They were first described by M J Pagnaniet al. Monllau et al in 1998 proposed adding a fourth type, 2008; 32:212219, Magee T. Accuracy of 3-Tesla MR and MR arthrography in diagnosis of meniscal retear in the post-operative knee. Knee Surg Sports Traumatol Arthrosc. On the sagittal fat-suppressed T2-weighted image (7B), fluid extends into the tear. 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. Repair techniques include inside-out, outside-in or all-inside approaches. Discoid lateral meniscus (DLM) is a common anatomic variant in the knee typically presented in young populations, with a greater incidence in the Asian population than in other populations. Considered a feature of knee osteoarthritis. For DSR inquiries or complaints, please reach out to Wes Vaux, Data Privacy Officer, This article focuses on of the meniscus. Clark CR, Ogden JA. Copy. 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. 2005; 234:5361. AJR Am J Roentgenol. There was no history of a specific knee injury. 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. Dr. Diduch, Associate Professor, Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, is Editor of Sports Medicine Reports. In 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. On imaging alone, the radiologist may not be able to distinguish a residual tear (failed repair) from a recurrent tear in the same location. trials, alternative billing arrangements or group and site discounts please call For root tears in general, sagittal imaging may demonstrate a meniscal ghost sign. At 1 year, 5 of 6 were completely asymptomatic with the remaining patient minimally painful with no suggestion of meniscal symptoms. The Journal of bone and joint surgery American volume. The most important clinical concern at the time of MRI imaging is often high-grade articular cartilage loss. The most frequent symptom is pain that usually begins with a minor These include looking for a Kim SJ, Choi CH. Radiology. The example above demonstrates the importance of baseline MRI comparison when evaluating the postoperative meniscus. is in fact reducing the volume of the meniscus and restoring a normal that this rare condition is also clinically asymptomatic. 17. There was no evidence of meniscal extrusion or a meniscal ghost sign (Fig. 4. The sutures are tied over a cortical fixation device or Endobutton (short arrow) with the knee flexed at 90 to secure the root repair. Type 1 is most common, and type To assess the prevalence of meniscal extrusion and its . This case features the following signs of meniscal tear: absent bow tie appearance of the lateral meniscus ghost meniscus: empty location of the anterior horn of the lateral meniscus Diagnostic performance is decreased following partial meniscectomy since the standard criteria used to diagnose a meniscus tear cannot be applied to the post-operative meniscus.3,4,5,6 Partial meniscectomy may distort the normal morphology of the meniscus and increased meniscal signal intensity may extend to the articular surface when a portion of the meniscus has been resected, simulating a tear. Semin Musculoskelet Radiol 2005;9(2):11624, Chung KS, Ha JK, Ra HJ, Nam GW, Kim JG. Thirty-one of these patients underwent subsequent arthroscopic evaluation to allow clinical correlation. 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. patella or Hoffas fat pad, and should be fairly easily differentiated tissue only persists at the edges, where differentiation into the However, clinically significant tears that can mechanically impinge were unlikely to have been missed. The prevalence of a medial discoid meniscus in patients with AIMM No meniscal tear is seen, but the root attachment was also noted to be 5. 2013;106(1):91-115. 6 months post-operative she had increased pain prompting follow-up MRI. The MRI sign of a radial tear is a linear, vertical cleft of abnormal high signal at the free edge (Fig. slab-like configuration on sagittal MR images, with > 3 bowties asymptomatic, although there is a greater propensity for discoid menisci If the tear does not show, it is considered a Grade 1 or 2 and is not as serious. 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). 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. The medial meniscus covers 60% of the medial compartment. 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. Monllau J, Gonzalez G, Puig L, Caceres E. Bilateral hypoplasia of the medial meniscus. 300). Symptomatic anomalous insertion of the medial meniscus. Lateral meniscus bucket handle tears can produce the double anterior horn sign or double ACL sign. A tear was found and the repair was revised at second look arthroscopy. (as previously described), meniscal cyst,26 discoid lateral meniscus in the same knee (Figure 9),25 and pathologic medial patella plica.27. Results: Arthroscopic examination of the anterior horn of the lateral meniscus in all 22 patients was normal. They often tend to be radial tears extending into the meniscal root. 1). meniscus is partial meniscal excision, leaving a 6- to 7-mm peripheral On MRI, longitudinal tears appear as a vertical line of abnormal signal contacting articular surface. 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. Discoid medial menisci are much less common than discoid lateral menisci,24 and they may be bilateral. The posterior root of the lateral meniscus (PRLM) attaches along the posterior aspect of the intercondylar eminence of the tibia (Fig. the intercondylar notch, most commonly to the mid ACL, and less commonly However, many clinicians opt to use conventional MRI as the initial postoperative imaging study and reserve MR arthrography for equivocal cases. Youderian A, Chmell S, Stull MA. 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 They found that 76 (8%) of these indicated a tear of the anterior horn of either the medial or lateral meniscus. no financial relationships to ineligible companies to disclose. St. Louis County's newspaper of politics and culture The shape of the meniscus is formed at the eighth week of 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 . In these cases, MR arthrography may provide additional diagnostic utility. Radiology. 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. The Wrisberg variant may present with a Surgery is useful if they are unstable and flipping in and out of the joint causing pain. Special thanks to David Rubin, MD for providing several cases used in this web clinic. 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. mesenchymal mass that differentiates into the tibia, femur, and Discoid lateral meniscus: Prevalence of peripheral rim instability. Financial Disclosure: None of the authors or planners for this educational activity have relevant financial relationships to disclose with ineligible companies whose primary business is producing, marketing, selling, reselling, or distributing healthcare products used by or on patients. The posterior cruciate ligament is intact. Continuous meniscal tissue bridged the anterior and posterior horns of the lateral meniscus on 3 consecutive sagittal slices (Figure 1B). show cupping of the medial tibial plateau, proximal medial tibial physis The patient underwent a successful partial medial meniscectomy and was encouraged to seek low-impact exercise. Heron, D, Bonnard C, Moraine C,Toutain A. Agenesis of cruciate When it involves the posterior root, medial root tears are easier to diagnose than lateral root tears. insertion of the medial meniscus (AIMM) has been described, and it is Presentation - Middle-older aged individuals, non-traumatic, progressive onset of pain. Arthrofibrosis and synovitis are also relatively common. The lateral meniscus is more circular with a shorter radius, covering 70% of the articular surface with the anterior and posterior horns approximately the same size. According to these authors, increased signal to the surface on only one slice should be interpreted as a possible tear. Cases of only one abnormal slice correlated to tears at arthroscopy 55 % of the time for the medial meniscus and 30 % for the lateral [, Accuracy of diagnosing meniscus tear with these criteria has been good. MR criteria are used to make the diagnosis. The camera can visualize the meniscus and other structures within the knee. Bilateral discoid medial menisci: Case report. 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. The posterior root lies anterior to the posterior cruciate ligament. Sagittal proton density-weighted image (9A) demonstrates no high signal abnormality. Create a new print or digital subscription to Applied Radiology. the rare ring-shaped meniscus, to the classification. Davidson D, Letts M, Glasgow R. Discoid meniscus in children: Treatment and outcome. ligament and meniscal fascicles. was saddle shaped. 2012;20(10):2098-103. Shepard et al have done a nice job of telling us just how frequently this mistake can be made by fellowship trained musculoskeletal radiologists. In cases like this, MR arthrography is quite helpful. After failing conservative management with NSAIDs, PT, and activity modification, he underwent an MRI. Stein T, Mehling AP, Welsch F, von EisenhartRothe R, Jger A. 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). There is no telling how much this error rate will change for radiologists less experienced with MRI. Analytical, Diagnostic and Therapeutic Techniques and Equipment 13. hypoplastic meniscus was not the cause of the patients pain, suggesting 1 ). Kim EY, Choi SH, Ahn JH, Kwon JW. Illustration of the medial and lateral menisci. Complex or deep radial tears were found in three of five cases of lateral meniscus extrusion and normal root. The MRI showed complete ACL tear with displaced bucket handle medial meniscus tear. Suprapatellar plica noticed, with no related cartilaginous erosions. 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 They often tend to be radial tears extending into the meniscal root. Findings indicate an intact meniscus following partial meniscectomy with normal intrameniscal signal. The anterior horn of the menisci, especially the lateral meniscus, is an area commonly confused on MRI. meniscus are not uncommon; they include an anomalous insertion of the 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. The self-reported complication rate for partial meniscectomy is 2.8% and meniscus repair is 7.6%. menisci occurs. MRI showed posterior horn of the medial meniscus (PHMM) horizontal tear with early degenerative changes. least common is complete congenital absence of the menisci. ligaments are absent, most commonly the anterior cruciate ligament (ACL) tear. 2006;239(3):805-10. 2006; 187:W565568. proximal medial tibia was convex and the distal medial femoral condyle The most commonly practiced You have reached your article limit for the month. Interested in Group Sales? 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"}. Sagittal PD (. The anterior and posterior sutures are shuttled down the tibial tunnel (arrowhead). Root tears are associated with a high risk for osteoarthritis. According to one source, they are thought to account for ~10% of all arthroscopic meniscectomies 5. anterior horn of the medial meniscus into the anterior cruciate ligament Both the healed peripheral tear and the new central tear were proved at second look arthroscopy. 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. In this case, the patient never obtained relief from the initial surgery, and the surgeon felt this was a residual tear (failed repair) rather than a recurrent tear. both enjoyable and insightful. The anterior and posterior meniscofemoral ligaments (Humphrey and Wrisberg respectively) are commonly present with one or both found in 93-100% of patients. Meniscal transplant is usually reserved for patients younger than 50 years who have normal axial alignment. 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. Partial meniscectomy is by far the most common procedure. The anomalous insertion The trusted source for healthcare information and CONTINUING EDUCATION. from AIMM. However, few studies have directly compared the medial and lateral root tears. An intact meniscal repair was confirmed at second look arthroscopy. 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. The medial meniscus is more tightly anchored than the lateral meniscus, allowing for approximately 5mm of anterior-posterior translation. The posterior horn is always larger than the anterior horn. 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. They maintain a relatively constant distance from the periphery of the meniscus [. The insertion site Volunteerism and Sports Medicine: Where do We Stand? Increased intrameniscal signal is commonly seen in the transplanted allograft but does not correlate with clinical outcome.
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