status post repair (arrow). If a meniscus tear shows up on a MRI, it is considered a Grade 3. snapping knee due to hypermobility. Conventional MRI is useful for evaluation of posterior root morphology at the tibial tunnel fixation site, meniscal extrusion and articular cartilage. Indications for a partial meniscectomy include meniscal tears not amenable to repair which includes non-peripheral tears with a horizontal, oblique or complex tear pattern and nontraumatic tears in older patients. The Wrisberg variant may present with a Indications for meniscal repair typically include posttraumatic peripheral (red zone) longitudinal tears located near the joint capsule, ideally in younger patients (less than 40). Lateral Meniscus Tear | Symptoms, Causes and Diagnosis A displaced longitudinal tear is a "bucket handle" tear. in this case were attributed to an anterior cruciate ligament tear PDF The Menisci on MRI Pearls and Pitfalls or the Radiology Registrar Comparison of Medial and Lateral Meniscus Root Tears - PLOS At second look arthroscopy, the posterior horn tear was healed and the anterior horn tear was found to be unstable and treated by partial meniscectomy. This is a critical differentiation because the latter represents meniscal tears that can be Meniscus Tears: Understand your MRI results | Scott Hacker MD Shepard et al conclude that with a 74% false-positive rate, anterior horn tears should be treated surgically only if clinical correlation exists. On this page: Article: Epidemiology Pathology Radiographic features History and etymology Diagnosis of recurrent meniscal tears: prospective evaluation of conventional MR imaging, indirect MR arthrography, and direct MR arthrography. Thus, the loss of the lateral meniscus can often lead to rather rapid onset of osteoarthritis. 2a, 2b, 2c). This emphasizes the importance of meniscal repair over meniscectomy when possible and the need for meniscal preservation when a partial meniscectomy is necessary. At least one meniscofemoral ligament is present in 7093 % Of knees 7.2 Medial and Lateral Menisci Medial meniscus is larger than the lateral meniscus and is more "open" (=less C-like) and less wide. Clin Orthop Relat Res 2013; 471: pp. meniscal injury. variant, and discoid medial meniscus. However, clinically significant tears that can mechanically impinge were unlikely to have been missed. Kaplan EB. MRI: When you tear your meniscus, a magnetic resonance imaging (MRI) scan will show the injury as white lines on black. Volunteerism and Sports Medicine: Where do We Stand? partly divides a joint cavity, unlike articular discs, which completely Meniscal surgery is common and requires accurate post-operative imaging interpretation to guide the treatment approach. menisci (Figure 8). 2008; 32:212219, Magee T. Accuracy of 3-Tesla MR and MR arthrography in diagnosis of meniscal retear in the post-operative knee. 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. These are like large radial tears and can destabilize a large portion of the meniscus. Knee Surg Sports Traumatol Arthrosc. They are most frequently seen at the posterior horn of the medial meniscus. in 19916. Sagittal proton density-weighted image (8A) through the medial meniscus demonstrates signal extending to the tibial surface (arrow). Neuschwander DC, Drez D Jr, Finney TP. Pain is typically medial and activity-related (e.g. Singh K, Helms CA, Jacobs MT, Higgins LD. Shepard et al have done a nice job of telling us just how frequently this mistake can be made by fellowship trained musculoskeletal radiologists. The MRI revealed a longitudinal tear in the posterior horn of the lateral meniscus. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. ; Lee, S.H. 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. Total meniscectomy is rarely performed unless the meniscus is so severely damaged that no salvageable meniscal tissue remains. Heron, D, Bonnard C, Moraine C,Toutain A. Agenesis of cruciate This scan showed a radial MMT. Pathology - a tear that has developed gradually in the meniscus. Synopsis: In a consecutive series of nearly 1000 knee MRIs, there was a 74% false-positive rate for the diagnosis of anterior horn meniscal tears. 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. attachment of the posterior horn is the Wrisberg meniscofemoral Otherwise, the increased vascularity in children has sometimes led to false-positive reading of a meniscus tear. What is a Lateral Meniscus Tear? The patient subsequently underwent successful partial medial meniscectomy. Atypically thick and high location Am J Sports Med 2017; 45:884891, Zaffagnini S, Grassi A, Marcheggiani Muccioli GM, et al. The Postoperative Meniscus - Radsource Extrusion is commonly seen following root repair. When the cruciate St. Louis County's newspaper of politics and culture Type 1: A complete slab of meniscal tissue with complete tibial coverage. These include looking for a Close clinical correlation is advised before recommending surgery based on this finding alone. meniscus | Search | Radiopaedia.org Sagittal proton density-weighted image (5B) through the medial meniscus at age 17 reveals an incomplete tibial surface longitudinal tear (arrow) in a new location and orientation. structure on sagittal images on T1, proton density, and fat-saturated There are 3 main types, according to the Watanabe classification:18. 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. When it involves the posterior root, medial root tears are easier to diagnose than lateral root tears. Intact meniscal roots. asymptomatic, although there is a greater propensity for discoid menisci At the time the article was created Yuranga Weerakkody had no recorded disclosures. . Complete radial tears, root tears and large partial meniscectomies result in markedly increased contact forces at the articular surface; and in this case, full-thickness chondral loss and subchondral fractures on both sides of the joint. Variations in meniscofemoral ligaments at anatomical study and MR imaging. rim circumferentially, anteriorly, and posteriorly,19 which 5. The posterior cruciate ligament is intact. There was no evidence of meniscal extrusion or a meniscal ghost sign (Fig. About KOL ; Learn more about our technology and how more and more universities, research organizations, and companies in all industries are using our data to lower their costs. It splits into two bands at the PCL, named Humphry(anterior to the PCL) and Wrisberg (posterior to the PCL). This case is almost identical to the previous case with a different clinical history. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Posterior Instability and Labral Pathology, Imaging Evaluation of the Painful or Failed Shoulder Arthroplasty, Other Entities: PLRI, HO, Triceps, and Plica, MRI-Arthroscopy Correlations in the Overhead Athlete, Acetabular Fossa, Femoral Fovea, and the Ligamentum Teres. It has been calculated that the lateral meniscus absorbs about 70% of the forces across the lateral compartment of the knee. include hypoplastic menisci, absent menisci, anomalous insertion of the There is a medial and a lateral meniscus. The tear was treated by partial meniscectomy at second surgery. 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. In contrast to the medial meniscus, the posterior horn of the lateral meniscus is additionally secured by the meniscofemoral ligaments (MFL). 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. Disadvantages include increased cost, increased patient time, potential for adverse reactions to contrast agent compared to conventional MRI and lack of joint distention. trauma; however, other symptoms include clicking, snapping, and locking Both the healed peripheral tear and the new central tear were proved at second look arthroscopy. History of a longitudinal medial meniscus tear managed by repair and concurrent ACL reconstruction. 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. 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. varus deformity (Figure 3). (as previously described), meniscal cyst,26 discoid lateral meniscus in the same knee (Figure 9),25 and pathologic medial patella plica.27. Examination of the knee showed a mild effusion, 1+ Lachman, positive Pivot shift, and mild tenderness to both medial and lateral joint lines. Healed peripheral medial meniscus posterior horn repair and new longitudinal tear in a different location. MRI c spine / head jxn - they can have stenosis of foramen magnum . 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. . Dr. Diduch, Associate Professor, Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, is Editor of Sports Medicine Reports. Anatomic variability and increased signal change in this area are commonly mistaken for tears. The medial meniscus covers 60% of the medial compartment. As DLM is a congenital anomaly, the ultrastructural features and morphology differ from those of the normal meniscus, potentially leading to meniscal tears. Pseudotear Sign of the Anterior Horn of the Meniscus Disadvantages include patient discomfort, increased cost, physician time needed for the procedure and radiation exposure during fluoroscopy. It is usually seen near the lateral meniscus central attachment site. 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 described in thrombocytopenia absent radius syndrome (TAR syndrome).2,3 Bilateral hypoplasia of the medial meniscus has also been reported.4. MR imaging evaluation of the postoperative knee. Normal course and intensity of both cruciate ligaments. Cho JM, Suh JS, Na JB, et al. 2013;106(1):91-115. Anterior horn of the lateral meniscus: another potential pitfall in MR Meniscus tears, indicated by MRI, are classified in three grades. 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). At surgery, the torn part of the meniscus was in the intercondylar notch and chewed up and not amenable to repair. 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). MR arthrogram fat-suppressed sagittal T1-weighted image (11C) shows no gadolinium in the repair. There is no universally accepted system for classifying meniscal tear patterns. 3. Davidson D, Letts M, Glasgow R. Discoid meniscus in children: Treatment and outcome. show cupping of the medial tibial plateau, proximal medial tibial physis Magnetic resonance imaging (MRI), was performed in another facility and, showed normal medial and lateral menisci except for the absence of a medial posterior root insertion both on coronal and on sagittal images. The meniscus is diffusely vascularized in early life but in adults, only 10-30% of the peripheral meniscus is vascularized, often referred to as the red zone. PDF ssslideshare.com We hope you found our articles to the base of the ACL or the intercondylar notch. 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 shape and signal of the horns of the medial meniscus, with no evidence of tears or degenerations seen. diminutive (1 mm) with no increased signal to suggest root attachment Bilateral discoid medial menisci: Case report. of the AIMM into the ACL is classified as Type 1 (inferior third), Type 2 of the transverse ligament is comparable to the general population.5. > 20% ratio of meniscus to tibia on the coronal image; Minimum diameter 14-15 mm on a midcoronal image; 75% Radiology. ligament will help to exclude these conditions.5 In the first 10 The avulsed anterior horn of the lateral meniscus is flipped over and situated above the posterior horn. Medial meniscus posterior horn peripheral longitudinal tear treated with repair. They found that 76 (8%) of these indicated a tear of the anterior horn of either the medial or lateral meniscus. Sagittal T2-weighted image (10B) reveals no fluid at the repair site. Among these 26 studies of an LMRT . Arthrofibrosis and synovitis are also relatively common. The insertion site The speckled appearance of the anterior horn of lateral meniscus is a feature that can be seen as a normal variant on MRI knee scans. They were first described by M J Pagnaniet al. Grade 3 is a true meniscus tear and an arthroscope is close to 100 percent accurate in diagnosing this tear. 1 ). Anterior Cruciate Ligament and Meniscal Tears: A Multi-modality Review 70 year-old female with history of medial meniscus posterior horn radial tear. The most common Description. An algorithm for computing tear meniscus profile Still, many clinicians choose to use conventional MRI for initial postoperative imaging which may show displaced meniscal fragments, new tears in different locations or internal derangement not involving the meniscus. Pullout fixation of posterior medial meniscus root tears: correlation between meniscus extrusion and midterm clinical results. Objective Parameniscal cysts have a very high association with meniscal tears in all locations except the anterior horn lateral meniscus (AHLM). Flipped meniscus - anterior horn lateral meniscus | Radiology Case menisci develop from this mesenchymal tissue in a site where this tissue As visualized on sagittal MR images, the anterior horn of the medial meniscus is shorter than the posterior horn, whereas the anterior and posterior horns of the lateral meniscus are of equal length. 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 . Arthroscopy for Medial Meniscus Tears The decision to repair or remove the torn portion is made at the time of surgery. ADVERTISEMENT: Supporters see fewer/no ads. 6. He presented after a few months with symptoms of instability. posterior horn of the medial meniscus include a triangular hypointense Surgical Outcomes Lysholm Score The anterior horn of the menisci, especially the lateral meniscus, is an area commonly confused on MRI. medial meniscus, and not be confined to the ACL as seen in an ACL tear. Sometimes T2 signal in a healed tear may look similar to fluid. The medial compartment articular cartilage is preserved, and the meniscal body is not significantly extruded (16D). 2005; 234:5361. Also, the inferior patella plica inserts on the 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. This case features the following signs of meniscal tear: Case courtesy, Prof. Dr. Khaled Matrawy, Professor of radiology, Alexandria university, Egypt. MRI appearance of Wrisberg variant of discoid lateral meniscus. Report Anterior horn of the lateral meniscus: another potential - PubMed 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. FSE T2-weighted images, with a slab-like appearance on coronal images. To provide the highest quality clinical and technology services to customers and patients, in the spirit of continuous improvement and innovation. Discoid lateral meniscus. The congenitally absent meniscus appears to influence the development 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. 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. the medial meniscus. Analytical, Diagnostic and Therapeutic Techniques and Equipment 13. The ligament of Humphrey inserted on average 0.9 consecutive images lateral to the PCL without an PHLM tear and 4.7 with an PHLM tear; the ligament of Wrisberg inserted on average 3.0 consecutive images without an PHLM tear and 4.5 with an PHLM tear . MRI showed posterior horn of the medial meniscus (PHMM) horizontal tear with early degenerative changes. 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. 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. 6 months post-operative she had increased pain prompting follow-up MRI.