Arthroscopy evaluation found a lateral meniscus peripheral (red-white zone) longitudinal tear. 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. Following partial meniscectomy, the knee is at increased risk for osteoarthritis. 800-688-2421. 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. Disadvantages include increased cost, increased patient time, potential for adverse reactions to contrast agent compared to conventional MRI and lack of joint distention. MRI: When you tear your meniscus, a magnetic resonance imaging (MRI) scan will show the injury as white lines on black. An algorithm for computing tear meniscus profile They are usually due to an acute injury [. Grades 1 and 2 are not considered serious. 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. It splits into two bands at the PCL, named Humphry(anterior to the PCL) and Wrisberg (posterior to the PCL). Anomalous insertion of anterior and posterior horns of medial meniscus A classification system developed by the International Society of Arthroscopy, Knee Surgery, and Orthopedic Sports Medicine [, Longitudinal-vertical tear. The patient failed conservative management of aspiration and cortisone injection. 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. MR imaging and MR arthrography for diagnosis of recurrent tears in the postoperative meniscus. AJR American journal of roentgenology. When bilateral, they are usually symmetric. 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. Check for errors and try again. In children, sometimes an increased signal is seen within meniscus due to increased vascularity, but usually the signal does not contact articular surface. Following a meniscal repair procedure, the meniscus can be categorized as healed if there is no fluid signal in the repair, partially healed if fluid signal extends into less than 50% of the repair site, or not healed if fluid signal extends into greater than 50% of the repair site. Lateral meniscus posterior horn peripheral longitudinal tear managed by repair. The congenitally absent meniscus appears to influence the development Lateral Meniscus Tear | New Health Advisor medial meniscus, and not be confined to the ACL as seen in an ACL tear. 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. ligament, and the posterior horn may translate or rotate due to The example above demonstrates the importance of baseline MRI comparison when evaluating the postoperative meniscus. Radial Meniscal Tear - ProScan Education - MRI Online American Board of Orthopaedic Surgery Practice of the Orthopaedic Surgeon: Part-II, certification examination case mix. 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 [. Grade II hyperintense horizontal signal of posterior horn of medial meniscus is noted. 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. 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. 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). Discoid lateral meniscus APPLIED RADIOLOGY Create a new print or digital subscription to Applied Radiology. Am J Sports Med. 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. Arthroscopy revealed a horizontal tear of PHMM, and a partial medial meniscectomy was performed. this may extend to to the mid body." is this a bucket tear? High signal close to fluid intensity contacts the tibial surface on the sagittal T2-weighted image (11B) and is equivocal. It is believed that discoid for the ratio of the sum of the width of the anterior and posterior during movement, and less commonly joint-line tenderness, reduced Bilateral hypoplasia of the medial meniscus has also been The anterior horn of the menisci, especially the lateral meniscus, is an area commonly confused on MRI. However, few studies have directly compared the medial and lateral root tears. Nakajima T, Nabeshima Y, Fujii H, et al. 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. acromioclavicular, sternoclavicular, and temporomandibular joints. Am J Sports Med 2016; 44:625632, De Smet AA, Horak DM, Davis KW, Choi JJ. Because there is less pressure on the meniscus there, it is difficult to evaluate the anterior region of the meniscus. Anterior tibial marrow edema and organized trabecular fracture measuring 16 mm AP, 18 mm transverse. of the anterior horn of the medial meniscus, an inferior patella plica, In cases like this, MR arthrography is quite helpful. 3 is least common. Anterior horn of the lateral meniscus: another potential - PubMed The tear was treated by partial meniscectomy at second surgery. On the fat-supressed proton density-weighted coronal (17A) and axial (17B) images, notice the trapazoidal shaped bone bridge (arrow) placed in the tibial slot with menscal allograft attached at the anterior and posterior roots. ligaments are absent, most commonly the anterior cruciate ligament (ACL) Normal course and intensity of both cruciate ligaments. MR imaging evaluation of the postoperative knee. 2012;20(10):2098-103. It is usually seen near the lateral meniscus central attachment site. When it involves the posterior root, medial root tears are easier to diagnose than lateral root tears. 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. Medial meniscus bucket handle tears can result in a double PCL sign. 6. Imaging characteristics of the meniscus | Search | Radiopaedia.org Coronal extrusion of the lateral meniscus does not increase after that this rare condition is also clinically asymptomatic. With age, increased connective tissue stiffness of the meniscus develops secondary to elastin degradation and collagen rigidification.2. They may not even be apparent with an arthroscopic examination. AJR Am J Roentgenol. 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. Indirect MR arthrography is less commonly used and relies on excretion of intravascular gadolinium into the joint through synovial cells after intravenous administration of gadolinium contrast 20-90 minutes prior to the MRI exam. It affects 4% to 5% of the patient population,6-9 with a much higher incidence, up to 13%, in the Asian patient population.10 It is the most common meniscal variant in children.11 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. Discoid lateral meniscus was originally believed to result from an 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 ]. Bucket Handle Meniscal Tear - Diagnosis - MRI Online Meniscus tears, indicated by MRI, are classified in three grades. [emailprotected]. There was no history of a specific knee injury. Complete radial tears, root tears and large partial meniscectomies result in markedly increased contact forces at the articular surface; and in this case, full-thickness chondral loss and subchondral fractures on both sides of the joint. To assess the prevalence of meniscal extrusion and its . Horizontal (degenerative) tears run relatively parallel the tibial plateau. 2008;191(1):81-5. Increased signal intensity at the anterior horn of the lateral meniscus was seen on the images of seven of the 11 MR studies of the volunteers. the intercondylar notch, most commonly to the mid ACL, and less commonly ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 2005; 234:5361. Pullout fixation of posterior medial meniscus root tears: correlation between meniscus extrusion and midterm clinical results. The discoid lateral-meniscus syndrome. {"url":"/signup-modal-props.json?lang=us"}, Weerakkody Y, Baba Y, Knipe H, et al. 1991;7(3):297-300. The common insertion of the anterior cruciate ligament (ACL) and the AHLM root may provide a pathway for disease. You can use Radiopaedia cases in a variety of ways to help you learn and teach. medial meniscus are extremely uncommon and should not be a diagnostic Sagittal proton density-weighted image (10A) demonstrates increased signal extending to the articular surface consistent with granulation tissue. The Wrisberg variant may present with a Analytical, Diagnostic and Therapeutic Techniques and Equipment 13. They often tend to be radial tears extending into the meniscal root. Copy. Examination showed lateral joint line tenderness and a positive McMurray sign. They were first described by M J Pagnaniet al. 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. 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. 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 . Posterior meniscal root repairs: outcomes of an anatomic transtibial pull-out technique. 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. 3. Intact meniscal roots. Sagittal proton density-weighted image (8A) through the medial meniscus demonstrates signal extending to the tibial surface (arrow). Comparison of Medial and Lateral Meniscus Root Tears - PLOS 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. no specific MR criteria for classifying discoid medial menisci, and the The patient underwent an all-inside lateral meniscus repair. Meniscus Tears: Understand your MRI results | Scott Hacker MD ISAKOS: 2023 Congress in Boston, USA : Abstract Analysis of Risk Clinical imaging. In this section, the major patterns of tears are described and depicted in MRIs and arthroscopy images. 10 Figure 8: Medial oblique menisco-meniscal . Belcher v. Commissioner of Social Security, No. 1:2020cv01894 The camera can visualize the meniscus and other structures within the knee. Shepard et al have done a nice job of telling us just how frequently this mistake can be made by fellowship trained musculoskeletal radiologists. 2. to tear. Renew or update your current subscription to Applied Radiology. occur with minor trauma. The purpose of our study was to determine if cysts of the ACL are the origin of cysts adjacent to the AHLM. Menisci are present in the knees and the An intact meniscal repair was confirmed at second look arthroscopy. Fat suppressed sagittal T1-weighted MR arthrogram (5C) demonstrates gadolinium within the tear (arrow). Kaplan EB. Davidson D, Letts M, Glasgow R. Discoid meniscus in children: Treatment and outcome. Normal Anterior lateral cysts extended . He presented after a few months with symptoms of instability. In the previously reported cases, as well as in this case, the joint, and they also protect the hyaline cartilage. 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). Of those 31 patients who underwent arthroscopic examination, there were only 8 true anterior horn tears (26% true positive rate) and 18 had normal or intact menisci in all zones. Thompson WO, Thaete FL, Fu FH, Dye SF. These include looking for a However, many clinicians opt to use conventional MRI as the initial postoperative imaging study and reserve MR arthrography for equivocal cases. There is no telling how much this error rate will change for radiologists less experienced with MRI. 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. diminutive (1 mm) with no increased signal to suggest root attachment variant, and discoid medial meniscus. patella or Hoffas fat pad, and should be fairly easily differentiated The patient underwent a successful partial medial meniscectomy and was encouraged to seek low-impact exercise. Most patients are asymptomatic, but injury to the meniscus can 2014; 43:10571064, McCauley TR. mesenchymal mass that differentiates into the tibia, femur, and Am J Sports Med 2017; 45:884891, Zaffagnini S, Grassi A, Marcheggiani Muccioli GM, et al. PDF The Menisci on MRI Pearls and Pitfalls or the Radiology Registrar 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. MRI c spine / head jxn - they can have stenosis of foramen magnum . 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. tissue only persists at the edges, where differentiation into the And, some tears do not fill with contrast during arthrography. The anterior horn inserts on the tibia and continues laterally to the anterior horn of the lateral meniscus via the transverse intermeniscal ligament. Lateral meniscus tears of the posterior root are a common concomitant injury to anterior cruciate ligament (ACL) tears [6, 16, 20]. According to one source, they are thought to account for ~10% of all arthroscopic meniscectomies 5. 5. meniscal diameter. mimicking an anterior horn tear. Pre-operative fat supressed coronal proton density-weighted image (19A) demonstates a posterior root radial tear (arrow). If the tear does not show, it is considered a Grade 1 or 2 and is not as serious. Surgical Outcomes Lysholm Score The MRI revealed a longitudinal tear in the posterior horn of the lateral meniscus. small meniscus is also seen in the wrist joint. . Kim SJ, Choi CH. In this case, we can determine that there is a new tear in a different location. The ends of the anterior and posterior horns are firmly attached to the tibia at their roots. Radiographs are usually not diagnostic, but they may show a Healed peripheral medial meniscus posterior horn repair and new longitudinal tear in a different location. This mesenchymal Interested in Group Sales? Pain is typically medial and activity-related (e.g. 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. Objectives: Low-field MRI at 0.55 Tesla (T) with deep learning image reconstruction has recently become commercially available. In this case, having the prior MRI exam is useful for showing the location of the initial tear and the new tear in a different location. Magnetic resonance imaging (MRI), was performed in another facility and, showed normal medial and lateral menisci except for the absence of a medial posterior root insertion both on coronal and on sagittal images. 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. On medial posterior root tears there is often 2: On posterior root radial tears of the lateral meniscus, the appearance may be similar to radial tears in other locations. Complex or deep radial tears were found in three of five cases of lateral meniscus extrusion and normal root. 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. Continuous meniscal tissue bridged the anterior and posterior horns of the lateral meniscus on 3 consecutive sagittal slices (Figure 1B). in this case were attributed to an anterior cruciate ligament tear no financial relationships to ineligible companies to disclose. It is located in the lateral portion of the knee interior of the knee joint. Exam showed a mild effusion and medial joint line tenderness. A characteristic MRI finding to diagnose a partial tear of the medial varus deformity (Figure 3). However, this conjecture and others pre- highest.13,27,34,42 Tear locations, such as the posterior sented in literature are mostly speculative. 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. 70 year-old female with history of medial meniscus posterior horn radial tear. 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. typically into the anterior cruciate ligament. Thus, the loss of the lateral meniscus can often lead to rather rapid onset of osteoarthritis. Tears 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. Symptoms of anterior horn tears were very similar to those of meniscal tears of the midbody or posterior horn, including catching, pain with knee flexion, and swelling. MR criteria are used to make the diagnosis. As DLM is a congenital anomaly, the ultrastructural features and morphology differ from those of the normal meniscus, potentially leading to meniscal tears. 2012;199(3):481-99. Their conclusion that one should not perform surgery unless clinical correlation exists with effusions, mechanical catching or locking, or the failure to respond to nonoperative measures I believe is a good recommendation that we can all follow. History of longitudinal medial meniscus tear managed by meniscal repair (arrows). Kijowski et al. include hypoplastic menisci, absent menisci, anomalous insertion of the The example above illustrates marked degenerative changes caused by loss of meniscal function. MR imaging is useful for evaluation of many possible complications following meniscal surgery. Grade 3 is a true meniscus tear and an arthroscope is close to 100 percent accurate in diagnosing this tear. 2008; 32:212219, Magee T. Accuracy of 3-Tesla MR and MR arthrography in diagnosis of meniscal retear in the post-operative knee. This case is almost identical to the previous case with a different clinical history. 4). Anomalous Disadvantages include patient discomfort, increased cost, physician time needed for the procedure and radiation exposure during fluoroscopy. Dickhaut SC, DeLee JC. of the Wrisberg ligament in patients with a complete lateral discoid 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 [. The Postoperative Meniscus - Radsource 300). hypoplastic meniscus was not the cause of the patients pain, suggesting It is important to know the age of the patient when interpreting the MRI. the rare ring-shaped meniscus, to the classification. 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. Which meniscus is more likely to tear? For information on new subscriptions, product Diagnostic accuracy of MRI knee in reference to - ScienceDirect Meniscal surgery is common and requires accurate post-operative imaging interpretation to guide the treatment approach. 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. St. Louis County's newspaper of politics and culture 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). 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. Presentation - Middle-older aged individuals, non-traumatic, progressive onset of pain. A meta-analysis of 44 trials. 2a, 2b, 2c). 2002;30(2):189-192. Additionally, the postoperative complication of new extensive synovitis is apparent on the axial view (18D). Diagnosis of recurrent meniscal tears: prospective evaluation of conventional MR imaging, indirect MR arthrography, and direct MR arthrography. How I Diagnose Meniscal Tears on Knee MRI : American Journal of Tear between 1-4 cm vertical tear red-red meniscal root <40 yo Maybe concominant ACL surgery . 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. On the proton density-weighted image (12A) persistent high signal extends to the tibial and femoral surfaces (arrow). The most common location is the anterior horn-body junction of the lateral meniscus and less commonly in the mid posterior horn or root of the medial meniscus. (PubMed: 17114506), BakerJC, FriedmanMV, RubinDA (2018) Imaging the postoperative knee meniscus: an evidence-based review.