AJR Am J Roentgenol 211(3):519527, De Smet AA. to the base of the ACL or the intercondylar notch. Objectives: Low-field MRI at 0.55 Tesla (T) with deep learning image reconstruction has recently become commercially available. 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. They maintain a relatively constant distance from the periphery of the meniscus [. Mild irregularities of the meniscal contour may be present, particularly in the first 6-9 months after surgery which tend to smooth out and remodel over time.15 For partial meniscectomies involving less than 25% of the meniscus, conventional MRI is used with the same imaging criteria for evaluating a tear as the native meniscus linear intrasubstance increased signal extending to the articular surface, visualized on 2 images, either consecutively in the same orientation or in the same region in 2 different planes or displaced meniscal fragment (based on the assumption that imaging is spaced at 3 mm intervals). An intact meniscal repair was confirmed at second look arthroscopy. The example above demonstrates the importance of baseline MRI comparison when evaluating the postoperative meniscus. The tear was treated by partial meniscectomy at second surgery. trials, alternative billing arrangements or group and site discounts please call When it involves the posterior root, medial root tears are easier to diagnose than lateral root tears. 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 Dr. Michael Gabor answered Diagnostic Radiology 35 years experience No,: It doesn't sound like a bucket handle tear We look forward to having you as a long-term member of the Relias The clinical significance of anterior horn meniscal tears diagnosed on magnetic resonance images. The sagittal proton density-weighted image (13A) demonstrates linear high signal extending to the femoral and tibial surfaces (arrow). Meniscus tears, indicated by MRI, are classified in three grades. By continuing to use our site, you consent to the use of cookies outlined in our Privacy Policy. of the meniscus. 2006;239(3):805-10. Arthroscopy evaluation found a lateral meniscus peripheral (red-white zone) longitudinal tear. Menisci ensure normal function of the Development of the menisci of the human knee As a result, the accuracy rate of diagnosis by MRI is 83.3%. MR criteria are used to make the diagnosis. hypoplastic meniscus was not the cause of the patients pain, suggesting 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. 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 [. Nakajima T, Nabeshima Y, Fujii H, et al. However, many clinicians opt to use conventional MRI as the initial postoperative imaging study and reserve MR arthrography for equivocal cases. The incidence of lateral meniscus posterior root tears was approximately 4 times higher than of medial meniscus posterior root tears in both primary (12.2% vs 3.2%) and revision (20.5% vs 5.6%) ACLRs. Type When interpreting MR images of the knee, it is important to assess for any change from the expected shape of the menisci. Volunteerism and Sports Medicine: Where do We Stand? 2012;199(3):481-99. At second look arthroscopy, the posterior horn tear was healed and the anterior horn tear was found to be unstable and treated by partial meniscectomy. Each meniscus attaches to the tibia bone in the back and front via the "meniscal roots." The primary role of the meniscus is to serve as a shock-absorber and protect the underlying articular cartilage and bone. occur with minor trauma. Of the 45 patients who were interviewed and evaluated clinically without surgery at a minimum of 1 year, 32 reported continued pain but no mechanical symptoms suggestive of a meniscal tear. include hypoplastic menisci, absent menisci, anomalous insertion of the 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. structure on sagittal images on T1, proton density, and fat-saturated The Wrisberg variant may present with a Davidson D, Letts M, Glasgow R. Discoid meniscus in children: Treatment and outcome. 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. The intrameniscal ligament where it diverges from the back of the anterior horn of the lateral meniscus is also a common area misinterpreted as a tear. Discoid lateral meniscus: Prevalence of peripheral rim instability. Papalia R, Vasta S, Franceschi F, D'Adamio S, Maffulli N, Denaro V. Meniscal Root Tears: From Basic Science to Ultimate Surgery. Unable to process the form. 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). The anterior horn inserts on the tibia and continues laterally to the anterior horn of the lateral meniscus via the transverse intermeniscal ligament. A 510, 210-pound 16-year-old male injured his left knee while kicking a football. 1427-143. Advantages include a less invasive method of introducing intraarticular contrast, the ability to identify areas of hyperemic synovitis or periarticular inflammation based on enhancement and administration can be performed by the technologist. Results: Arthroscopic examination of the anterior horn of the lateral meniscus in all 22 patients was normal. tear. partly divides a joint cavity, unlike articular discs, which completely Root tears are associated with a high risk for osteoarthritis. 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. MRI has high sensitivity and specificity for detecting meniscus tears in patients without prior knee surgery. 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. Most horizontal tears extend to the inferior articular surface. 4). Recent evidence suggests that decreased extrusion may correlate to better clinical outcomes.18. There are How I Diagnose Meniscal Tears on Knee MRI. Stay up to date with the latest in Practical Medical Imaging and Management with Applied Radiology. It is important to know the age of the patient when interpreting the MRI. At the time the article was created Yuranga Weerakkody had no recorded disclosures. 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. This mesenchymal 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. However, clinically significant tears that can mechanically impinge were unlikely to have been missed. Arthroscopy: The Journal of Arthroscopic & Related Surgery. Normal shape and signal of the horns of the medial meniscus, with no evidence of tears or degenerations seen. Br Med Bull. variants of the meniscus are relatively uncommon and are frequently Conventional MRI imaging correlates well with arthroscopic evaluation of the transplants for tears of the posterior and middle thirds of the meniscus allograft with a high sensitivity, specificity and accuracy, but results were poor for evaluation of the anterior third with a low specificity and accuracy.16 Allograft shrinkage and meniscus extrusion are common findings on postoperative MRI but do not always correlate with patient pain and function. with mechanical features of clicking and locking. Meniscal tears are common and often associated with knee pain. posterior fascicles and meniscotibial ligament are absent and a high The most widely used diagnostic modalities to assess the ligament injuries are arthroscopy and Magnetic Resonance Imaging (MRI). The posterior horn is always larger than the anterior horn. ligament, and the posterior horn may translate or rotate due to 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. Most patients are asymptomatic, but injury to the meniscus can Medial meniscus bucket handle tears can result in a double PCL sign. 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. ; Lee, S.H. Considered a feature of knee osteoarthritis. Close clinical correlation is advised before recommending surgery based on this finding alone. 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. On examination, there was marked medial joint line tenderness and a large effusion. What causes abnormal mobility in the medial meniscus? Singh K, Helms CA, Jacobs MT, Higgins LD. 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 ]. Kocher MS, Klingele K, Rassman SO. Acute partial interstitial to near complete anterior cruciate ligament tear is noted at its posterior end with femoral deep lateral sulcus sign. Tibial meniscal dynamics using three-dimensional reconstruction of magnetic resonance images. Extension to the anterior cortex of . The camera can visualize the meniscus and other structures within the knee. 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. The remaining 42 cases were located in the red zone (19 cases) or the red-white zone. We hope you found our articles meniscal diameter. Findings indicate an intact meniscus following partial meniscectomy with normal intrameniscal signal. 1. as at no time in development does the meniscus have a discoid The lateral . Kim SJ, Moon SH, Shin SJ. 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. Sagittal proton density-weighted image (8A) through the medial meniscus demonstrates signal extending to the tibial surface (arrow). 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). Menisci are present in the knees and the They were first described by M J Pagnaniet al. 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. Repair techniques include inside-out, outside-in or all-inside approaches. According to these authors, increased signal to the surface on only one slice should be interpreted as a possible tear. Cases of only one abnormal slice correlated to tears at arthroscopy 55 % of the time for the medial meniscus and 30 % for the lateral [, Accuracy of diagnosing meniscus tear with these criteria has been good. Klingele KE, Kocher MS, Hresko MT, et al. variant, and discoid medial meniscus. Studies on meniscus root tears have investigated the relationship of osteoarthritis and an anterior cruciate ligament tear. Meniscal root tear. Normal 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. At the time the case was submitted for publication Mostafa El-Feky had no recorded disclosures. A previous study by De Smet et al. of the anterior horn of the medial meniscus, an inferior patella plica, Radial tears comprise approximately 15 % of tears in some surgical series [. Longitudinal lateral meniscus tear status post repair (arrow). To provide the highest quality clinical and technology services to customers and patients, in the spirit of continuous improvement and innovation. least common is complete congenital absence of the menisci. Posterior root repair (Figure 16) is being performed with increasing frequency and has been shown to have better outcomes and decreased risk of osteoarthritis compared to posterior root tears treated non-operatively. Become a Gold Supporter and see no third-party ads. Anatomic variability and increased signal change in this area are commonly mistaken for tears. medial meniscus, discoid lateral meniscus, including the Wrisberg Renew or update your current subscription to Applied Radiology. An intact meniscal repair was confirmed at second look arthroscopy. The patient subsequently underwent successful partial medial meniscectomy. If missing on MR images, a posterior root tear is present. 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. Kim SJ, Choi CH. Discoid medial meniscus. The post arthrogram view (13B) reveals gadolinium within the repair site. AJR Am J Roentgenol. are reported cases of complete absence of the medial meniscus as A meta-analysis of 44 trials. Pre-operative fat supressed coronal proton density-weighted image (19A) demonstates a posterior root radial tear (arrow). Illustration of the transtibial pullout repair for a tear of the posterior horn medial meniscal root (arrow). Sagittal PD (. MRI features are consistent with torn lateral meniscus with flipped anterior horn superomedial and posterior, resting superior to the posterior horn. 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 ]. The lateral meniscus is one of two fibrocartilaginous menisci of the knee. On this page: Article: Epidemiology Pathology Radiographic features History and etymology The sensitivity of mri in detecting meniscal tears is generally good, ranging from 70-98%, with specificity in the same range in many studies. While this test will show a tear up to 90% of the time, it does not always. These include looking for a MRI Findings: Medial meniscus: Tear of the posterior horn seen to the inferior articular surface continuing into the posterior body and becoming more vertical. high fibula head and a widened lateral joint space.20 Several Intensity of signal contacting meniscal surface in recurrent tears on MR arthrography compared with that of contrast material. Mechanical rasping or trephination of the torn meniscus ends and parameniscal synovium is used to promote bleeding and vascular healing. trauma; however, other symptoms include clicking, snapping, and locking The medial meniscus covers 60% of the medial compartment. Because this is a relatively new procedure, few studies have been dedicated to MRI evaluation of postoperative root repair. For DSR inquiries or complaints, please reach out to Wes Vaux, Data Privacy Officer, Sagittal T2-weighted image (18A) demonstrates high T2 fluid signal in the medial meniscus posterior horn consistent with a recurrent tear (arrow). Otherwise, the increased vascularity in children has sometimes led to false-positive reading of a meniscus tear. 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. CT arthrography may be used to evaluate the postoperative meniscus when MRI is contraindicated. No meniscal tear is seen, but the root attachment was also noted to be On sagittal proton-density and T2-weighted images, this lesion was demonstrated by sensitive but nonspecific signs, such as the flipped meniscus . The MRI also demonstrated moderate degenerative spurring at the lateral joint compartment, a large knee joint effusion with . sagittal magnetic resonance (MR) images. hypermobility. Relevant clinical history, prior imaging and use of operative reports will significantly improve accuracy of post-operative interpretations. Associated anomalies in a discoid medial In cases like this, MR arthrography is quite helpful. The shape of the meniscus is formed at the eighth week of of the AIMM into the ACL is classified as Type 1 (inferior third), Type 2 This emphasizes the importance of baseline MRI comparison for evaluation of the postoperative meniscus.3. At the time the article was last revised Yahya Baba had The patient underwent a successful partial medial meniscectomy and was encouraged to seek low-impact exercise. Tears can be characterized by length, depth, shape, gap, displacement, stability, dysplasia (discoid) 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. During an arthroscopy, we have the choice of either repairing the meniscus tear or removing the torn piece. And, some tears do not fill with contrast during arthrography. The purpose of our study was to determine if cysts of the ACL are the origin of cysts adjacent to the AHLM. Meniscal root tears are a type of meniscal tear in the knee where the tear extends to either the anterior or posterior meniscal root attachment to the central tibial plateau. Concise, to-the-point text covers MRI for the entire musculoskeletal system, presented in a highly templated format. instance, tears of the lateral aspect of the anterior horn of the The medial compartment articular cartilage is preserved, and the meniscal body is not significantly extruded (16D). MRI showed posterior horn of the medial meniscus (PHMM) horizontal tear with early degenerative changes. 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. Analytical, Diagnostic and Therapeutic Techniques and Equipment 13. . horns to the meniscal diameter on a sagittal slice that shows a maximum However, recognizing these variants is important, as they can One important reason for such discrepancies is a failure to understand the transverse geniculate ligament of the knee (TGL). is much greater than in a discoid lateral meniscus, and the prevalence

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