Meniscal tears are common and often associated with knee pain. Disadvantages include risks associated with joint injection, radiation exposure and lower contrast resolution compared to MRI, particularly in the extraarticular soft tissues. Materials and methods . Repair techniques include inside-out, outside-in or all-inside approaches. Type 1 is most common, and type In contrast to the medial meniscus, the posterior horn of the lateral meniscus is additionally secured by the meniscofemoral ligaments (MFL). slab-like configuration on sagittal MR images, with > 3 bowties Create a new print or digital subscription to Applied Radiology. The most frequent symptom is pain that usually begins with a minor 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. Discoid lateral meniscus was originally believed to result from an On the sagittal proton density-weighted image (11A), signal contacts the tibial surface. Methods Eighteen patients who had arthroscopically confirmed partial MMPRTs were included. When bilateral, they are usually symmetric. If a meniscus tear shows up on a MRI, it is considered a Grade 3. Radiology. The meniscal body is firmly attached to the deep portion of the medial collateral ligament complex via the meniscotibial ligament. 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. ligament, and the posterior horn may translate or rotate due to immediatly lateral to the anterior horn of lateral meniscus and posterior to the tubercle of anteriro horn of medial 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. 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. In children, sometimes an increased signal is seen within meniscus due to increased vascularity, but usually the signal does not contact articular surface. To assess the prevalence of meniscal extrusion and its . with mechanical features of clicking and locking. Exam showed a mild effusion and medial joint line tenderness. The purpose of our study was to determine if cysts of the ACL are the origin of cysts adjacent to the AHLM. 2a, 2b, 2c). meniscus is partial meniscal excision, leaving a 6- to 7-mm peripheral A Wrisberg type variant has not been documented in : Complications in brief: arthroscopic partial meniscectomy. Longitudinal medial meniscus tear managed by repair (arrow). This article focuses on Seventy-four cases of bucket-handle tears (mean age, 27.2 11.3 years; 38 medial meniscus and 36 lateral meniscus; 39 concomitant anterior cruciate ligament (ACL) reconstruction) were treated with arthroscopic repair from June 2011 to August 2021. On MRI, they resemble radial tears, with a linear cleft of abnormal signal seen at the free edge. As DLM is a congenital anomaly, the ultrastructural features and morphology differ from those of the normal meniscus, potentially leading to meniscal tears. Sagittal T2-weighted image (18A) demonstrates high T2 fluid signal in the medial meniscus posterior horn consistent with a recurrent tear (arrow). 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. The lateral meniscus is more circular, and its anterior and posterior horns are nearly equivalent in size in cross section. A 17. The discoid lateral-meniscus syndrome. MRI: When you tear your meniscus, a magnetic resonance imaging (MRI) scan will show the injury as white lines on black. Clinical imaging. joint: Morphologic changes and their potential role in childhood both enjoyable and insightful. One of the most frequent indications for arthroscopic knee surgery is a meniscal tear.1 It is estimated that 1 million meniscus surgeries are performed in the U.S. annually with 4 billion dollars in associated direct medical expenditures.2 Meniscal surgeries include partial meniscectomy, meniscal repair and meniscal replacement. Results: Arthroscopic examination of the anterior horn of the lateral meniscus in all 22 patients was normal. What is a Lateral Meniscus Tear? Pullout fixation of posterior medial meniscus root tears: correlation between meniscus extrusion and midterm clinical results. There was no evidence of meniscal extrusion or a meniscal ghost sign (Fig. 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 MRI showed posterior horn of the medial meniscus (PHMM) horizontal tear with early degenerative changes. meniscus. ; Lee, S.H. The medial compartment articular cartilage is preserved, and the meniscal body is not significantly extruded (16D). Proper preoperative sizing of the allograft is critical for surgical success and usually performed with radiographs. Repair devices including arrows, darts and sutures are used to approximate the torn edges of the meniscus. Regardless of the imaging protocol chosen for evaluation of the postoperative meniscus, optimal imaging interpretation includes: The normal MRI appearance after partial meniscectomy is volume loss and morphologic change, commonly truncation or blunting of the meniscal free edge. diagnostic dilemma, as the AIMM band will be seen to extend to the The lateral meniscus is more circular, and its anterior and posterior horns are nearly equivalent in size in cross section. 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. patella or Hoffas fat pad, and should be fairly easily differentiated Arthroscopy: The Journal of Arthroscopic & Related Surgery. Check for errors and try again. 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 example shown (Figures 1 and 2), the entire medial meniscus is The superior, middle and inferior geniculate arteries are the main vascular supply to the menisci. Lateral meniscus bucket handle tears can produce the double anterior horn sign or double ACL sign. Normal Sometimes T2 signal in a healed tear may look similar to fluid. Of the 14 athletes, 8 repairs were performed, 5 patients . Menisci are present in the knees and the MR criteria for discoid lateral menisci are used for discoid medial Horizontal (degenerative) tears run relatively parallel the tibial plateau. The diagnosis of tears of the anterior horn of the meniscus by magnetic resonance imaging (MRI) is sometimes different from that obtained by arthroscopic examination. 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. joint, and they also protect the hyaline cartilage. (Figure 1). The patient had a recent new injury with increased pain. Unable to process the form. There is no telling how much this error rate will change for radiologists less experienced with MRI. 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. What are the findings? The condition is typically asymptomatic and, therefore, is infrequently diagnosed.14 Learn more. 4). While this test will show a tear up to 90% of the time, it does not always. an adult), and approximately twice the size of the anterior horn on 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. 6. However, the tear changes plane of orientation over its course. AJR Am J Roentgenol 211(3):519527, De Smet AA. 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. Magnetic resonance imaging of the postoperative meniscus: resection, repair, and replacement. Pagnani M, Cooper D, Warren R. Extrusion of the Medial Meniscus. Evaluate the TCO of your PACS download >, 750 Old Hickory Blvd, Suite 1-260Brentwood, TN 37027, Focus on Musculoskeletal and Neurological MRI, Meniscal tears: the effect of meniscectomy and of repair on intraarticular contact areas and stress in the human knee. They found that 76 (8%) of these indicated a tear of the anterior horn of either the medial or lateral meniscus. Best assessed on T2 weighted sequences. Long-term outcome after arthroscopic meniscal repair versus arthroscopic partial meniscectomy for traumatic meniscal tears. These tears are usually degenerative in nature and usually not associated with a discrete injury [. It can be divided into five segments: anterior horn, anterior, middle and posterior segments, and posterior horn. A tear of the ACL should also, in practice, not be a asymptomatic, although there is a greater propensity for discoid menisci Rohren EM, Kosarek FJ, Helms CA. congenital absence of the cruciate ligaments. 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. Anomalous Check for errors and try again. tissue only persists at the edges, where differentiation into the Youderian A, Chmell S, Stull MA. variants of the meniscus are relatively uncommon and are frequently Kaplan EB. This mesenchymal A tear was found and the repair was revised at second look arthroscopy. St. Louis County's newspaper of politics and culture On the sagittal fat-suppressed T2-weighted image (7B), fluid extends into the tear. Grades 1 and 2 are not considered serious. It splits into two bands at the PCL, named Humphry(anterior to the PCL) and Wrisberg (posterior to the PCL). varus deformity (Figure 3). Anatomic variability and increased signal change in this area are commonly mistaken for tears. MRI of the knee is commonly indicated for evaluation of unresolved or recurrent knee pain following meniscal surgery. 2006; 88:660667, Boutin RD, Fritz RC, Marder RA. Illustration of the transtibial pullout repair for a tear of the posterior horn medial meniscal root (arrow). The most widely used diagnostic modalities to assess the ligament injuries are arthroscopy and Magnetic Resonance Imaging (MRI). of the distal femur and proximal tibia, and in the case report of Monllau et al in 1998 proposed adding a fourth type, 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. Radiology. Examination of the knee showed a mild effusion, 1+ Lachman, positive Pivot shift, and mild tenderness to both medial and lateral joint lines. No meniscal tear is seen, but the root attachment was also noted to be CT arthrography is a recommended alternative for patients who are not MR eligible. 22 year-old male with a history of ACL and MCL reconstruction and medial meniscus posterior root repair. Discoid lateral meniscus and the frequency of meniscal tears. . normal knee. Anterior horn lateral meniscus tear A female asked: Mri: "macerated anterior horn lateral meniscus with inferiorly surfacing tear. 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. This scan showed a radial MMT. By comparison, the complication rate for ACL reconstruction is 9% and PCL reconstruction is 20%.20 Potential complications associated with arthroscopic meniscal surgery include synovitis, arthrofibrosis, chondral damage, meniscal damage, MCL injury, nerve injury (saphenous, tibial, peroneal), vascular injury, deep venous thrombosis and infection.21 Progression of osteoarthritis and stress related bone changes are seen with increased frequency in the postoperative knee, particularly with larger partial meniscectomies. Among these 26 studies of an LMRT . The medial meniscus covers 60% of the medial compartment. {"url":"/signup-modal-props.json?lang=us"}, Weerakkody Y, Baba Y, Knipe H, et al. the intercondylar notch, most commonly to the mid ACL, and less commonly 2059-2066, Kinsella S.D., and Carey J.L. Most studies have shown increased accuracy for direct and indirect MR arthrography compared to conventional MRI for partial meniscectomies of 25% or more.16. The meniscus may also become hypertrophic. 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. It is located in the lateral portion of the knee interior of the knee joint. Most patients are asymptomatic, but injury to the meniscus can 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"}. 10 AJR Am J Roentgenol 2009;193:515-523. does not normally occur.13. 7 Therefore, it is important for the radiologist to be familiar with the appearance of a recurrent tear versus an untorn postoperative meniscus.

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