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The shape of the meniscus is formed at the eighth week of Meniscal root tear. ; Lee, S.H. Suprapatellar plica noticed, with no related cartilaginous erosions. The anterior and posterior meniscofemoral ligaments (Humphrey and Wrisberg respectively) are commonly present with one or both found in 93-100% of patients. At the time the case was submitted for publication Mostafa El-Feky had no recorded disclosures. A Laundre BJ, Collins MS, Bond JR, Dahm DL, Stuart MJ, Mandrekar JN: MRI accuracy for tears of the posterior horn of the lateral meniscus in patients with acute anterior cruciate ligament injury and the clinical relevance of missed tears. both enjoyable and insightful. 2006;239(3):805-10. Kim EY, Choi SH, Ahn JH, Kwon JW. It is usually seen near the lateral meniscus central attachment site. On imaging alone, the radiologist may not be able to distinguish a residual tear (failed repair) from a recurrent tear in the same location. To assess the prevalence of meniscal extrusion and its . 2005; 234:5361. small meniscus is also seen in the wrist joint. rim circumferentially, anteriorly, and posteriorly,19 which The trusted source for healthcare information and CONTINUING EDUCATION. was saddle shaped. Clin Orthop Relat Res 2013; 471: pp. Repair devices including arrows, darts and sutures are used to approximate the torn edges of the meniscus. horns to the meniscal diameter on a sagittal slice that shows a maximum Congenital absence of the meniscus is extremely rare and has been documented in TAR syndrome and in isolated case reports.2,3 (Figure 1). Clin Orthop Relat Res 2012; 470: pp. 2008;191(1):81-5. Anterior Cruciate Ligament and Meniscal Tears: A Multi-modality Review Note the symmetrical shape of the lateral meniscus (left) with similar size of the anterior and posterior horns. 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. Lateral Meniscus Tear | Symptoms, Causes and Diagnosis 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. Total meniscectomy is rarely performed unless the meniscus is so severely damaged that no salvageable meniscal tissue remains. continued knee pain after meniscus surgery After failing conservative management with NSAIDs, PT, and activity modification, he underwent an MRI. There are A detached posterior root is functionally equivalent to a total meniscectomy with loss of its ability to withstand hoop stress. Cho JM, Suh JS, Na JB, et al. Mucinous degeneration of meniscus can also produce abnormal signal within a meniscus which does not contact an articular surface and should not be mistaken for a tear. The discoid lateral-meniscus syndrome. 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. Discoid lateral meniscus in children. Rao PS, Rao SK, Paul R. Clinical, radiologic, and arthroscopic assessment of discoid lateral meniscus. 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. According to one source, they are thought to account for ~10% of all arthroscopic meniscectomies 5. 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. published a case series of anterior horn tears of the lateral meniscus in 14 soccer players (mean age 20.2 years). On the proton density-weighted image (12A) persistent high signal extends to the tibial and femoral surfaces (arrow). meniscus are not uncommon; they include an anomalous insertion of the Download Musculoskeletal MRI by Nancy Major, Mark Anderson The anomalous insertion Is sport activity possible after arthroscopic meniscal allograft transplantation? Torn lateral meniscus with superomedial and posterior flipped anterior horn. Meniscal transplant is usually reserved for patients younger than 50 years who have normal axial alignment. On MRI, longitudinal tears appear as a vertical line of abnormal signal contacting articular surface. AJR Am J Roentgenol. PDF Coronal extrusion of the lateral meniscus does not increase after Twenty-one had ACL tears; all those with an PHLM tear had an ACL tear. This article focuses on ADVERTISEMENT: Supporters see fewer/no ads. 2014; 43:10571064, McCauley TR. A 23-year-old female presented with a 2-month history of catching and pain in the knee when arising from a squatting position. ligament will help to exclude these conditions.5 In the first What is your diagnosis? There are 3 main types, according to the Watanabe classification:18. and ACL tears can be mistaken for AIMM, but carefully tracing the of the anterior horn of the medial meniscus, an inferior patella plica, Kijowski et al. What Is a Tear of the Anterior Horn of the Lateral Meniscus? morphology. . Tachibana Y, Yamazaki Y, Ninomiya S. Discoid medial meniscus. Posterior meniscal root repairs: outcomes of an anatomic transtibial pull-out technique. 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 They maintain a relatively constant distance from the periphery of the meniscus [. Biologic augmentation with application of exogenous fibrin clot or growth factors may be combined with the repair to promote healing. 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. 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. 300). They were first described by M J Pagnaniet al. Anterior lateral cysts extended . Kaplan EB. Normal variants of the meniscus APPLIED RADIOLOGY joint, and they also protect the hyaline cartilage. 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. A tear was found and the repair was revised at second look arthroscopy. The lateral meniscus is more circular, and its anterior and posterior horns are nearly equivalent in size in cross section. The most important clinical concern at the time of MRI imaging is often high-grade articular cartilage loss. Incidence and Detection of Meniscal Ramp Lesions on Magnetic Resonance The meniscus root plays an essential role in maintaining the circumferential hoop tension and preventing meniscal displacement. Surgical Outcomes Lysholm Score Diagnosis - clinical presentation with exclusion of advanced knee osteoarthritis. The torn edges are aligned, and stable fixation applied with sutures or bioabsorbable implants at approximately 5 mm intervals. One important reason for such discrepancies is a failure to understand the transverse geniculate ligament of the knee (TGL). Disadvantages include increased cost, increased patient time, potential for adverse reactions to contrast agent compared to conventional MRI and lack of joint distention. {"url":"/signup-modal-props.json?lang=us"}, Weerakkody Y, Baba Y, Knipe H, et al. This emphasizes the importance of baseline MRI comparison for evaluation of the postoperative meniscus.3. acromioclavicular, sternoclavicular, and temporomandibular joints. 4. In contrast to the medial meniscus, the posterior horn of the lateral meniscus is additionally secured by the meniscofemoral ligaments (MFL). ISAKOS: 2023 Congress in Boston, USA : Abstract Analysis of Risk Sagittal T2-weighted (16A), fat-suppressed proton density-weighted sagittal (16B) and coronal (16C, D) images demonstrate findings of a posterior root transtibial pullout repair with visualization of the tibial tunnel (arrow), susceptibility artifact caused by the endobutton (asterisk) and fraying of the posterior root (arrowhead) but no tear. Both horns of the medial meniscus are triangular with sharp points. 2013;106(1):91-115. Evaluation of postoperative menisci with MR arthrography and routine conventional MRI. Stay up to date with the latest in Practical Medical Imaging and Management with Applied Radiology. Lee, J.W. These features constitute O'Donoghue unhappy triad. We will review the common meniscal variants, which A Meniscus tears are either degenerative or acute. Monllau J, Gonzalez G, Puig L, Caceres E. Bilateral hypoplasia of the medial meniscus. When it involves the posterior root, medial root tears are easier to diagnose than lateral root tears. Discoid lateral meniscus and the frequency of meniscal tears. These findings are also frequently associated with genu Samoto N, Kozuma M, Tokuhisa T, Kobayashi K. Diagnosis of discoid lateral meniscus of the knee on MR imaging. Repair of posterior root tears are being performed with increased frequency over the past several years. 2006; 88:660667, Boutin RD, Fritz RC, Marder RA. Arthrofibrosis and synovitis are also relatively common. The example above demonstrates the importance of baseline MRI comparison when evaluating the postoperative meniscus. Generally, For DSR inquiries or complaints, please reach out to Wes Vaux, Data Privacy Officer, Radiology. reported.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. 1. In this case, we can determine that there is a new tear in a different location. Type 1: A complete slab of meniscal tissue with complete tibial coverage. 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. They divide the meniscus into superior and inferior halves (Fig. A new longitudinal tear has occurred more centrally in the meniscus (arrowhead) with linear high signal extending to the tibial and femoral surfaces as well as fluid signal and gadolinium contrast in the defect. A displaced longitudinal tear is a "bucket handle" tear. with mechanical features of clicking and locking. If a horizontal tear involves a long segment of the meniscus, the central fragment may displace centrally from the peripheral portion of the meniscus [, Bucket handle tears (BHT) often cause pain and mechanical symptoms, such as locking, catching, and giving way [. 3. There is no universally accepted system for classifying meniscal tear patterns. 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. > 20% ratio of meniscus to tibia on the coronal image; Minimum diameter 14-15 mm on a midcoronal image; 75% 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. Direct MR arthrography requires intraarticular injection of 20-50 mL of dilute gadolinium contrast prior to imaging which distends the joint capsule and offers a high signal to noise ratio on T1-weighted images with contrast extension into the meniscal substance indicating a recurrent tear or an unhealed repair. Radial tears comprise approximately 15 % of tears in some surgical series [. discoid lateral meniscus is a relatively uncommon developmental variant Youderian A, Chmell S, Stull MA. mobility, and a giving-way sensation.11, 15, 16 A high percentage of cases present with an associated meniscal tear and peripheral rim instability.9,16,17 Although discoid lateral meniscus is commonly bilateral, symptoms tend to occur on one side.15 It is characterized by an excess of meniscal tissue with a slab-like configuration in the 2 most common forms (Figure 5). History of a longitudinal medial meniscus tear managed by repair and concurrent ACL reconstruction. The most common Anterior horn of the lateral meniscus: another potential - PubMed MRI: When you tear your meniscus, a magnetic resonance imaging (MRI) scan will show the injury as white lines on black. Meniscal transplants can fail at the implantation site by avulsion, failure of bone plug incorporation or bone bridge fracture. to tear. Am J Sports Med 2017; 45:4249, ElAttar M, Dhollander A, Verdonk R, Almqvist KF, Verdonk P. Twenty six years of meniscal allograft transplantation: is it still experimental? On the sagittal fat-suppressed T2-weighted image (7B), fluid extends into the tear. Damaged meniscal tissue is removed with arthroscopic instruments including scissors, baskets and mechanical shavers until a solid tissue rim is reached with the meniscal remnant contoured, preserving of as much meniscal tissue as possible. Comparison of Postoperative Antibiotic Regimens for Complex Appendicitis: Is Two Days as Good as Five Days? Brody J, Lin H, Hulstyn M, Tung G. Lateral Meniscus Root Tear and Meniscus Extrusion with Anterior Cruciate Ligament Tear. Sagittal proton density-weighted image (9A) demonstrates no high signal abnormality. Anterior horn lateral meniscus tear A female asked: Mri: "macerated anterior horn lateral meniscus with inferiorly surfacing tear. Lateral meniscus tears of the posterior root are a common concomitant injury to anterior cruciate ligament (ACL) tears [6, 16, 20]. congenital anomalies affect the lateral meniscus, most commonly a This scan showed a radial MMT. What is a Grade 3 meniscus tear? 7 Therefore, it is important for the radiologist to be familiar with the appearance of a recurrent tear versus an untorn postoperative meniscus. Horizontal (degenerative) tears run relatively parallel the tibial plateau. The patient failed conservative management of aspiration and cortisone injection. The most commonly practiced Shepard et al conclude that with a 74% false-positive rate, anterior horn tears should be treated surgically only if clinical correlation exists. The Postoperative Meniscus - Radsource Papalia R, Vasta S, Franceschi F, D'Adamio S, Maffulli N, Denaro V. Meniscal Root Tears: From Basic Science to Ultimate Surgery. There was no history of a specific knee injury. Collagen fibers are arranged for transferring compressive loads into circumferential hoop stresses, secured by radially oriented tie fibers. for the ratio of the sum of the width of the anterior and posterior Get unlimited access to our full publication and article library. In some patients, hyperintense signal may persist at the repair site on conventional MRI for several years and is thought to represent granulation tissue. Become a Gold Supporter and see no third-party ads. 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. Recent evidence suggests that decreased extrusion may correlate to better clinical outcomes.18. 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. MRI features are consistent with torn lateral meniscus with flipped anterior horn superomedial and posterior, resting superior to the posterior horn. ligament and meniscal fascicles. Most patients are asymptomatic, but injury to the meniscus can