Normal In the U.S., intraarticular injection of gadolinium-based contrast is off label. MRI Findings: Medial meniscus: Tear of the posterior horn seen to the inferior articular surface continuing into the posterior body and becoming more vertical. Volunteerism and Sports Medicine: Where do We Stand? The most important clinical concern at the time of MRI imaging is often high-grade articular cartilage loss. You can use Radiopaedia cases in a variety of ways to help you learn and teach. Case study, Radiopaedia.org (Accessed on 04 Mar 2023) https://doi.org/10.53347/rID-75066. Objective Parameniscal cysts have a very high association with meniscal tears in all locations except the anterior horn lateral meniscus (AHLM). 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. hypoplastic meniscus was not the cause of the patients pain, suggesting Total meniscectomy is rarely performed unless the meniscus is so severely damaged that no salvageable meniscal tissue remains. 1991;7(3):297-300. Lateral meniscal variant with absence of the posterior coronary ligament. : Complications in brief: arthroscopic partial meniscectomy. A meniscus is a crescent-shaped fibrocartilaginous structure that This injury is biomechanically comparable to a total meniscectomy, leading to compromised hoop stressesresulting in decreased tibiofemoral contact area and increased contact pressures in the involved compartment.These changes are detrimental to the articular cartilage and . They often tend to be radial tears extending into the meniscal root. They often tend to be radial tears extending into the meniscal root. 7 Therefore, it is important for the radiologist to be familiar with the appearance of a recurrent tear versus an untorn postoperative meniscus. Torn lateral meniscus with superomedial and posterior flipped anterior horn. Absence of the meniscus results in a 200 to 300% increase in contact stresses on the articular surfaces.8The meniscus has a heterogeneous cellular composition with regional and zonal variation, with high proteoglycan content at the thin free edge where compressive forces predominate and low proteoglycan content at the thicker peripheral region where circumferential tensile loads predominate. No paralabral cyst. Direct intraarticular injection of 20-50 mL of dilute iodinated contrast is performed with rapid image acquisition using multidetector CT with high spatial resolution and multiplanar reformatted images. Results: Arthroscopic examination of the anterior horn of the lateral meniscus in all 22 patients was normal. Sagittal T2-weighted image (18A) demonstrates high T2 fluid signal in the medial meniscus posterior horn consistent with a recurrent tear (arrow). Interested in Group Sales? In these cases, MR arthrography may provide additional diagnostic utility. This emphasizes the importance of meniscal repair over meniscectomy when possible and the need for meniscal preservation when a partial meniscectomy is necessary. However, many clinicians opt to use conventional MRI as the initial postoperative imaging study and reserve MR arthrography for equivocal cases. Papalia R, Vasta S, Franceschi F, D'Adamio S, Maffulli N, Denaro V. Meniscal Root Tears: From Basic Science to Ultimate Surgery. This case is almost identical to the previous case with a different clinical history. On imaging alone, the radiologist may not be able to distinguish a residual tear (failed repair) from a recurrent tear in the same location. morphology but lacks its posterior attachments; ie, the meniscotibial 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. Of the 14 athletes, 8 repairs were performed, 5 patients . Semin Musculoskelet Radiol 2005;9(2):11624, Chung KS, Ha JK, Ra HJ, Nam GW, Kim JG. of the meniscus. Report The patient underwent partial medial meniscectomy and ACL reconstruction. 4. in 19916. Lee S, Jee W, Kim J. mesenchymal mass that differentiates into the tibia, femur, and Pagnani M, Cooper D, Warren R. Extrusion of the Medial Meniscus. Regardless of the imaging protocol chosen for evaluation of the postoperative meniscus, optimal imaging interpretation includes: The normal MRI appearance after partial meniscectomy is volume loss and morphologic change, commonly truncation or blunting of the meniscal free edge. However, recognizing these variants is important, as they can 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 . 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. Radiology. This article focuses on An intact meniscal repair was confirmed at second look arthroscopy. Disadvantages include risks associated with joint injection, radiation exposure and lower contrast resolution compared to MRI, particularly in the extraarticular soft tissues. Meniscal root tear. One of the most frequent indications for arthroscopic knee surgery is a meniscal tear.1 It is estimated that 1 million meniscus surgeries are performed in the U.S. annually with 4 billion dollars in associated direct medical expenditures.2 Meniscal surgeries include partial meniscectomy, meniscal repair and meniscal replacement. A tear was found and the repair was revised at second look arthroscopy. For DSR inquiries or complaints, please reach out to Wes Vaux, Data Privacy Officer, The meniscus root plays an essential role in maintaining the circumferential hoop tension and preventing meniscal displacement. 3 years later the sagittal proton density-weighted image (15B) shows a healed posterior horn (arrow) with a new flap tear in the medial meniscus anterior horn (arrowhead). It is located in the lateral portion of the knee interior of the knee joint. occur with minor trauma. 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. The incidence was calculated based on arthroscopic findings, and the potential secondary signs of meniscal ramp tears were evaluated on MRI. 22 year-old male with a history of ACL and MCL reconstruction and medial meniscus posterior root repair. Analytical, Diagnostic and Therapeutic Techniques and Equipment 13. separate the cavity. With age, increased connective tissue stiffness of the meniscus develops secondary to elastin degradation and collagen rigidification.2. Radial tears comprise approximately 15 % of tears in some surgical series [. varus deformity (Figure 3). Kijowski et al. Discoid lateral meniscus and the frequency of meniscal tears. The MRI sign of a radial tear is a linear, vertical cleft of abnormal high signal at the free edge (Fig. The posterior horn is always larger than the anterior horn. 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. Complex or deep radial tears were found in three of five cases of lateral meniscus extrusion and normal root. They may not even be apparent with an arthroscopic examination. 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 lateral meniscus is more circular, and its anterior and posterior horns are nearly equivalent in size in cross section. mimicking an anterior horn tear. the intercondylar notch, most commonly to the mid ACL, and less commonly (1A) Proton density-weighted, (1B) T2-weighted, and (1C) fat-suppressed T1-weighted MR arthrographic sagittal images are provided. Midterm results in active patients. CT arthrography is a recommended alternative for patients who are not MR eligible. This scan showed a radial MMT. The MFL was not observed in five (19%) of 26 studies of an LMRT. The patient underwent a successful partial medial meniscectomy and was encouraged to seek low-impact exercise. In children, sometimes an increased signal is seen within meniscus due to increased vascularity, but usually the signal does not contact articular surface. Problems encountered in a discoid medial meniscus are the same as a In contrast to the medial meniscus, the posterior horn of the lateral meniscus is additionally secured by the meniscofemoral ligaments (MFL). Findings indicate an intact meniscus following partial meniscectomy with normal intrameniscal signal. Sagittal PD (. incomplete breakdown of the central meniscus, but this is now disputed, The Wrisberg variant may present with a Lateral meniscus extrusion was present in six (23%) of 26 LMRTs and five (2.2%) of 231 patients with normal meniscus roots ( P < .001). 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. Discoid lateral meniscus. Discoid medial meniscus. 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 ]. Arthroscopy for Medial Meniscus Tears The decision to repair or remove the torn portion is made at the time of surgery. History of medial meniscus posterior horn and body partial meniscectomy. Associated anomalies in a discoid medial 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. 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. The post arthrogram view (13B) reveals gadolinium within the repair site. The self-reported complication rate for partial meniscectomy is 2.8% and meniscus repair is 7.6%. A tear of the meniscal root means the tear is near where it attaches to the bone, usually far in the back. This arises from the posterior horn of the lateral meniscus and attaches to the lateral aspect of the medial femoral condyle. Type 1: A complete slab of meniscal tissue with complete tibial coverage. ligaments are absent, most commonly the anterior cruciate ligament (ACL) A Magnetic resonance imaging (MRI) and computed tomography (CT) arthrography are both well suited for evaluation of these lesions though somewhat limited by cost and access for MRI and by invasiveness for CT arthrography . problem in practice. (as previously described), meniscal cyst,26 discoid lateral meniscus in the same knee (Figure 9),25 and pathologic medial patella plica.27. They are usually due to an acute injury [. Longitudinal (longitudinal, peripheral-vertical) tears run parallel to the circumference of the meniscus along its longitudinal axis, separating the meniscus into central and peripheral portions (Fig. The anterior root of the medial meniscus attaches to the anterior midline of the tibial plateau or sometimes the anterior surface of the tibia just below the plateau. Indications for meniscal repair typically include posttraumatic peripheral (red zone) longitudinal tears located near the joint capsule, ideally in younger patients (less than 40). Lateral meniscus tears of the posterior root are a common concomitant injury to anterior cruciate ligament (ACL) tears [6, 16, 20]. MRI features are consistent with torn lateral meniscus with flipped anterior horn superomedial and posterior, resting superior to the posterior horn. At the time the case was submitted for publication Mostafa El-Feky had no recorded disclosures. 5. Suprapatellar plica noticed, with no related cartilaginous erosions. Repair devices including arrows, darts and sutures are used to approximate the torn edges of the meniscus. 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. Generally, also found various MRI characteristics highly specific for detection of a recurrent tear including a line of intermediate-to-high signal or high signal through the meniscus extending into the articular surface on T2-weighted images with 95.8% specificity and change in the signal intensity pattern through the meniscus on intermediate weighted or T2-weighted images when compared to the baseline MRI with 98.2% specificity. Criteria for a recurrent tear after greater than 25% meniscectomy Definite surfacing T2 fluid signal (or high T1 signal isointense to intra-articular gadolinium on MR arthrography) on 2 or more images or displaced meniscal fragment.17 Definite surfacing fluid signal on only one image represents a possible tear.

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