MR imaging is useful for evaluation of many possible complications following meniscal surgery. Zonal variation is also seen in the density of meniscus cells and their phenotypes with a chondrocytic inner zone and fibroblastic outer zone. The menisci are C-shaped fibrocartilaginous structures composed of radial and circumferential collagen fibers that have several roles, including joint stabilization, load distribution, articular cartilage protection and joint lubrication. signal fluid cleft interposed between the posterior horn and the capsule In this case, having the prior MRI exam is useful for showing the location of the initial tear and the new tear in a different location. is affected. In contrast to the medial meniscus, the posterior horn of the lateral meniscus is additionally secured by the meniscofemoral ligaments (MFL). The posterior cruciate ligament is intact. Illustration of the medial and lateral menisci. Meniscal tears were found on MRI or arthroscopy in all 28 patients with a lateral cyst overlying the body or posterior horn of the lateral meniscus, whereas a tear was found on MRI or arthroscopy in only 14 (64%) of 22 patients with cysts adjacent to or extending to the lateral meniscus anterior horn (p = 0.006). However, the tear changes plane of orientation over its course. In this case, we can determine that there is a new tear in a different location. Br Med Bull. 2012;20(10):2098-103. the medial meniscus. Total meniscectomy is rarely performed unless the meniscus is so severely damaged that no salvageable meniscal tissue remains. A tear of the meniscal root means the tear is near where it attaches to the bone, usually far in the back. Unable to process the form. Kocher MS, Klingele K, Rassman SO. The Wrisberg variant may present with a In children, sometimes an increased signal is seen within meniscus due to increased vascularity, but usually the signal does not contact articular surface. It is usually seen near the lateral meniscus central attachment site. Thompson WO, Thaete FL, Fu FH, Dye SF. This case is almost identical to the previous case with a different clinical history. 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. Also, the inferior patella plica inserts on the AJR American journal of roentgenology. Meniscal root tears are a form of radial tear that involves the central attachment of the meniscus (12a). Torn lateral meniscus with superomedial and posterior flipped anterior horn. Am J Sports Med 2010; 38:15421548, LaPrade RF, Matheny LM, Moulton SG, James EW, Dean CS. Interested in Group Sales? gestation, about the time when the knee joint is fully formed.1 Throughout fetal development, they found that the size of the lateral meniscus is highly variable, unlike the medial meniscus. Similarly, the postoperative meniscus is at increased risk for a recurrent tear either at the same or different location due redistribution of forces and increased stress on the articular surface. 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. However, the use of MRI arthrography should be considered for post-operative menisci with equivocal findings on conventional MRI as the presence of high gadolinium-like signal within the meniscus would allow for a definitive diagnosis of re-tear. 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 . Objective Parameniscal cysts have a very high association with meniscal tears in all locations except the anterior horn lateral meniscus (AHLM). The MRI also demonstrated moderate degenerative spurring at the lateral joint compartment, a large knee joint effusion with . The remaining 42 cases were located in the red zone (19 cases) or the red-white zone. At 1 year, 5 of 6 were completely asymptomatic with the remaining patient minimally painful with no suggestion of meniscal symptoms. For DSR inquiries or complaints, please reach out to Wes Vaux, Data Privacy Officer, discoid lateral meniscus is a relatively uncommon developmental variant The posterior root of the medial meniscus attaches to the tibia, just anterior and medial to the posterior cruciate ligament (PCL). However, many clinicians opt to use conventional MRI as the initial postoperative imaging study and reserve MR arthrography for equivocal cases. 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. insertion of the medial meniscus (AIMM) has been described, and it is What are the findings? horns to the meniscal diameter on a sagittal slice that shows a maximum Examination of the knee showed a mild effusion, 1+ Lachman, positive Pivot shift, and mild tenderness to both medial and lateral joint lines. What causes abnormal mobility in the medial meniscus? Root tears are associated with a high risk for osteoarthritis. CT arthrography may be used to evaluate the postoperative meniscus when MRI is contraindicated. On this page: Article: Epidemiology Pathology Radiographic features History and etymology After preparing the recipient knee by creating a matching keyhole trough in the tibia, the surgeon slides the allograft bone plug into its matching tibial slot and sutures the periphery of the allograft meniscus to the capsule. The superior, middle and inferior geniculate arteries are the main vascular supply to the menisci. Twenty-one had ACL tears; all those with an PHLM tear had an ACL tear. 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 (1A) Proton density-weighted, (1B) T2-weighted, and (1C) fat-suppressed T1-weighted MR arthrographic sagittal images are provided. problem in practice. In the previously reported cases, as well as in this case, the These include looking for a American Board of Orthopaedic Surgery Practice of the Orthopaedic Surgeon: Part-II, certification examination case mix. Presentation - Middle-older aged individuals, non-traumatic, progressive onset of pain. 300). Illustration of the transtibial pullout repair for a tear of the posterior horn medial meniscal root (arrow). For root tears in general, sagittal imaging may demonstrate a meniscal ghost sign. as at no time in development does the meniscus have a discoid Become a Gold Supporter and see no third-party ads. 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. Biologic augmentation with application of exogenous fibrin clot or growth factors may be combined with the repair to promote healing. may simulate a peripheral tear (Figure 6).23 The only Arthroscopy for Medial Meniscus Tears The decision to repair or remove the torn portion is made at the time of surgery. Meniscal disorders: Normal, discoid, and cysts. 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 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. They were first described by M J Pagnaniet al. . Healed peripheral medial meniscus posterior horn repair and new longitudinal tear in a different location. diagnostic dilemma, as the AIMM band will be seen to extend to the 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. In some patients, hyperintense signal may persist at the repair site on conventional MRI for several years and is thought to represent granulation tissue. Kim EY, Choi SH, Ahn JH, Kwon JW. Radial Meniscal Tear: Pearls May be degenerative or traumatic, vertical, millimeters in size, on the inner edge of the lateral meniscus more commonly than the medial meniscus runs from the anterior horn of the medial meniscus to either the ACL or 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. 3: The Wrisberg variant, where the meniscus may have a normal 9 The lateral meniscus is more loosely attached than the medial and can translate approximately 11mm with normal knee motion. Kaplan EB. Variations in meniscofemoral ligaments at anatomical study and MR imaging. The example above illustrates marked degenerative changes caused by loss of meniscal function. tear. Shepard et al conclude that with a 74% false-positive rate, anterior horn tears should be treated surgically only if clinical correlation exists. 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 Neuschwander DC, Drez D Jr, Finney TP. described in thrombocytopenia absent radius syndrome (TAR syndrome).2,3 Bilateral hypoplasia of the medial meniscus has also been reported.4. Note the symmetrical shape of the lateral meniscus (left) with similar size of the anterior and posterior horns. The most important clinical concern at the time of MRI imaging is often high-grade articular cartilage loss. The MRI revealed a vertical flap (oblique) tear of the medial meniscus. the posterior horn is usually much larger than the anterior horn (the Cho JM, Suh JS, Na JB, et al. On MRI, they exhibit abnormal horizontal linear signal contacting the inferior articular surface near the free edge or less commonly the superior surface. Exam showed a mild effusion and medial joint line tenderness. Mechanical rasping or trephination of the torn meniscus ends and parameniscal synovium is used to promote bleeding and vascular healing. 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. 2013;106(1):91-115. treatment for stable complete or incomplete types of discoid lateral A Because this is a relatively new procedure, few studies have been dedicated to MRI evaluation of postoperative root repair. 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 Their conclusion that one should not perform surgery unless clinical correlation exists with effusions, mechanical catching or locking, or the failure to respond to nonoperative measures I believe is a good recommendation that we can all follow. An athletic 52-year-old male, who was an avid runner all his adult life, presented with medial pain and a popping sensation in knee. Normal Lateral meniscus bucket handle tears can produce the double anterior horn sign or double ACL sign. Tachibana Y, Yamazaki Y, Ninomiya S. Discoid medial meniscus. Meniscal root tears are defined as radial tears located within 1 cm from the meniscal attachment or a bony rootavulsion. of the Wrisberg ligament in patients with a complete lateral discoid 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. Complex or deep radial tears were found in three of five cases of lateral meniscus extrusion and normal root. pretzels dipped in sour cream. Fat suppressed sagittal T1-weighted MR arthrogram (5C) demonstrates gadolinium within the tear (arrow). typically into the anterior cruciate ligament. Bilateral hypoplasia of the medial meniscus has also been AJR Am J Roentgenol 211(3):519527, De Smet AA. (Tr. Klingele KE, Kocher MS, Hresko MT, et al. The most widely used diagnostic modalities to assess the ligament injuries are arthroscopy and Magnetic Resonance Imaging (MRI). Because there is less pressure on the meniscus there, it is difficult to evaluate the anterior region of the meniscus. (PubMed: 17114506), BakerJC, FriedmanMV, RubinDA (2018) Imaging the postoperative knee meniscus: an evidence-based review. 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. Partial meniscectomy is by far the most common procedure. How I Diagnose Meniscal Tears on Knee MRI. The most common Intact meniscal roots. This patient had relief after the initial repair surgery, then had a second injury with recurrent symptoms, which is why the surgeon felt this was a recurrent tear. Tears 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. He presented after a few months with symptoms of instability. For information on new subscriptions, product Following partial meniscectomy, the knee is at increased risk for osteoarthritis. You can use Radiopaedia cases in a variety of ways to help you learn and teach. Brody J, Lin H, Hulstyn M, Tung G. Lateral Meniscus Root Tear and Meniscus Extrusion with Anterior Cruciate Ligament Tear. Is sport activity possible after arthroscopic meniscal allograft transplantation?

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