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The main functions 2008; 32:212219, Magee T. Accuracy of 3-Tesla MR and MR arthrography in diagnosis of meniscal retear in the post-operative knee. The insertion site 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. Thirty-one of these patients underwent subsequent arthroscopic evaluation to allow clinical correlation. RESULTS. as at no time in development does the meniscus have a discoid A 22-years old male presented with injury to right knee in a road traffic accident MRI images shows double posterior horn of lateral meniscus and absent anterior horn in coronal (A: PD; B: STIR; C . The posterior root lies anterior to the posterior cruciate ligament. Anterior horn of the lateral meniscus: another potential pitfall in MR imaging of the knee. Healed peripheral medial meniscus posterior horn repair and new longitudinal tear in a different location. 1. However, recognizing these variants is important, as they can Most horizontal tears extend to the inferior articular surface. Incidence and Detection of Meniscal Ramp Lesions on Magnetic Resonance FSE T2-weighted images, with a slab-like appearance on coronal images. At the time the article was created Yuranga Weerakkody had no recorded disclosures. The meniscus is two crescent-shaped, thick pieces of cartilage that sit in the knee between the tibia and the femur. That reported case was also associated with 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 Skeletal radiology. The speckled appearance of the anterior horn of lateral meniscus is a feature that can be seen as a normal variant on MRI knee scans. 10 joint, and they also protect the hyaline cartilage. Monllau et al in 1998 proposed adding a fourth type, They maintain a relatively constant distance from the periphery of the meniscus [. A detached posterior root is functionally equivalent to a total meniscectomy with loss of its ability to withstand hoop stress. The trusted source for healthcare information and CONTINUING EDUCATION. 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. Medial meniscus posterior horn peripheral longitudinal tear (arrow) seen on the sagittal proton density-weighted image (15A) and managed by repair. Of the 54 participants, 5 had PHLM tears and 49 were normal. hypermobility. Disadvantages include risks associated with joint injection, radiation exposure and lower contrast resolution compared to MRI, particularly in the extraarticular soft tissues. Objective Parameniscal cysts have a very high association with meniscal tears in all locations except the anterior horn lateral meniscus (AHLM). congenital anomalies affect the lateral meniscus, most commonly a pivoting). 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. trauma; however, other symptoms include clicking, snapping, and locking If the tear does not show, it is considered a Grade 1 or 2 and is not as serious. 1427-143. Clark CR, Ogden JA. 2013;106(1):91-115. 2006;239(3):805-10. Additionally, the postoperative complication of new extensive synovitis is apparent on the axial view (18D). Indications for a partial meniscectomy include meniscal tears not amenable to repair which includes non-peripheral tears with a horizontal, oblique or complex tear pattern and nontraumatic tears in older patients. A tear of the lateral meniscus can occur from a sudden injury, or from chronic wear and overload. Cho JM, Suh JS, Na JB, et al. Become a Gold Supporter and see no third-party ads. Shepard and colleagues at UCLA specifically analyzed this by reviewing 947 consecutive MRIs. They were first described by M J Pagnaniet al. A meta-analysis of 44 trials. At least one meniscofemoral ligament is present in 7093 % Of knees 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. Which meniscus is more likely to tear? OITE 7 Flashcards | Chegg.com Surgery Needed?? : r/MeniscusInjuries 2012;199(3):481-99. At the time the article was last revised Yahya Baba had The clinical significance of anterior horn meniscal tears diagnosed on magnetic resonance images. 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 (Figure 1). Renew or update your current subscription to Applied Radiology. The avulsed anterior horn of the lateral meniscus is flipped over and situated above the posterior horn. 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. This article focuses on Anterior lateral cysts extended . ligament, and the posterior horn may translate or rotate due to Lateral meniscus bucket handle tears can produce the double anterior horn sign or double ACL sign. Development of the menisci of the human knee Tears in the red zone have the potential to heal and are more amenable to repair. What are the findings? 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. meniscus | Search | Radiopaedia.org 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). found that the absence of a line of increased signal through the meniscus extending to the articular surface on proton density and T2-weighted images was a reliable MRI finding for an untorn post-operative meniscus with 100% sensitivity. In this case, the patient never obtained relief from the initial surgery, and the surgeon felt this was a residual tear (failed repair) rather than a recurrent tear. 3 years later the sagittal proton density-weighted image (15B) shows a healed posterior horn (arrow) with a new flap tear in the medial meniscus anterior horn (arrowhead). MR imaging is useful for evaluation of many possible complications following meniscal surgery. Discoid lateral meniscus and the frequency of meniscal tears. MRI features are consistent with torn lateral meniscus with flipped anterior horn superomedial and posterior, resting superior to the posterior horn. 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. Youderian A, Chmell S, Stull MA. 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. For DSR inquiries or complaints, please reach out to Wes Vaux, Data Privacy Officer, Brody J, Lin H, Hulstyn M, Tung G. Lateral Meniscus Root Tear and Meniscus Extrusion with Anterior Cruciate Ligament Tear. Continuous meniscal tissue bridged the anterior and posterior horns of the lateral meniscus on 3 consecutive sagittal slices (Figure 1B). 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. Singh K, Helms CA, Jacobs MT, Higgins LD. Following partial meniscectomy, the knee is at increased risk for osteoarthritis. 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. Note the symmetrical shape of the lateral meniscus (left) with similar size of the anterior and posterior horns. MRI: When you tear your meniscus, a magnetic resonance imaging (MRI) scan will show the injury as white lines on black. Diagnosis of recurrent meniscal tears: prospective evaluation of conventional MR imaging, indirect MR arthrography, and direct MR arthrography. These are like large radial tears and can destabilize a large portion of the meniscus. In contrast to the medial meniscus, the posterior horn of the lateral meniscus is additionally secured by the meniscofemoral ligaments (MFL). noted to be diminutive, with the posterior horn measuring 7 mm to 8 mm. Am J Sports Med 2010; 38:15421548, LaPrade RF, Matheny LM, Moulton SG, James EW, Dean CS. On imaging alone, the radiologist may not be able to distinguish a residual tear (failed repair) from a recurrent tear in the same location. Sagittal proton density-weighted image (6A) through the medial meniscus following partial meniscectomy and debridement of the inferior articular surface shows increased PD signal contacting the inferior articular surface (arrow) but no T2 fluid signal at the surgical site (6B) and no gadolinium signal in the meniscus (6C). 2a, 2b, 2c). Knee Examination - Samarpan Physio In this case, we can determine that there is a new tear in a different location. Disadvantages include patient discomfort, increased cost, physician time needed for the procedure and radiation exposure during fluoroscopy. during movement, and less commonly joint-line tenderness, reduced On the proton density-weighted image (12A) persistent high signal extends to the tibial and femoral surfaces (arrow). Discoid lateral meniscus. It is possible that there could have been some tears missed at arthroscopy that were on the undersurface of the anterior horn, an area which is extremely difficultif not impossibleto visualize. The posterior root of the lateral meniscus (PRLM) attaches along the posterior aspect of the intercondylar eminence of the tibia (Fig. 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. 6 months post-operative she had increased pain prompting follow-up MRI. Lateral meniscus posterior horn peripheral longitudinal tear managed by repair. typically into the anterior cruciate ligament. Pagnani M, Cooper D, Warren R. Extrusion of the Medial Meniscus. Anterior Cruciate Ligament and Meniscal Tears: A Multi-modality Review While this test will show a tear up to 90% of the time, it does not always. 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. Flipped meniscus - anterior horn lateral meniscus | Radiology Case 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 However, few studies have directly compared the medial and lateral root tears. 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. be misinterpreted for more significant pathology on MRI. Posterior Horn Medial Meniscus Tears - Howard J. Luks, MD At 1 year, 5 of 6 were completely asymptomatic with the remaining patient minimally painful with no suggestion of meniscal symptoms. {"url":"/signup-modal-props.json?lang=us"}, El-Feky M, Flipped meniscus - anterior horn lateral meniscus. The purpose of our study was to determine if cysts of the ACL are the origin of cysts adjacent to the AHLM. Increased intrameniscal signal is commonly seen in the transplanted allograft but does not correlate with clinical outcome. Disadvantages include increased cost, increased patient time, potential for adverse reactions to contrast agent compared to conventional MRI and lack of joint distention. History of medial meniscus posterior horn and body partial meniscectomy. The anterior horn of the menisci, especially the lateral meniscus, is an area commonly confused on MRI. The discoid lateral-meniscus syndrome. is in fact reducing the volume of the meniscus and restoring a normal Source: Shepard MF, et al. A tear of the meniscal root means the tear is near where it attaches to the bone, usually far in the back. CT arthrography may be used to evaluate the postoperative meniscus when MRI is contraindicated. 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 . Medial meniscus bucket handle tears can result in a double PCL sign. Following meniscal allograft transplantation (Figure 17), complications occur in up to 21% of procedures, including allograft failure and progressive cartilage loss.19 Repeat operations occur in up to 35% of patients, 12% requiring conversion to total knee arthroplasty. There is no telling how much this error rate will change for radiologists less experienced with MRI. horn of the lateral meniscus, and oblique tear orientation In the present study, the patients analyzed came from the have been the most difficult for imaging planes to visualize same geographical area . 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. Radiology. Bilateral Hypoplasia of the Medial and Lateral Menisci - PMC ; Lee, S.H. What is a Grade 3 meniscus tear? Thompson WO, Thaete FL, Fu FH, Dye SF. Pinar H, Akseki D, Karaoglan O, et al. The common insertion of the anterior cruciate ligament (ACL) and the AHLM root may provide a pathway for disease. The post arthrogram view (13B) reveals gadolinium within the repair site. in 19916. 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. Posteroinferior displacement of the meniscal tissue (arrowheads) is also diagnostic of recurrent tear. The anterior meniscofemoral ligament (Humphrey ligament) attaches proximally on the medial femoral condyle, inferior to the PCL insertion. 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. We will review the common meniscal variants, which 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. Meniscal tears are common and often associated with knee pain. Meniscus Tear MRI Correlation | SpringerLink No gadolinium extension into the meniscus on fat-suppressed sagittal T1-weighted (9B) post arthrogram view. Anomalous insertion of anterior and posterior horns of medial meniscus The knee is a complex synovial joint that can be affected by a range of pathologies: ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. It is important to know the age of the patient when interpreting the MRI. Diagnostic accuracy of MRI knee in reference to - ScienceDirect Monllau J, Gonzalez G, Puig L, Caceres E. Bilateral hypoplasia of the medial meniscus. History of longitudinal medial meniscus tear managed by meniscal repair (arrows). 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. 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). In the U.S., intraarticular injection of gadolinium-based contrast is off label. 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. Results: In a consecutive series of 301 ACL reconstructions, 50 patients (33 male, 17 female) with a mean age of 29.6 years (range, 14-61 years) were diagnosed with a medial meniscal ramp lesion at . Download Musculoskeletal MRI by Nancy Major, Mark Anderson The patient failed conservative management of aspiration and cortisone injection. 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 Menisci are present in the knees and the The medial meniscus is more tightly anchored than the lateral meniscus, allowing for approximately 5mm of anterior-posterior translation. Radiology. Close clinical correlation is advised before recommending surgery based on this finding alone. The lateral meniscus is produced by the varus tension and tibial IR. Is sport activity possible after arthroscopic meniscal allograft transplantation? Meniscal surgery is common and requires accurate post-operative imaging interpretation to guide the treatment approach. MRI c spine / head jxn - they can have stenosis of foramen magnum . Longitudinal lateral meniscus tear status post repair (arrow). of these meniscal variants is the discoid lateral meniscus, and the attachment of the posterior horn is the Wrisberg meniscofemoral 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. Acute partial interstitial to near complete anterior cruciate ligament tear is noted at its posterior end with femoral deep lateral sulcus sign. Meniscus | Radiology Key Normal shape and signal of the horns of the medial meniscus, with no evidence of tears or degenerations seen. Kelly BT, Green DW. trials, alternative billing arrangements or group and site discounts please call The posterior root of the medial meniscus attaches to the tibia, just anterior and medial to the posterior cruciate ligament (PCL). It splits into two bands at the PCL, named Humphry(anterior to the PCL) and Wrisberg (posterior to the PCL). On MRI, they exhibit abnormal horizontal linear signal contacting the inferior articular surface near the free edge or less commonly the superior surface. An algorithm for computing tear meniscus profile continued knee pain after meniscus surgery It is often explained by fibers of the anterior cruciate ligament and the covering synovium . Meniscal disorders: Normal, discoid, and cysts. Sagittal T2-weighted image (18A) demonstrates high T2 fluid signal in the medial meniscus posterior horn consistent with a recurrent tear (arrow). Absence of the meniscus results in a 200 to 300% increase in contact stresses on the articular surfaces.8The meniscus has a heterogeneous cellular composition with regional and zonal variation, with high proteoglycan content at the thin free edge where compressive forces predominate and low proteoglycan content at the thicker peripheral region where circumferential tensile loads predominate. the example shown (Figures 1 and 2), the entire medial meniscus is an adult), and approximately twice the size of the anterior horn on 2006; 187:W565568. Lee, J.W. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. the medial meniscus. It is believed that discoid There was no history of a specific knee injury. 4). Create a new print or digital subscription to Applied Radiology. 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 A Study of Retrieved Allografts Used for ACL Surgery, Long-Term Results of Meniscus Allograft Transplantation with Concurrent ACL Reconstruction, Anterior Horn Meniscal Tears — Fact or Fiction, How Triathletes Can Use Cycling Cadence to Maximize Running Performance, Pharmacology Watch: HRT - Position Paper Places Benefits in Question, Clinical Briefs in Primary Care Supplement. They often tend to be radial tears extending into the meniscal root. No paralabral cyst. 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. They often tend to be radial tears extending into the meniscal root. Pathology - a tear that has developed gradually in the meniscus. The most frequent symptom is pain that usually begins with a minor What Is a Tear of the Anterior Horn of the Lateral Meniscus? 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. for the ratio of the sum of the width of the anterior and posterior MRIs of BHT may have several characteristic appearances including (1) fragment in the notch sign; (2) double anterior horn sign, in which there is an additional meniscal fragment in the anterior joint on top of the native anterior horn; (3) the absent bow tie sign; (4) the double PCL sign, in which the centrally displaced fragment lies just anterior and parallel to the PCL giving the appearance of two PCLs; and (5) the coronal truncation sign, in which the free edge of the meniscal body appears clipped off on coronal images (Fig. Repair devices including arrows, darts and sutures are used to approximate the torn edges of the meniscus. appearance.12 It is now believed that the knee develops from 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. Illustration of the medial and lateral menisci. 7.2 Medial and Lateral Menisci Medial meniscus is larger than the lateral meniscus and is more "open" (=less C-like) and less wide. may simulate a peripheral tear (Figure 6).23 The only 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 medial meniscus covers 60% of the medial compartment. What causes abnormal mobility in the medial meniscus? Sagittal T2-weighted (8B) and fat-suppressed coronal T2-weighted (8C) images reveal fluid signal (arrows) extending into the meniscal substance indicating a recurrent tear which was confirmed at second look arthroscopy. This emphasizes the importance of meniscal repair over meniscectomy when possible and the need for meniscal preservation when a partial meniscectomy is necessary. Repair techniques include inside-out, outside-in or all-inside approaches. Criteria for a recurrent tear after greater than 25% meniscectomy Definite surfacing T2 fluid signal (or high T1 signal isointense to intra-articular gadolinium on MR arthrography) on 2 or more images or displaced meniscal fragment.17 Definite surfacing fluid signal on only one image represents a possible tear. meniscal injury. To provide the highest quality clinical and technology services to customers and patients, in the spirit of continuous improvement and innovation. They may not even be apparent with an arthroscopic examination.