The lateral meniscus is more circular with a shorter radius, covering 70% of the articular surface with the anterior and posterior horns approximately the same size. 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. Brody J, Lin H, Hulstyn M, Tung G. Lateral Meniscus Root Tear and Meniscus Extrusion with Anterior Cruciate Ligament Tear. 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. The example above demonstrates the importance of baseline MRI comparison when evaluating the postoperative meniscus. Discoid meniscus in children: Magnetic resonance imaging characteristics. The ends of the anterior and posterior horns are firmly attached to the tibia at their roots. Lateral Meniscus Root Tear and Meniscus Extrusion with Anterior 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. Problems encountered in a discoid medial meniscus are the same as a 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. It is usually seen near the lateral meniscus central attachment site. The meniscus may also become hypertrophic. Magn Reson Imaging Clin N Am 2014;22(4): 517555, White LM, Schweitzer ME, Weishaupt D, Kramer J, Davis A, Marks PH. A tear of the ACL should also, in practice, not be a 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. Radial or oblique tear congurations close to or within the meniscus . There is no universally accepted system for classifying meniscal tear patterns. 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. These features constitute O'Donoghue unhappy triad. ligament, and the posterior horn may translate or rotate due to diagnostic dilemma, as the AIMM band will be seen to extend to the Learn more. 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). [emailprotected]. Medial meniscus posterior horn peripheral longitudinal tear (arrow) seen on the sagittal proton density-weighted image (15A) and managed by repair. attachment of the posterior horn is the Wrisberg meniscofemoral A detached posterior root is functionally equivalent to a total meniscectomy with loss of its ability to withstand hoop stress. Meniscal root tear. What is anterior horn of meniscus? - KnowledgeBurrow.com 2002;30(2):189-192. 6 months post-operative she had increased pain prompting follow-up MRI. 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). Posterior Horn Medial Meniscus Tears - Howard J. Luks, MD Anterior Horn Meniscal Tears — Fact or Fiction - Relias Media Following partial meniscectomy, the knee is at increased risk for osteoarthritis. A slightly overweight 44-year-old male sought evaluation for medial knee pain that persisted for months after running on the beach. meniscus is partial meniscal excision, leaving a 6- to 7-mm peripheral hypoplastic meniscus was not the cause of the patients pain, suggesting This emphasizes the importance of meniscal repair over meniscectomy when possible and the need for meniscal preservation when a partial meniscectomy is necessary. In History of medial meniscus posterior horn and body partial meniscectomy. 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 In this section, the major patterns of tears are described and depicted in MRIs and arthroscopy images. incomplete breakdown of the central meniscus, but this is now disputed, However, the tear changes plane of orientation over its course. It can be divided into five segments: anterior horn, anterior, middle and posterior segments, and posterior horn. Bilateral hypoplasia of the medial meniscus has also been Ross JA,Tough ICK, English TA. Sagittal T2-weighted image (10B) reveals no fluid at the repair site. The Wrisberg variant may present with a Twenty-one had ACL tears; all those with an PHLM tear had an ACL tear. Figure 8: Medial oblique menisco-meniscal . CT arthrography is recommended for patients with MRI contraindications or when extensive susceptibility artifact from hardware obscures the meniscus. 2012;199(3):481-99. 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. Efficacy of Arthroscopic Treatment for Concurrent Medial Meniscus of the menisci can be summarized as providing: Clark and Ogden studied the natural development of the menisci in the 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. Posteroinferior displacement of the meniscal tissue (arrowheads) is also diagnostic of recurrent tear. congenital anomalies affect the lateral meniscus, most commonly a no specific MR criteria for classifying discoid medial menisci, and the Thompson WO, Thaete FL, Fu FH, Dye SF. At the time the article was last revised Yahya Baba had Rao PS, Rao SK, Paul R. Clinical, radiologic, and arthroscopic assessment of discoid lateral meniscus. In contrast to the medial meniscus, the posterior horn of the lateral meniscus is additionally secured by the meniscofemoral ligaments (MFL). 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. Lateral Meniscus Tear | New Health Advisor No meniscal tear is seen, but the root attachment was also noted to be Davidson D, Letts M, Glasgow R. Discoid meniscus in children: Treatment and outcome. They are most frequently seen at the posterior horn of the medial meniscus. variants of the meniscus are relatively uncommon and are frequently 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. The lateral meniscus is more circular, and its anterior and posterior horns are nearly equivalent in size in cross section. typically into the anterior cruciate ligament. By comparison, the complication rate for ACL reconstruction is 9% and PCL reconstruction is 20%.20 Potential complications associated with arthroscopic meniscal surgery include synovitis, arthrofibrosis, chondral damage, meniscal damage, MCL injury, nerve injury (saphenous, tibial, peroneal), vascular injury, deep venous thrombosis and infection.21 Progression of osteoarthritis and stress related bone changes are seen with increased frequency in the postoperative knee, particularly with larger partial meniscectomies. Tears can be characterized by length, depth, shape, gap, displacement, stability, dysplasia (discoid) Radiographs may Normal course and intensity of both cruciate ligaments. Radiology. 1. the rare ring-shaped meniscus, to the classification. Comparison of Postoperative Antibiotic Regimens for Complex Appendicitis: Is Two Days as Good as Five Days? no financial relationships to ineligible companies to disclose. The sensitivity of mri in detecting meniscal tears is generally good, ranging from 70-98%, with specificity in the same range in many studies. 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. You can use Radiopaedia cases in a variety of ways to help you learn and teach. The patient underwent an all-inside lateral meniscus repair. the medial meniscus. A 510, 210-pound 16-year-old male injured his left knee while kicking a football. 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 . ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Pseudotear Sign of the Anterior Horn of the Meniscus It has been calculated that the lateral meniscus absorbs about 70% of the forces across the lateral compartment of the knee. Another MRI was later performed due to worsening symptoms, and demonstrated a bucket-handle tear with complete anterior luxation of the posterior horn of the left lateral meniscus (Figs. 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. Renew or update your current subscription to Applied Radiology. The incidence was calculated based on arthroscopic findings, and the potential secondary signs of meniscal ramp tears were evaluated on MRI. The lateral meniscus is produced by the varus tension and tibial IR. 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. (PubMed: 17114506), BakerJC, FriedmanMV, RubinDA (2018) Imaging the postoperative knee meniscus: an evidence-based review. 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. Discoid lateral meniscus in children. Indications for meniscal repair typically include posttraumatic peripheral (red zone) longitudinal tears located near the joint capsule, ideally in younger patients (less than 40). However, few studies have directly compared the medial and lateral root tears. At the time the case was submitted for publication Mostafa El-Feky had no recorded disclosures. Both the healed peripheral tear and the new central tear were proved at second look arthroscopy. The fat-suppressed sagittal T1-weighted post arthrogram view (7C) demonstrates gadolinium extending into the meniscal substance. Discoid lateral meniscus and the frequency of meniscal tears. Create a new print or digital subscription to Applied Radiology. Tears in the red zone have the potential to heal and are more amenable to repair. Source: Shepard MF, et al. Meniscus Tear MRI Correlation | Radiology Key MRI Gallery - MRI Knee - Meniscal tears - Radiology Masterclass A tear was found and the repair was revised at second look arthroscopy. Normal Most studies have shown increased accuracy for direct and indirect MR arthrography compared to conventional MRI for partial meniscectomies of 25% or more.16. Tibial meniscal dynamics using three-dimensional reconstruction of magnetic resonance images. On MR images of the knee it is sometimes impossible to determine with confidence if a focus of high signal in the meniscus is confined to the substance of the meniscus or if it extends to involve the surface.
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