meniscus | Search | Radiopaedia.org (1A) Proton density-weighted, (1B) T2-weighted, and (1C) fat-suppressed T1-weighted MR arthrographic sagittal images are provided. Anterior tibial marrow edema and organized trabecular fracture measuring 16 mm AP, 18 mm transverse. With age, increased connective tissue stiffness of the meniscus develops secondary to elastin degradation and collagen rigidification.2. It splits into two bands at the PCL, named Humphry(anterior to the PCL) and Wrisberg (posterior to the PCL). History of medial meniscus posterior horn partial meniscectomy. Renew or update your current subscription to Applied Radiology. MRI features are consistent with torn lateral meniscus with flipped anterior horn superomedial and posterior, resting superior to the posterior horn. PDF ssslideshare.com Congenital absence of the meniscus is extremely rare and has been documented in TAR syndrome and in isolated case reports.2,3 In these cases, MR arthrography may provide additional diagnostic utility. Analytical, Diagnostic and Therapeutic Techniques and Equipment 13. Sagittal PD (. O'Donoghue unhappy triad | Radiology Case | Radiopaedia.org show cupping of the medial tibial plateau, proximal medial tibial physis Stein T, Mehling AP, Welsch F, von EisenhartRothe R, Jger A. Surgery Needed?? : r/MeniscusInjuries 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. 9 The lateral meniscus is more loosely attached than the medial and can translate approximately 11mm with normal knee motion. The MRI also demonstrated moderate degenerative spurring at the lateral joint compartment, a large knee joint effusion with . continued knee pain after meniscus surgery 3 is least common. The trusted source for healthcare information and CONTINUING EDUCATION. Sagittal proton density-weighted image (9A) demonstrates no high signal abnormality. Among these 26 studies of an LMRT . Sagittal proton density-weighted (14A) and coronal T1-weighted (14B) images reveal a recurrent bucket-handle tear through the original repair site with typical findings of a displaced meniscal flap (arrow) into the intercondylar notch. 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. for the ratio of the sum of the width of the anterior and posterior The lateral meniscus is more circular, and its anterior and posterior horns are nearly equivalent in size in cross section. Discoid lateral meniscus: Prevalence of peripheral rim instability. However, many clinicians opt to use conventional MRI as the initial postoperative imaging study and reserve MR arthrography for equivocal cases. It is believed that discoid (PubMed: 17114506), BakerJC, FriedmanMV, RubinDA (2018) Imaging the postoperative knee meniscus: an evidence-based review. Anterior horn of the lateral meniscus: another potential - PubMed Dickhaut SC, DeLee JC. Again, this emphasizes the importance of accurate history, prior imaging and operative reports. This mesenchymal immediatly lateral to the anterior horn of lateral meniscus and posterior to the tubercle of anteriro horn of medial meniscus . This article focuses on the rare ring-shaped meniscus, to the classification. These include looking for a (as previously described), meniscal cyst,26 discoid lateral meniscus in the same knee (Figure 9),25 and pathologic medial patella plica.27. measurements of the posterior horn of the medial meniscus may vary, but During an arthroscopy, we have the choice of either repairing the meniscus tear or removing the torn piece. Association of Parameniscal Cysts With Underlying Meniscal Tears as 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 Acute partial interstitial to near complete anterior cruciate ligament tear is noted at its posterior end with femoral deep lateral sulcus sign. They were first described by M J Pagnaniet al. This arises from the posterior horn of the lateral meniscus and attaches to the lateral aspect of the medial femoral condyle. acromioclavicular, sternoclavicular, and temporomandibular joints. {"url":"/signup-modal-props.json?lang=us"}, El-Feky M, Flipped meniscus - anterior horn lateral meniscus. 2005; 234:5361. The medial meniscus covers 60% of the medial compartment. Thirty-one of these patients underwent subsequent arthroscopic evaluation to allow clinical correlation. Studies on meniscus root tears have investigated the relationship of osteoarthritis and an anterior cruciate ligament tear. MRI plays a critical role in influencing the treatment decision and enables information that would obviate unnecessary surgery including diagnostic arthroscopy. Radiographs are usually not diagnostic, but they may show a Most horizontal tears extend to the inferior articular surface. 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. Radial tears comprise approximately 15 % of tears in some surgical series [. discoid lateral meniscus is a relatively uncommon developmental variant It is important to know the age of the patient when interpreting the MRI. Tear between 1-4 cm vertical tear red-red meniscal root <40 yo Maybe concominant ACL surgery . Anterior lateral cysts extended . 6. the menisci of the knees. 7 Therefore, it is important for the radiologist to be familiar with the appearance of a recurrent tear versus an untorn postoperative meniscus. The anomalous insertion The symptoms 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. Twenty-one had ACL tears; all those with an PHLM tear had an ACL tear. . 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. Heron, D, Bonnard C, Moraine C,Toutain A. Agenesis of cruciate from AIMM. Kijowski et al. Anterior horn of the lateral meniscus: another potential pitfall in MR treatment for stable complete or incomplete types of discoid lateral Type 1 is most common, and type Flipped meniscus - anterior horn lateral meniscus | Radiology Case (PDF) Sensitivity and Specificity of MRI in Diagnosing Concomitant At surgery, the torn part of the meniscus was in the intercondylar notch and chewed up and not amenable to repair. The meniscal body is firmly attached to the deep portion of the medial collateral ligament complex via the meniscotibial ligament. ligament will help to exclude these conditions.5 In the first Meniscal transplants can fail at the implantation site by avulsion, failure of bone plug incorporation or bone bridge fracture. in 19916. Is sport activity possible after arthroscopic meniscal allograft transplantation? variant, and discoid medial meniscus. Meniscal tears are common and often associated with knee pain. The camera can visualize the meniscus and other structures within the knee. Become a Gold Supporter and see no third-party ads. The superior, middle and inferior geniculate arteries are the main vascular supply to the menisci. 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. this may extend to to the mid body." is this a bucket tear? 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. Meniscal root tears are defined as radial tears located within 1 cm from the meniscal attachment or a bony rootavulsion. Menisci are present in the knees and the Normal menisci. In the above case there is no gross chondral defect although the articular cartilage is noticeably thinner compared to the baseline study despite the patients young age. 36 year old male with history of meniscus surgery 7 years ago. Resnick D, Goergen TG, Kaye JJ, et al. patella or Hoffas fat pad, and should be fairly easily differentiated runs from the anterior horn of the medial meniscus to either the ACL or both enjoyable and insightful. Following partial meniscectomy, the knee is at increased risk for osteoarthritis. They are usually due to an acute injury [. 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. The most widely used diagnostic modalities to assess the ligament injuries are arthroscopy and Magnetic Resonance Imaging (MRI). 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. the intercondylar notch, most commonly to the mid ACL, and less commonly On MRI, they resemble radial tears, with a linear cleft of abnormal signal seen at the free edge. 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. morphology. 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 Objectives: Low-field MRI at 0.55 Tesla (T) with deep learning image reconstruction has recently become commercially available. Both ligaments attach distally to the posterior horn of the lateral meniscus and contribute to posterior drawer stability . 2059-2066, Kinsella S.D., and Carey J.L. Kijowski et al. 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"}. Mechanical rasping or trephination of the torn meniscus ends and parameniscal synovium is used to promote bleeding and vascular healing. They often tend to be radial tears extending into the meniscal root. 1 ). Otherwise, the increased vascularity in children has sometimes led to false-positive reading of a meniscus tear. Radiographic knee dimensions in discoid lateral meniscus: Comparison with normal control. Shepard and colleagues at UCLA specifically analyzed this by reviewing 947 consecutive MRIs. An algorithm for computing tear meniscus profile 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. Anatomic variability and increased signal change in this area are commonly mistaken for tears. No paralabral cyst. menisci (Figure 8). The most common location is the anterior horn-body junction of the lateral meniscus and less commonly in the mid posterior horn or root of the medial meniscus. 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. Biologic augmentation with application of exogenous fibrin clot or growth factors may be combined with the repair to promote healing. 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. Evaluation of postoperative menisci with MR arthrography and routine conventional MRI. On imaging alone, the radiologist may not be able to distinguish a residual tear (failed repair) from a recurrent tear in the same location. noted to be diminutive, with the posterior horn measuring 7 mm to 8 mm. For information on new subscriptions, product of the AIMM into the ACL is classified as Type 1 (inferior third), Type 2 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. We will review the common meniscal variants, which 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 [. Illustration of the transtibial pullout repair for a tear of the posterior horn medial meniscal root (arrow). My own experience has been similar and I make it a policy not to recommend surgery based on this diagnosis alone without good clinical correlation. Meniscal Tear Patterns - Radsource AJR Am J Roentgenol. congenital anomalies affect the lateral meniscus, most commonly a There Recent evidence suggests that decreased extrusion may correlate to better clinical outcomes.18. Bilateral Hypoplasia of the Medial and Lateral Menisci - PMC Horizontal (degenerative) tears run relatively parallel the tibial plateau. medial meniscus are extremely uncommon and should not be a diagnostic Each meniscus has three main parts, the back (posterior horn), middle (body), and front (anterior horn). Note the symmetrical shape of the lateral meniscus (left) with similar size of the anterior and posterior horns. These features constitute O'Donoghue unhappy triad. Following a meniscal repair procedure, the meniscus can be categorized as healed if there is no fluid signal in the repair, partially healed if fluid signal extends into less than 50% of the repair site, or not healed if fluid signal extends into greater than 50% of the repair site. Diagnosis of meniscal tears on MRI improves when these guidelines are followed to optimize signal-to-noise ratio: high-field-strength magnets are preferable (1.5 T and stronger); a high-resolution surface coil should be used; the field of view should only encompass the necessary structures and routinely be 16 cm or less; image slices should not be too thick (34 mm); and the matrix size should be at least 256192 or higher [, A normal meniscus is low signal on all sequences. As a result, the accuracy rate of diagnosis by MRI is 83.3%. A tear of the meniscal root means the tear is near where it attaches to the bone, usually far in the back. insertion of the medial meniscus (AIMM) has been described, and it is 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. The Wrisberg variant may present with a 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. One important reason for such discrepancies is a failure to understand the transverse geniculate ligament of the knee (TGL). Special thanks to David Rubin, MD for providing several cases used in this web clinic. The articular cartilage is well seen on the pre-operative sagittal proton density-weighted image (19B). The most frequent symptom is pain that usually begins with a minor Report 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. Partial meniscectomy is by far the most common procedure. Meniscus tears are either degenerative or acute. Meniscal root tears are a form of radial tear that involves the central attachment of the meniscus (12a). A 510, 210-pound 16-year-old male injured his left knee while kicking a football. A There was no evidence of meniscal extrusion or a meniscal ghost sign (Fig. Tears of the anterior horn of the medial meniscus, an inferior patella plica, The purpose of our study was to determine if cysts of the ACL are the origin of cysts adjacent to the AHLM. 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). A characteristic MRI finding to diagnose a partial tear of the medial Conventional MRI imaging correlates well with arthroscopic evaluation of the transplants for tears of the posterior and middle thirds of the meniscus allograft with a high sensitivity, specificity and accuracy, but results were poor for evaluation of the anterior third with a low specificity and accuracy.16 Allograft shrinkage and meniscus extrusion are common findings on postoperative MRI but do not always correlate with patient pain and function.

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