(Figure 1). And, some tears do not fill with contrast during arthrography. Posteroinferior displacement of the meniscal tissue (arrowheads) is also diagnostic of recurrent tear. 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. Arthroscopy evaluation found a lateral meniscus peripheral (red-white zone) longitudinal tear. Br Med Bull. Thirty-one of these patients underwent subsequent arthroscopic evaluation to allow clinical correlation. Pathology - a tear that has developed gradually in the meniscus. Weight-bearing knee X-rays showed a 50 % narrowing in the medial compartment. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. At 1 year, 5 of 6 were completely asymptomatic with the remaining patient minimally painful with no suggestion of meniscal symptoms. This case is almost identical to the previous case with a different clinical history. Horizontal (degenerative) tears run relatively parallel the tibial plateau. structure on sagittal images on T1, proton density, and fat-saturated . While they can arise from a number of mechanisms, root tears are generally thought to be chronic 5. The patient subsequently underwent successful partial medial meniscectomy. Discoid medial menisci are much less common than discoid lateral menisci,24 and they may be bilateral. Indications for meniscal repair typically include posttraumatic peripheral (red zone) longitudinal tears located near the joint capsule, ideally in younger patients (less than 40). 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 Unable to process the form. However, few studies have directly compared the medial and lateral root tears. An intact meniscal repair was confirmed at second look arthroscopy. The post arthrogram view (13B) reveals gadolinium within the repair site. frequently. 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). The MRI revealed a longitudinal tear in the posterior horn of the lateral meniscus. Among these 26 studies of an LMRT . Forty-five of the remaining patients did not undergo surgery but did undergo clinical follow-up and interview at a minimum of 1 year after the MRI to determine if they had any residual symptoms or if they received further medical treatment. Evaluation of postoperative menisci with MR arthrography and routine conventional MRI. Discoid lateral meniscus was originally believed to result from an The Wrisberg variant may present with a Torn lateral meniscus with superomedial and posterior flipped anterior horn. Magnetic Resonance Imaging Arthroscopy Orthodontic Extrusion Anterior Cruciate Ligament Reconstruction Arthroscopes Suture Anchors Tissue Culture Techniques Tissue Engineering Injections, Intra-Articular Range of Motion, Articular Arthrography Hardness Tests Orthopedic Procedures MR imaging is useful for evaluation of many possible complications following meniscal surgery. 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 [. In Their 74% false-positive rate I believe is accurate and one that we can incorporate mentally into our practice as we evaluate patients and the MRI scan results. 5. trials, alternative billing arrangements or group and site discounts please call Also, the inferior patella plica inserts on the A slightly overweight 44-year-old male sought evaluation for medial knee pain that persisted for months after running on the beach. 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. 10 It can be divided into five segments: anterior horn, anterior, middle and posterior segments, and posterior horn. 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. ligament, and the posterior horn may translate or rotate due to 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. Each meniscus has three main parts, the back (posterior horn), middle (body), and front (anterior horn). Synopsis: In a consecutive series of nearly 1000 knee MRIs, there was a 74% false-positive rate for the diagnosis of anterior horn meniscal tears. Close clinical correlation is advised before recommending surgery based on this finding alone. The sagittal proton density-weighted image (2A) demonstrates increased signal intensity at the periphery of the medial meniscus posterior horn (arrow) but no fluid signal on the sagittal T2-weighted image (2B) and no gadolinium extension into this area on the MR arthrogram sagittal fat-suppressed T1-weighted arthrographic image (2C) consistent with a healed repair. ADVERTISEMENT: Supporters see fewer/no ads. Sagittal PD (. It is often explained by fibers of the anterior cruciate ligament and the covering synovium . 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. AJR Am J Roentgenol. Examination showed lateral joint line tenderness and a positive McMurray sign. has shown that 41% of patients with a surgically confirmed torn post-operative meniscus had signal intensity within the meniscus extending into the articular surface which was lower than the signal intensity of gadolinium contrast.14 Like the presence of a line of intermediate T2 signal extending into the articular surface on conventional MRI, diagnosis of a torn post-operative meniscus on MRI arthrography is challenging when the intra-meniscal signal intensity is not as bright as gadolinium contrast. discoid lateral meniscus, including a propensity for tears to occur and Magnetic resonance imaging of the postoperative meniscus: resection, repair, and replacement. De Smet A. of the meniscus. He presented after a few months with symptoms of instability. Kijowski et al. Learn more. They found that 76 (8%) of these indicated a tear of the anterior horn of either the medial or lateral meniscus. Congenital absence of the meniscus is extremely rare and has been documented in TAR syndrome and in isolated case reports.2,3 This scan showed a radial MMT. 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. the rare ring-shaped meniscus, to the classification. Root tears are associated with a high risk for osteoarthritis. signal fluid cleft interposed between the posterior horn and the capsule Type 1: A complete slab of meniscal tissue with complete tibial coverage. Posterior meniscal root repairs: outcomes of an anatomic transtibial pull-out technique. Direct and indirect MR arthrography have been shown to be superior to conventional MRI for detection of recurrent meniscal tears in greater than 25% partial meniscectomies and meniscal repairs; however, conventional MRI is commonly used for initial evaluation of the postoperative meniscus with MR arthrography reserved for equivocal cases. Type 1 is most common, and type During an arthroscopy, we have the choice of either repairing the meniscus tear or removing the torn piece. 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. The lateral meniscus is more circular, and its anterior and posterior horns are nearly equivalent in size in cross section. Kaplan EB. Mechanical rasping or trephination of the torn meniscus ends and parameniscal synovium is used to promote bleeding and vascular healing. Radiology. Objective Parameniscal cysts have a very high association with meniscal tears in all locations except the anterior horn lateral meniscus (AHLM). 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. Thompson WO, Thaete FL, Fu FH, Dye SF. Meniscal transplant is usually reserved for patients younger than 50 years who have normal axial alignment. Am J Sports Med 2017; 45:884891, Zaffagnini S, Grassi A, Marcheggiani Muccioli GM, et al. The lateral meniscus attaches to the popliteus tendon and capsule via the popliteomeniscal fascicles at the posterior horn and to the medial femoral condyle by the meniscofemoral ligaments. As DLM is a congenital anomaly, the ultrastructural features and morphology differ from those of the normal meniscus, potentially leading to meniscal tears. Kijowski et al. Dr. Michael Gabor answered Diagnostic Radiology 35 years experience No,: It doesn't sound like a bucket handle tear The anterior meniscofemoral ligament (Humphrey ligament) attaches proximally on the medial femoral condyle, inferior to the PCL insertion. However, many clinicians opt to use conventional MRI as the initial postoperative imaging study and reserve MR arthrography for equivocal cases. Of the 54 participants, 5 had PHLM tears and 49 were normal. A 23-year-old female presented with a 2-month history of catching and pain in the knee when arising from a squatting position. medial meniscus, discoid lateral meniscus, including the Wrisberg small meniscus is also seen in the wrist joint. What is a Lateral Meniscus Tear? Controlling Blood Pressure During Pregnancy Could Lower Dementia Risk, Researchers Address HIV Treatment Gap Among Underserved Population, HHS Announces Reorganization of Office for Civil Rights, FDA Adopts Flu-Like Plan for an Annual COVID Vaccine. 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 Conventional MRI is useful for evaluation of posterior root morphology at the tibial tunnel fixation site, meniscal extrusion and articular cartilage. In the previously reported cases, as well as in this case, the The anterior horn of the menisci, especially the lateral meniscus, is an area commonly confused on MRI. This mesenchymal Anterior horn lateral meniscus tear A female asked: Mri: "macerated anterior horn lateral meniscus with inferiorly surfacing tear. The patient underwent a successful partial medial meniscectomy and was encouraged to seek low-impact exercise. treatment for stable complete or incomplete types of discoid lateral Tears in the red zone have the potential to heal and are more amenable to repair. 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. of the Wrisberg ligament in patients with a complete lateral discoid > 20% ratio of meniscus to tibia on the coronal image; Minimum diameter 14-15 mm on a midcoronal image; 75% Sagittal T2-weighted (18B) and fat-suppressed sagittal proton density-weighted sagittal (18C) images demonstrate fluid-like signal in the posterior horn suggestive of a recurrent tear. The sutures are tied over a cortical fixation device or Endobutton (short arrow) with the knee flexed at 90 to secure the root repair. 6. The lateral meniscus is one of two fibrocartilaginous menisci of the knee. 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 [ 8, 11, 12 ]. Both horns of the medial meniscus are triangular with sharp points. One important reason for such discrepancies is a failure to understand the transverse geniculate ligament of the knee (TGL). 2006; 187:W565568. 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. Extrusion is commonly seen following root repair. At the time the article was last revised Yahya Baba had Concise, to-the-point text covers MRI for the entire musculoskeletal system, presented in a highly templated format. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Posterior Instability and Labral Pathology, Imaging Evaluation of the Painful or Failed Shoulder Arthroplasty, Other Entities: PLRI, HO, Triceps, and Plica, MRI-Arthroscopy Correlations in the Overhead Athlete, Acetabular Fossa, Femoral Fovea, and the Ligamentum Teres. of a case of discoid medial cartilage, with an embryological note. Pain is typically medial and activity-related (e.g. Skeletal radiology. No gadolinium extension into the meniscus on fat-suppressed sagittal T1-weighted (9B) post arthrogram view. An MRI of plaintiff's left knee conducted in May 2018 demonstrated a complex 7 tear of the posterior horn of the lateral meniscus and a suspected horizontal tear of the anterior horn of the lateral meniscus. to the base of the ACL or the intercondylar notch. A tear of the lateral meniscus can occur from a sudden injury, or from chronic wear and overload. The MRI showed complete ACL tear with displaced bucket handle medial meniscus tear. The fat-suppressed sagittal T1-weighted post arthrogram view (7C) demonstrates gadolinium extending into the meniscal substance. Most horizontal tears extend to the inferior articular surface. Imaging characteristics of the The avulsed anterior horn of the lateral meniscus is flipped over and situated above the posterior horn. As such, I can count on my hands the number of isolated anterior horn meniscal tears that I have seen at surgery that I felt were symptomatic over the past 5 years. If the tear does not show, it is considered a Grade 1 or 2 and is not as serious. Meniscus tears, indicated by MRI, are classified in three grades. A tear of the anterior horn of the lateral meniscus is damage to the front part of one of the two structures that act as shock absorbers between the thigh bone and the lower leg, explains The Steadman Clinic. anterior horn of the medial meniscus into the anterior cruciate ligament The LaPrade classification systemof meniscal root tears has become commonly used in arthroscopy, and there is evidence that this system can be to some extent translated to MRI assessment of these tears ref. . 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. Sagittal proton density (PD) images through normal medial (, The medial meniscus is larger, more oblong, and normally has a larger posterior horn than anterior horn in cross section. A tear of the meniscal root means the tear is near where it attaches to the bone, usually far in the back. St. Louis County's newspaper of politics and culture Anomalous 2008;191(1):81-5. 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 rim circumferentially, anteriorly, and posteriorly,19 which 2014; 43:10571064, McCauley TR. Methods Eighteen patients who had arthroscopically confirmed partial MMPRTs were included. Clark CR, Ogden JA. By continuing to use our site, you consent to the use of cookies outlined in our Privacy Policy. The anterior root of the lateral meniscus attaches to the tibia, just lateral to the midline and posterior to fibers of the anterior cruciate ligament (ACL). There was no history of a specific knee injury. The meniscal body is firmly attached to the deep portion of the medial collateral ligament complex via the meniscotibial ligament. 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. These are like large radial tears and can destabilize a large portion of the meniscus. The symptoms Magnetic resonance imaging (MRI) revealed an elongated free edge of the diffusely enlarged lateral meniscus extending toward the intercondylar region on coronal T1-weighted images (Figure 1A). This has also been described as grade 2 signal [, Sagittal fat-suppressed T2 image of a 14-year-old patient showing a grade 2 signal in the posterior horn of the medial meniscus (PHMM). However, recognizing these variants is important, as they can diminutive (1 mm) with no increased signal to suggest root attachment : Complications in brief: arthroscopic partial meniscectomy. Sagittal proton density-weighted image (10A) demonstrates increased signal extending to the articular surface consistent with granulation tissue. These findings are also frequently associated with genu Case study, Radiopaedia.org (Accessed on 04 Mar 2023) https://doi.org/10.53347/rID-75066. The meniscus root plays an essential role in maintaining the circumferential hoop tension and preventing meniscal displacement. Lee, J.W. For partial meniscectomies involving 25% or more, conventional MRI has lower accuracy. Nakajima T, Nabeshima Y, Fujii H, et al. (middle third), or Type 3 (superior third; intercondylar notch) (Figure Fat suppressed sagittal T1-weighted MR arthrogram (5C) demonstrates gadolinium within the tear (arrow). 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). MRI appearance of Wrisberg variant of discoid lateral meniscus. Disadvantages include increased cost, increased patient time, potential for adverse reactions to contrast agent compared to conventional MRI and lack of joint distention. They maintain a relatively constant distance from the periphery of the meniscus [. This arises from the posterior horn of the lateral meniscus and attaches to the lateral aspect of the medial femoral condyle. A Wrisberg type variant has not been documented in The lateral meniscus is more circular, and its anterior and posterior horns are nearly equivalent in size in cross section. The torn edges are aligned, and stable fixation applied with sutures or bioabsorbable implants at approximately 5 mm intervals. The incidence was calculated based on arthroscopic findings, and the potential secondary signs of meniscal ramp tears were evaluated on MRI. The articular cartilage is well seen on the pre-operative sagittal proton density-weighted image (19B). discoid meniscus, although discoid medial menisci can occur much less Am J Sports Med 2010; 38:15421548, LaPrade RF, Matheny LM, Moulton SG, James EW, Dean CS. A meta-analysis of 44 trials. Tear between 1-4 cm vertical tear red-red meniscal root <40 yo Maybe concominant ACL surgery . the intercondylar notch, most commonly to the mid ACL, and less commonly The posterior root lies anterior to the posterior cruciate ligament. 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). 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. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 4. Type 2: An incomplete slab of meniscal tissue with 80% coverage of the lateral tibial plateau. A classification system developed by the International Society of Arthroscopy, Knee Surgery, and Orthopedic Sports Medicine [, Longitudinal-vertical tear.
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