Diagnostic accuracy of MRI knee in reference to - ScienceDirect We use cookies to create a better experience. Twenty-one had ACL tears; all those with an PHLM tear had an ACL tear. 2a, 2b, 2c). It splits into two bands at the PCL, named Humphry(anterior to the PCL) and Wrisberg (posterior to the PCL). In the previously reported cases, as well as in this case, the The patient subsequently underwent successful partial medial meniscectomy. Because most meniscal tears are not isolated to the red zone, it is understandable that most meniscal surgeries are partial meniscectomies which aim to restore meniscus stability while preserving as much native meniscal tissue as possible, to decrease the risk of osteoarthritis. 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. Knee Surg Sports Traumatol Arthrosc 2011; 19:147157, Gwathmey F.W., Golish S.R., Diduch D.R., et al: Complications in brief: meniscus repair. Discoid meniscus in children: Magnetic resonance imaging characteristics. 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. The anomalous insertion Pathology - a tear that has developed gradually in the meniscus. The posterior cruciate ligament is intact. Reporting knee meniscal tears: technical aspects, typical pitfalls and 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. 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). Symptomatic anomalous insertion of the medial meniscus. Total meniscectomy is rarely performed unless the meniscus is so severely damaged that no salvageable meniscal tissue remains. Pullout fixation of posterior medial meniscus root tears: correlation between meniscus extrusion and midterm clinical results. 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. Best assessed on T2 weighted sequences. Repair devices including arrows, darts and sutures are used to approximate the torn edges of the meniscus. 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. Diagnostic performance is decreased following partial meniscectomy since the standard criteria used to diagnose a meniscus tear cannot be applied to the post-operative meniscus.3,4,5,6 Partial meniscectomy may distort the normal morphology of the meniscus and increased meniscal signal intensity may extend to the articular surface when a portion of the meniscus has been resected, simulating a tear. Which meniscus is more likely to tear? The MRI showed complete ACL tear with displaced bucket handle medial meniscus tear. Meniscal disorders: Normal, discoid, and cysts. Diagnosis of recurrent meniscal tears: prospective evaluation of conventional MR imaging, indirect MR arthrography, and direct MR arthrography. 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. collapse and widening of the medial joint space (Figure 7). Is sport activity possible after arthroscopic meniscal allograft transplantation? The condition is typically asymptomatic and, therefore, is infrequently diagnosed.14 No gadolinium extension into the meniscus on fat-suppressed sagittal T1-weighted (9B) post arthrogram view. These tears are usually degenerative in nature and usually not associated with a discrete injury [. This case is almost identical to the previous case with a different clinical history. This case features the following signs of meniscal tear: Case courtesy, Prof. Dr. Khaled Matrawy, Professor of radiology, Alexandria university, Egypt. Zonal variation is also seen in the density of meniscus cells and their phenotypes with a chondrocytic inner zone and fibroblastic outer zone. A previous study by De Smet et al. Posteroinferior displacement of the meniscal tissue (arrowheads) is also diagnostic of recurrent tear. To assess the prevalence of meniscal extrusion and its . pivoting). Considered a feature of knee osteoarthritis. 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 Meniscal root tears are defined as radial tears located within 1 cm from the meniscal attachment or a bony rootavulsion. anterior horn of the medial meniscus into the anterior cruciate ligament Radiology. History of a longitudinal medial meniscus tear managed by repair and concurrent ACL reconstruction. Root tears are associated with a high risk for osteoarthritis. Findings indicate an intact meniscus following partial meniscectomy with normal intrameniscal signal. Arthroscopy revealed a horizontal tear of PHMM, and a partial medial meniscectomy was performed. 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. Conventional MRI imaging of the postop meniscus offers a noninvasive evaluation of the knee, but postoperative changes can mimic a recurrent or residual meniscus tear. 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. of the anterior horn of the medial meniscus, an inferior patella plica, The Journal of bone and joint surgery American volume. The insertion site Vertical flap (oblique, flap, parrots beak) tears are unstable tears and occur in younger patients. A tear was found and the repair was revised at second look arthroscopy. This article focuses on Anterior horn of the lateral meniscus: another potential pitfall in MR imaging of the knee. Extension to the anterior cortex of . Meniscal Tear Patterns - Radsource Indications for meniscal repair typically include posttraumatic peripheral (red zone) longitudinal tears located near the joint capsule, ideally in younger patients (less than 40). MRI showed posterior horn of the medial meniscus (PHMM) horizontal tear with early degenerative changes. Diagnostic Image Quality of a Low-Field (0.55T) Knee MRI Protocol Using 9 The lateral meniscus is more loosely attached than the medial and can translate approximately 11mm with normal knee motion. Dickhaut SC, DeLee JC. The symptoms Tears 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. Examination showed lateral joint line tenderness and a positive McMurray sign. MR criteria are used to make the diagnosis. > 20% ratio of meniscus to tibia on the coronal image; Minimum diameter 14-15 mm on a midcoronal image; 75% Meniscus tears are either degenerative or acute. Discoid lateral meniscus of the knee joint: Nature, mechanism, and operative treatment. Monllau et al in 1998 proposed adding a fourth type, Knee Examination - Samarpan Physio O'Donoghue unhappy triad | Radiology Case | Radiopaedia.org Complex or deep radial tears were found in three of five cases of lateral meniscus extrusion and normal root. The remaining 42 cases were located in the red zone (19 cases) or the red-white zone. 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. Meniscal surgery is common and requires accurate post-operative imaging interpretation to guide the treatment approach. 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. Evaluation of postoperative menisci with MR arthrography and routine conventional MRI. 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. (Tr. The purpose of our study was to determine if cysts of the ACL are the origin of cysts adjacent to the AHLM. 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. Youderian A, Chmell S, Stull MA. Mucinous degeneration of meniscus can also produce abnormal signal within a meniscus which does not contact an articular surface and should not be mistaken for a tear. 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. snapping knee due to hypermobility. Thirty-one of these patients underwent subsequent arthroscopic evaluation to allow clinical correlation. Normal frequently. 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. Meniscal Roots: Current Concepts Review (middle third), or Type 3 (superior third; intercondylar notch) (Figure this may extend to to the mid body." is this a bucket tear? This is a well-done study with clinical correlation and adequate follow-up. Clinical Examination in the Diagnosis of Anterior Cruciate : JAAOS That reported case was also associated with Surgical Outcomes Lysholm Score 2006; 187:W565568. During an arthroscopy, we have the choice of either repairing the meniscus tear or removing the torn piece. 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. It is believed that discoid signal fluid cleft interposed between the posterior horn and the capsule 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. The anterior horn of the menisci, especially the lateral meniscus, is an area commonly confused on MRI. Sagittal T2-weighted image (18A) demonstrates high T2 fluid signal in the medial meniscus posterior horn consistent with a recurrent tear (arrow). PDF The Menisci on MRI Pearls and Pitfalls or the Radiology Registrar On MRI, they exhibit abnormal horizontal linear signal contacting the inferior articular surface near the free edge or less commonly the superior surface. {"url":"/signup-modal-props.json?lang=us"}, Weerakkody Y, Baba Y, Knipe H, et al. Disadvantages include patient discomfort, increased cost, physician time needed for the procedure and radiation exposure during fluoroscopy. The self-reported complication rate for partial meniscectomy is 2.8% and meniscus repair is 7.6%. 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. The posterior horn is always larger than the anterior horn. Long-term outcome after arthroscopic meniscal repair versus arthroscopic partial meniscectomy for traumatic meniscal tears. 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. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. The MRI revealed a longitudinal tear in the posterior horn of the lateral meniscus. This high rate of success, however, may not apply to anterior horn tears, which occur much less commonly than posterior horn and meniscal body tears. Development of the menisci of the human knee However, many clinicians opt to use conventional MRI as the initial postoperative imaging study and reserve MR arthrography for equivocal cases. mimicking an anterior horn tear. How I Diagnose Meniscal Tears on Knee MRI. However, few studies have directly compared the medial and lateral root tears. The anterior meniscofemoral ligament (Humphrey ligament) attaches proximally on the medial femoral condyle, inferior to the PCL insertion. Results: Arthroscopic examination of the anterior horn of the lateral meniscus in all 22 patients was normal. The meniscus may also become hypertrophic. The shape of the meniscus is formed at the eighth week of normal knee. Sometimes T2 signal in a healed tear may look similar to fluid. A meniscus is a crescent-shaped fibrocartilaginous structure that Horizontal (degenerative) tears run relatively parallel the tibial plateau. The torn edges are aligned, and stable fixation applied with sutures or bioabsorbable implants at approximately 5 mm intervals. 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). A 2003 systematic review of the literature, in which 29 publications met strict inclusion criteria, demonstrated pooled weighted sensitivity and specificity of 93.3 % and 88.4 % for the medial meniscus and 79.3 % and 95.7 % for the lateral meniscus, respectively [, Most meniscal tears are visible and best seen on sagittal images. The superior, middle and inferior geniculate arteries are the main vascular supply to the menisci. The patient underwent partial medial meniscectomy and ACL reconstruction. 17. MRI of the knee is commonly indicated for evaluation of unresolved or recurrent knee pain following meniscal surgery. to the base of the ACL or the intercondylar notch. Meniscal tears are common and often associated with knee pain. What are the findings? Discoid medial menisci are much less common than discoid lateral menisci,24 and they may be bilateral. 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. of the Wrisberg ligament in patients with a complete lateral discoid the menisci of the knees. In the U.S., intraarticular injection of gadolinium-based contrast is off label. 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. Of the 14 athletes, 8 repairs were performed, 5 patients . Mechanical rasping or trephination of the torn meniscus ends and parameniscal synovium is used to promote bleeding and vascular healing. 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. Volunteerism and Sports Medicine: Where do We Stand? 22 year-old male with a history of ACL and MCL reconstruction and medial meniscus posterior root repair. 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. MRI plays a critical role in influencing the treatment decision and enables information that would obviate unnecessary surgery including diagnostic arthroscopy. Bilateral hypoplasia of the medial meniscus has also been ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. On the sagittal proton density-weighted image (11A), signal contacts the tibial surface. Radial or oblique tear congurations close to or within the meniscus . Congenital absence of the meniscus is extremely rare and has been documented in TAR syndrome and in isolated case reports.2,3 Grade 3 is a true meniscus tear and an arthroscope is close to 100 percent accurate in diagnosing this tear. Partial meniscectomy is by far the most common procedure. Anterior Horn Meniscal Repair Using an Outside-In Suture Technique Flipped meniscus - anterior horn lateral meniscus | Radiology Case In these cases, surfacing meniscal signal on low TE series may represent recurrent tear, granulation tissue or residual grade 2 degenerative signal that contacts the meniscal surface after debridement. Media community. Learn more. of the transverse ligament is comparable to the general population.5. ligament will help to exclude these conditions.5 In the first morphology but lacks its posterior attachments; ie, the meniscotibial 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. 2005; 234:5361. runs from the anterior horn of the medial meniscus to either the ACL or Sagittal proton density-weighted image (8A) through the medial meniscus demonstrates signal extending to the tibial surface (arrow). The lateral meniscus is more circular, and its anterior and posterior horns are nearly equivalent in size in cross section. At the time the article was last revised Yahya Baba had from AIMM. of the distal femur and proximal tibia, and in the case report of Discoid lateral meniscus in children. Unable to process the form. reported.4. tissue only persists at the edges, where differentiation into the ; Lee, S.H. proximal medial tibia was convex and the distal medial femoral condyle meniscal injury. The lateral meniscus is produced by the varus tension and tibial IR. Tachibana Y, Yamazaki Y, Ninomiya S. Discoid medial meniscus. Otherwise, the increased vascularity in children has sometimes led to false-positive reading of a meniscus tear. Bucket-handle tear of the lateral meniscus: Flipped meniscus sign If the tear does not show, it is considered a Grade 1 or 2 and is not as serious. 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). Coronal extrusion of the lateral meniscus does not increase after In these cases, MR arthrography may provide additional diagnostic utility. A 510, 210-pound 16-year-old male injured his left knee while kicking a football. When bilateral, they are usually symmetric. Proper preoperative sizing of the allograft is critical for surgical success and usually performed with radiographs. The anterior and posterior meniscofemoral ligaments (Humphrey and Wrisberg respectively) are commonly present with one or both found in 93-100% of patients. Anterior lateral cysts extended . PRIME PubMed | Posterior horn lateral meniscal tears simulating partly divides a joint cavity, unlike articular discs, which completely discoid meniscus, although discoid medial menisci can occur much less Brody J, Lin H, Hulstyn M, Tung G. Lateral Meniscus Root Tear and Meniscus Extrusion with Anterior Cruciate Ligament Tear. 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. MRI Findings: Medial meniscus: Tear of the posterior horn seen to the inferior articular surface continuing into the posterior body and becoming more vertical. 1). meniscus. They often tend to be radial tears extending into the meniscal root. Collagen fibers are arranged for transferring compressive loads into circumferential hoop stresses, secured by radially oriented tie fibers. For root tears in general, sagittal imaging may demonstrate a meniscal ghost sign. Arthroscopy is considered gold standard in the diagnosis of knee ligament injuries, with diagnostic accuracy up to 94% [1], [2]; and can be used therapeutically as well. CT arthrography is recommended for patients with MRI contraindications or when extensive susceptibility artifact from hardware obscures the meniscus. However, recognizing these variants is important, as they can A detached posterior root is functionally equivalent to a total meniscectomy with loss of its ability to withstand hoop stress. the rare ring-shaped meniscus, to the classification. Weight-bearing knee X-rays showed a 50 % narrowing in the medial compartment. Both ligaments attach distally to the posterior horn of the lateral meniscus and contribute to posterior drawer stability . Dr. Diduch, Associate Professor, Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, is Editor of Sports Medicine Reports. Longitudinal medial meniscus tear managed by repair (arrow). 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 Source: Shepard MF, et al. Concise, to-the-point text covers MRI for the entire musculoskeletal system, presented in a highly templated format. A 23-year-old female presented with a 2-month history of catching and pain in the knee when arising from a squatting position. Continuous meniscal tissue bridged the anterior and posterior horns of the lateral meniscus on 3 consecutive sagittal slices (Figure 1B). Grades 1 and 2 are not considered serious. Shepard and colleagues at UCLA specifically analyzed this by reviewing 947 consecutive MRIs. Clinical imaging. 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. Analytical, Diagnostic and Therapeutic Techniques and Equipment 13. Efficacy of Arthroscopic Treatment for Concurrent Medial Meniscus 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. This arises from the posterior horn of the lateral meniscus and attaches to the lateral aspect of the medial femoral condyle. No paralabral cyst. Shepard et al conclude that with a 74% false-positive rate, anterior horn tears should be treated surgically only if clinical correlation exists. Most horizontal tears extend to the inferior articular surface. Discoid lateral meniscus and the frequency of meniscal tears. The anterior horn of the menisci, especially the lateral meniscus, is an area commonly confused on MRI. Nakajima T, Nabeshima Y, Fujii H, et al. A classification system developed by the International Society of Arthroscopy, Knee Surgery, and Orthopedic Sports Medicine [, Longitudinal-vertical tear. After failing conservative management with NSAIDs, PT, and activity modification, he underwent an MRI. Lee, J.W. Case study, Radiopaedia.org (Accessed on 04 Mar 2023) https://doi.org/10.53347/rID-75066. Financial Disclosure: None of the authors or planners for this educational activity have relevant financial relationships to disclose with ineligible companies whose primary business is producing, marketing, selling, reselling, or distributing healthcare products used by or on patients. Lateral Meniscus: Anatomy The lateral meniscus is seen as a symmetric bow tie in the sagittal plane on at least one or two sections before it divides into two asymmetric triangles near the midline. Shepard et al have done a nice job of telling us just how frequently this mistake can be made by fellowship trained musculoskeletal radiologists. These are like large radial tears and can destabilize a large portion of the meniscus. 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. of the AIMM into the ACL is classified as Type 1 (inferior third), Type 2 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. 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. medial meniscus, and not be confined to the ACL as seen in an ACL tear. Recent evidence suggests that decreased extrusion may correlate to better clinical outcomes.18. posterior horn usually measures 12 mm to 16 mm in the sagittal plane in This emphasizes the importance of baseline MRI comparison for evaluation of the postoperative meniscus.3. The anterior and posterior sutures are shuttled down the tibial tunnel (arrowhead). What is a Lateral Meniscus Tear? On examination, there was marked medial joint line tenderness and a large effusion. At surgery, the torn part of the meniscus was in the intercondylar notch and chewed up and not amenable to repair. Again, this emphasizes the importance of accurate history, prior imaging and operative reports. 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. Meniscus tears, indicated by MRI, are classified in three grades. Interested in Group Sales? The common insertion of the anterior cruciate ligament (ACL) and the AHLM root may provide a pathway for disease.
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