1 ). Menisci are present in the knees and the This emphasizes the importance of meniscal repair over meniscectomy when possible and the need for meniscal preservation when a partial meniscectomy is necessary. 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 meniscal body is firmly attached to the deep portion of the medial collateral ligament complex via the meniscotibial ligament. published a case series of anterior horn tears of the lateral meniscus in 14 soccer players (mean age 20.2 years). Because there is less pressure on the meniscus there, it is difficult to evaluate the anterior region of the meniscus. Both the healed peripheral tear and the new central tear were proved at second look arthroscopy. AJR American journal of roentgenology. Lateral meniscus tears of the posterior root are a common concomitant injury to anterior cruciate ligament (ACL) tears [6, 16, 20]. Resnick D, Goergen TG, Kaye JJ, et al. There are Clinical History: An 18 year-old male with a history of a posterior horn medial meniscus peripheral longitudinal tear treated with meniscal repair at age 16 presents for MR imaging. Pagnani M, Cooper D, Warren R. Extrusion of the Medial Meniscus. 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 . The meniscus is two crescent-shaped, thick pieces of cartilage that sit in the knee between the tibia and the femur. 4. RESULTS. pivoting). congenital absence of the cruciate ligaments. bilaterally absent menisci reported by Tolo et al,3 the was saddle shaped. Symptomatic anomalous insertion of the medial meniscus. The examiner can test the entire posterior horn up to the middle segment of the meniscus using the IR of the tibia followed by an extension. snapping knee due to hypermobility. occur with minor trauma. This injury is biomechanically comparable to a total meniscectomy, leading to compromised hoop stressesresulting in decreased tibiofemoral contact area and increased contact pressures in the involved compartment.These changes are detrimental to the articular cartilage and . partly divides a joint cavity, unlike articular discs, which completely Extrusion is commonly seen following root repair. This emphasizes the importance of baseline MRI comparison for evaluation of the postoperative meniscus.3. to tear. congenital anomalies affect the lateral meniscus, most commonly a In 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. On MRI, they exhibit abnormal horizontal linear signal contacting the inferior articular surface near the free edge or less commonly the superior surface. Thirty-one of these patients underwent subsequent arthroscopic evaluation to allow clinical correlation. They often tend to be radial tears extending into the meniscal root. Studies on meniscus root tears have investigated the relationship of osteoarthritis and an anterior cruciate ligament tear. treatment for stable complete or incomplete types of discoid lateral ligament, and the posterior horn may translate or rotate due to The meniscal repair is intact. Intensity of signal contacting meniscal surface in recurrent tears on MR arthrography compared with that of contrast material. A recurrent tear was proved at second look arthroscopy. rim circumferentially, anteriorly, and posteriorly,19 which Magnetic resonance imaging (MRI) is the most accurate imaging technique in the diagnosis of meniscal lesions and represents a standard tool in knee evaluation. The aim of this study was to evaluate diagnostic values involved in conventional magnetic resonance imaging (MRI) features of MM posterior root tears (MMPRTs) and find other MRI-based findings in patients with partial MMPRTs. If a meniscus tear shows up on a MRI, it is considered a Grade 3. It affects 4% to 5% of the patient population,6-9 with a much higher incidence, up to 13%, in the Asian patient population.10 It is the most common meniscal variant in children.11 : Complications in brief: arthroscopic partial meniscectomy. Case study, Radiopaedia.org (Accessed on 04 Mar 2023) https://doi.org/10.53347/rID-75066. Davidson D, Letts M, Glasgow R. Discoid meniscus in children: Treatment and outcome. Anomalous Magnetic resonance imaging of the postoperative meniscus: resection, repair, and replacement. Congenital discoid cartilage. 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. They maintain a relatively constant distance from the periphery of the meniscus [. 2006; 187:W565568. The MRI sign of a radial tear is a linear, vertical cleft of abnormal high signal at the free edge (Fig. It is often explained by fibers of the anterior cruciate ligament and the covering synovium . show cupping of the medial tibial plateau, proximal medial tibial physis Problems encountered in a discoid medial meniscus are the same as a asymptomatic, although there is a greater propensity for discoid menisci On sagittal proton-density and T2-weighted images, this lesion was demonstrated by sensitive but nonspecific signs, such as the flipped meniscus . As a result, the accuracy rate of diagnosis by MRI is 83.3%. 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. There are 3 main types, according to the Watanabe classification:18. 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. does not normally occur.13. The anterior horn inserts on the tibia and continues laterally to the anterior horn of the lateral meniscus via the transverse intermeniscal ligament. Kelly BT, Green DW. Tear between 1-4 cm vertical tear red-red meniscal root <40 yo Maybe concominant ACL surgery . 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. Proper preoperative sizing of the allograft is critical for surgical success and usually performed with radiographs. 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. 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. Check for errors and try again. Development of the menisci of the human knee They found that 76 (8%) of these indicated a tear of the anterior horn of either the medial or lateral meniscus. an adult), and approximately twice the size of the anterior horn on Special thanks to David Rubin, MD for providing several cases used in this web clinic. The torn edges are aligned, and stable fixation applied with sutures or bioabsorbable implants at approximately 5 mm intervals. While they can arise from a number of mechanisms, root tears are generally thought to be chronic 5. Knee Surg Sports Traumatol Arthrosc 2011; 19:147157, Gwathmey F.W., Golish S.R., Diduch D.R., et al: Complications in brief: meniscus repair. Connolly B, Babyn PS, Wright JG, Thorner PS. morphology but lacks its posterior attachments; ie, the meniscotibial Anatomic variability and increased signal change in this area are commonly mistaken for tears. CT arthrography may be used to evaluate the postoperative meniscus when MRI is contraindicated. History of a longitudinal medial meniscus tear managed by repair and concurrent ACL reconstruction. You have reached your article limit for the month. The patient failed conservative management of aspiration and cortisone injection. They may not even be apparent with an arthroscopic examination. 5 In the first instance, tears of the lateral aspect of the anterior horn of the medial meniscus are extremely uncommon and should not be a diagnostic ligaments are absent, most commonly the anterior cruciate ligament (ACL) A 510, 210-pound 16-year-old male injured his left knee while kicking a football. Am J Sports Med 2016; 44:625632, De Smet AA, Horak DM, Davis KW, Choi JJ. The medial meniscus is more tightly anchored than the lateral meniscus, allowing for approximately 5mm of anterior-posterior translation. 17. 36 year old male with history of meniscus surgery 7 years ago. They divide the meniscus into superior and inferior halves (Fig. The ends of the anterior and posterior horns are firmly attached to the tibia at their roots. AJR Am J Roentgenol 2009;193:515-523. We look forward to having you as a long-term member of the Relias and ACL tears can be mistaken for AIMM, but carefully tracing the typically into the anterior cruciate ligament. What are the findings? 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. Anterior tibial marrow edema and organized trabecular fracture measuring 16 mm AP, 18 mm transverse. Grade II hyperintense horizontal signal of posterior horn of medial meniscus is noted. 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. Menisci ensure normal function of the You can use Radiopaedia cases in a variety of ways to help you learn and teach. noted to be diminutive, with the posterior horn measuring 7 mm to 8 mm. during movement, and less commonly joint-line tenderness, reduced The patient underwent a successful partial medial meniscectomy and was encouraged to seek low-impact exercise. Vertical flap (oblique, flap, parrots beak) tears are unstable tears and occur in younger patients. At surgery, the torn part of the meniscus was in the intercondylar notch and chewed up and not amenable to repair. 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. Normal 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? The remaining 42 cases were located in the red zone (19 cases) or the red-white zone. 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. Illustration of the transtibial pullout repair for a tear of the posterior horn medial meniscal root (arrow). 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. (as previously described), meniscal cyst,26 discoid lateral meniscus in the same knee (Figure 9),25 and pathologic medial patella plica.27. joint, and they also protect the hyaline cartilage. The patient subsequently underwent successful partial medial meniscectomy. Repair devices including arrows, darts and sutures are used to approximate the torn edges of the meniscus. MR criteria are used to make the diagnosis. 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.
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