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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 . joint, and they also protect the hyaline cartilage. 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. AJR American journal of roentgenology. Report Cho JM, Suh JS, Na JB, et al. The patient underwent an all-inside lateral meniscus repair. 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. Bucket Handle Meniscal Tear - Diagnosis - MRI Online discoid lateral meniscus is a relatively uncommon developmental variant posterior fascicles and meniscotibial ligament are absent and a high Rohren EM, Kosarek FJ, Helms CA. When it involves the posterior root, medial root tears are easier to diagnose than lateral root tears. Kocher MS, Klingele K, Rassman SO. Intensity of signal contacting meniscal surface in recurrent tears on MR arthrography compared with that of contrast material. Anterior horn tear of the lateral meniscus in footballers with a stable knee is characterized by pain at the anterolateral aspect of the knee during knee extension, especially when kicking. At the time the article was last revised Yahya Baba had anterior horn of the medial meniscus into the anterior cruciate ligament Fat suppressed sagittal T1-weighted MR arthrogram (5C) demonstrates gadolinium within the tear (arrow). The lateral . The same imaging criteria (as for the case of greater than 25% partial meniscectomy), the presence of fluid signal on T2-weighted or contrast extending into the meniscal substance is used to diagnose a recurrent tear. Increased intrameniscal signal is commonly seen in the transplanted allograft but does not correlate with clinical outcome. Analytical, Diagnostic and Therapeutic Techniques and Equipment 13. 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. 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. 6. 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. They may not even be apparent with an arthroscopic examination. Pain is typically medial and activity-related (e.g. Anterior tibial marrow edema and organized trabecular fracture measuring 16 mm AP, 18 mm transverse. Weight-bearing knee X-rays showed a 50 % narrowing in the medial compartment. Another finding is the abnormal size or shape of the meniscus, which would indicate damaged surfaces [, To provide a greater degree of accuracy, De Smet advocated the two-slice-touch rule. To call a definite tear, one should see increased signal contacting the articular surface of the menisci on at least two images (sagittal or coronal). Magn Reson Imaging Clin N Am 2014;22(4): 517555, White LM, Schweitzer ME, Weishaupt D, Kramer J, Davis A, Marks PH. There is no universally accepted system for classifying meniscal tear patterns. The incidence was calculated based on arthroscopic findings, and the potential secondary signs of meniscal ramp tears were evaluated on MRI. By continuing to use our site, you consent to the use of cookies outlined in our Privacy Policy. An intact meniscal repair was confirmed at second look arthroscopy. proximal medial tibia was convex and the distal medial femoral condyle When the cruciate morphology but lacks its posterior attachments; ie, the meniscotibial Symptomatic anomalous insertion of the medial meniscus. an adult), and approximately twice the size of the anterior horn on 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. And, some tears do not fill with contrast during arthrography. normal knee. 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 Atypically thick and high location Meniscus Tear MRI Correlation | SpringerLink Lee S, Jee W, Kim J. menisci develop from this mesenchymal tissue in a site where this tissue When bilateral, they are usually symmetric. De Smet A. Tibial meniscal dynamics using three-dimensional reconstruction of magnetic resonance images. The medial meniscus is more tightly anchored than the lateral meniscus, allowing for approximately 5mm of anterior-posterior translation. MRI Findings: Medial meniscus: Tear of the posterior horn seen to the inferior articular surface continuing into the posterior body and becoming more vertical. Intact meniscal roots. Suprapatellar plica noticed, with no related cartilaginous erosions. The location of meniscal tears or signal alterations (anterior/posterior horn or body of the medial/lateral meniscus) and the grade (normal/intra-substance signal abnormality = 0 and tear = 1) were determined on 2D . Both horns of the medial meniscus are triangular with sharp points. Grades 1 and 2 are not considered serious. 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. Anterior horn of the lateral meniscus: another potential pitfall in MR imaging of the knee. Lateral Meniscus - ProScan Education - MRI Online MR criteria for discoid lateral menisci are used for discoid medial The MRI sign of a radial tear is a linear, vertical cleft of abnormal high signal at the free edge (Fig. diminutive (1 mm) with no increased signal to suggest root attachment Efficacy of Arthroscopic Treatment for Concurrent Medial Meniscus Skeletal radiology. Discoid lateral meniscus APPLIED RADIOLOGY 36 year old male with history of meniscus surgery 7 years ago. the menisci of the knees. Normal shape and signal of the horns of the medial meniscus, with no evidence of tears or degenerations seen. Sagittal proton density-weighted image (9A) demonstrates no high signal abnormality. Extension to the anterior cortex of . Factors affecting meniscal extrusion: correlation with MRI, clinical 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. While this test will show a tear up to 90% of the time, it does not always. They were first described by M J Pagnaniet al. Both the healed peripheral tear and the new central tear were proved at second look arthroscopy. meniscus is partial meniscal excision, leaving a 6- to 7-mm peripheral Coronal extrusion of the lateral meniscus does not increase after MRI features are consistent with torn lateral meniscus with flipped anterior horn superomedial and posterior, resting superior to the posterior horn. 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. Of the 14 athletes, 8 repairs were performed, 5 patients . Am J Sports Med 2017; 45:884891, Zaffagnini S, Grassi A, Marcheggiani Muccioli GM, et al. 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. 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. They divide the meniscus into superior and inferior halves (Fig. 800-688-2421. ligaments are absent, most commonly the anterior cruciate ligament (ACL) 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. . of the transverse ligament is comparable to the general population.5. It is usually seen near the lateral meniscus central attachment site. Fellowship-trained musculoskeletal radiologists read 99% of the MRIs. 1. Shepard et al have done a nice job of telling us just how frequently this mistake can be made by fellowship trained musculoskeletal radiologists. The MRI revealed a longitudinal tear in the posterior horn of the lateral meniscus. The avulsed anterior horn of the lateral meniscus is flipped over and situated above the posterior horn. When evaluating a portion of the meniscus that is in a different location than the repair, criteria for evaluating a virgin meniscus may be used for that area. 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. 7 Therefore, it is important for the radiologist to be familiar with the appearance of a recurrent tear versus an untorn postoperative meniscus. The posterior cruciate ligament is intact. However, few studies have directly compared the medial and lateral root tears. We will review the common meniscal variants, which appearance.12 It is now believed that the knee develops from a They are usually due to an acute injury [. In cases like this, MR arthrography is quite helpful. 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. Sagittal T2-weighted image (10B) reveals no fluid at the repair site. Anatomic variability and increased signal change in this area are commonly mistaken for tears. PDF Coronal extrusion of the lateral meniscus does not increase after 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. separate the cavity. Of the 54 participants, 5 had PHLM tears and 49 were normal. 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. Become a Gold Supporter and see no third-party ads. He presented after a few months with symptoms of instability. Presentation - Middle-older aged individuals, non-traumatic, progressive onset of pain. 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. This article focuses on To provide the highest quality clinical and technology services to customers and patients, in the spirit of continuous improvement and innovation. Considered a feature of knee osteoarthritis. problem in practice. sagittal magnetic resonance (MR) images. The sutures are tied over a cortical fixation device or Endobutton (short arrow) with the knee flexed at 90 to secure the root repair. 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. Proper preoperative sizing of the allograft is critical for surgical success and usually performed with radiographs. both enjoyable and insightful. Associated anomalies in a discoid medial small meniscus is also seen in the wrist joint. Twenty-one had ACL tears; all those with an PHLM tear had an ACL tear. A recurrent tear was proved at second look arthroscopy. RESULTS. that this rare condition is also clinically asymptomatic. 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. Bilateral hypoplasia of the medial meniscus has also been During an arthroscopy, we have the choice of either repairing the meniscus tear or removing the torn piece. noted to be diminutive, with the posterior horn measuring 7 mm to 8 mm. 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. The shape of the meniscus is formed at the eighth week of The Knee Resource | Degenerative Meniscus Tear Congenital absence of the meniscus is extremely rare and has been documented in TAR syndrome and in isolated case reports.2,3 ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Examination showed lateral joint line tenderness and a positive McMurray sign. 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. (middle third), or Type 3 (superior third; intercondylar notch) (Figure {"url":"/signup-modal-props.json?lang=us"}, Weerakkody Y, Baba Y, Knipe H, et al. Kijowski et al. Comparison of Medial and Lateral Meniscus Root Tears - PLOS [emailprotected]. 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. 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. Am J Sports Med 2017; 45:4249, ElAttar M, Dhollander A, Verdonk R, Almqvist KF, Verdonk P. Twenty six years of meniscal allograft transplantation: is it still experimental? Collagen fibers are arranged for transferring compressive loads into circumferential hoop stresses, secured by radially oriented tie fibers. A tear was found and the repair was revised at second look arthroscopy. You have reached your article limit for the month. 22 year-old male with a history of ACL and MCL reconstruction and medial meniscus posterior root repair. 3: The Wrisberg variant, where the meniscus may have a normal Association of Parameniscal Cysts With Underlying Meniscal Tears as Studies on meniscus root tears have investigated the relationship of osteoarthritis and an anterior cruciate ligament tear. Lateral Meniscus Tear | Tyler Welch, MD 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 was no history of a specific knee injury. The Wrisberg variant may present with a ligaments and menisci causing severe knee dysplasia in TAR syndrome. There are It is believed that discoid