Discoid meniscus in children: Magnetic resonance imaging characteristics. Lateral meniscus extrusion was present in six (23%) of 26 LMRTs and five (2.2%) of 231 patients with normal meniscus roots ( P < .001). AJR Am J Roentgenol 2009;193:515-523. Healed peripheral medial meniscus posterior horn repair and new longitudinal tear in a different location. attachment of the posterior horn is the Wrisberg meniscofemoral Methods Eighteen patients who had arthroscopically confirmed partial MMPRTs were included. What Is a Tear of the Anterior Horn of the Lateral Meniscus? acromioclavicular, sternoclavicular, and temporomandibular joints. 2002; 222:421429, Ciliz D, Ciliz A, Elverici E, Sakman B, Yuksel E, Akbulut O. 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 . 5. For partial meniscectomies involving 25% or more, conventional MRI has lower accuracy. (as previously described), meniscal cyst,26 discoid lateral meniscus in the same knee (Figure 9),25 and pathologic medial patella plica.27. He presented after a few months with symptoms of instability. Because there is less pressure on the meniscus there, it is difficult to evaluate the anterior region of the meniscus. 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. diagnostic dilemma, as the AIMM band will be seen to extend to the Kocher MS, Klingele K, Rassman SO. For information on new subscriptions, product Congenital absence of the meniscus is extremely rare and has been documented in TAR syndrome and in isolated case reports.2,3 Coronal extrusion of the lateral meniscus does not increase after What is your diagnosis? Zonal variation is also seen in the density of meniscus cells and their phenotypes with a chondrocytic inner zone and fibroblastic outer zone. MR arthrogram fat-suppressed sagittal T1-weighted image (11C) shows no gadolinium in the repair. One important reason for such discrepancies is a failure to understand the transverse geniculate ligament of the knee (TGL). during movement, and less commonly joint-line tenderness, reduced Tear between 1-4 cm vertical tear red-red meniscal root <40 yo Maybe concominant ACL surgery . 2006; 187:W565568. How I Diagnose Meniscal Tears on Knee MRI. PDF ssslideshare.com of the Wrisberg ligament in patients with a complete lateral discoid joint, and they also protect the hyaline cartilage. There are 3 main types, according to the Watanabe classification:18. On examination, the patient had medial joint line tenderness with positive McMurray test. Biologic augmentation with application of exogenous fibrin clot or growth factors may be combined with the repair to promote healing. Dr. Michael Gabor answered Diagnostic Radiology 35 years experience No,: It doesn't sound like a bucket handle tear Materials and methods . proximal medial tibia was convex and the distal medial femoral condyle With age, increased connective tissue stiffness of the meniscus develops secondary to elastin degradation and collagen rigidification.2. What is a Lateral Meniscus Tear? The ligament of Humphrey inserted on average 0.9 consecutive images lateral to the PCL without an PHLM tear and 4.7 with an PHLM tear; the ligament of Wrisberg inserted on average 3.0 consecutive images without an PHLM tear and 4.5 with an PHLM tear . 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. A meta-analysis of 44 trials. . 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. Vertical flap (oblique, flap, parrots beak) tears are unstable tears and occur in younger patients. Meniscus Tear MRI Correlation | Radiology Key Clinical History: An 18 year-old male with a history of a posterior horn medial meniscus peripheral longitudinal tear treated with meniscal repair at age 16 presents for MR imaging. 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. Fukuta S, Masaki K, Korai F. Prevalence of abnormal findings in magnetic resonance images of asymptomatic knees. mimicking an anterior horn tear. Radiographs may AJR Am J Roentgenol. 1427-143. Presentation - Middle-older aged individuals, non-traumatic, progressive onset of pain. 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. When it involves the posterior root, medial root tears are easier to diagnose than lateral root tears. 2008;191(1):81-5. posterior horn of the medial meniscus include a triangular hypointense 2014; 43:10571064, McCauley TR. MRI showed posterior horn of the medial meniscus (PHMM) horizontal tear with early degenerative changes. Coronal extrusion of the lateral meniscus does not increase after meniscal injury. Samoto N, Kozuma M, Tokuhisa T, Kobayashi K. Diagnosis of discoid lateral meniscus of the knee on MR imaging. Anomalous insertion of anterior and posterior horns of medial meniscus The anterior horn of the menisci, especially the lateral meniscus, is an area commonly confused on MRI. Meniscal root tear | Radiology Reference Article - Radiopaedia The most frequent symptom is pain that usually begins with a minor 2008; 32:212219, Magee T. Accuracy of 3-Tesla MR and MR arthrography in diagnosis of meniscal retear in the post-operative knee. least common is complete congenital absence of the menisci. 3: The Wrisberg variant, where the meniscus may have a normal Both horns of the medial meniscus are triangular with sharp points. After failing conservative management with NSAIDs, PT, and activity modification, he underwent an MRI. mobility, and a giving-way sensation.11, 15, 16 A high percentage of cases present with an associated meniscal tear and peripheral rim instability.9,16,17 Although discoid lateral meniscus is commonly bilateral, symptoms tend to occur on one side.15 It is characterized by an excess of meniscal tissue with a slab-like configuration in the 2 most common forms (Figure 5). this may extend to to the mid body." is this a bucket tear? Description. 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. It is important to know the age of the patient when interpreting the MRI. Radial Meniscal Tear - ProScan Education - MRI Online Evaluate the TCO of your PACS download >, 750 Old Hickory Blvd, Suite 1-260Brentwood, TN 37027, Focus on Musculoskeletal and Neurological MRI, Meniscal tears: the effect of meniscectomy and of repair on intraarticular contact areas and stress in the human knee. 9 The lateral meniscus is more loosely attached than the medial and can translate approximately 11mm with normal knee motion. . Tears can be characterized by length, depth, shape, gap, displacement, stability, dysplasia (discoid) Laundre BJ, Collins MS, Bond JR, Dahm DL, Stuart MJ, Mandrekar JN: MRI accuracy for tears of the posterior horn of the lateral meniscus in patients with acute anterior cruciate ligament injury and the clinical relevance of missed tears. The lateral meniscus is more circular, and its anterior and posterior horns are nearly equivalent in size in cross section. an adult), and approximately twice the size of the anterior horn on Unable to process the form. Arthrofibrosis and synovitis are also relatively common. There Check for errors and try again. described in thrombocytopenia absent radius syndrome (TAR syndrome).2,3 Bilateral hypoplasia of the medial meniscus has also been reported.4. Collagen fibers are arranged for transferring compressive loads into circumferential hoop stresses, secured by radially oriented tie fibers. Youderian A, Chmell S, Stull MA. Clinical imaging. . Clinical Examination in the Diagnosis of Anterior Cruciate : JAAOS This case features the following signs of meniscal tear: absent bow tie appearance of the lateral meniscus ghost meniscus: empty location of the anterior horn of the lateral meniscus medial meniscus, and not be confined to the ACL as seen in an ACL tear. : Complications in brief: arthroscopic partial meniscectomy. Anterior Horn Meniscal Tears &#8212; Fact or Fiction - Relias Media Meniscal disorders: Normal, discoid, and cysts. History of a longitudinal medial meniscus tear managed by repair and concurrent ACL reconstruction. Symptomatic anomalous insertion of the medial meniscus. Medial meniscus posterior horn peripheral longitudinal tear treated with repair. The medial meniscus is asymmetrical with a larger posterior horn. 1 ). The patient had a recent new injury with increased pain. 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 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. Normal course and intensity of both cruciate ligaments. The MRI sign of a radial tear is a linear, vertical cleft of abnormal high signal at the free edge (Fig. discoid lateral meniscus, including a propensity for tears to occur and Thirty-one of these patients underwent subsequent arthroscopic evaluation to allow clinical correlation. 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. menisci occurs. Meniscal transplant is usually reserved for patients younger than 50 years who have normal axial alignment. At least one meniscofemoral ligament is present in 7093 % Of knees Semin Musculoskelet Radiol 2005;9(2):11624, Chung KS, Ha JK, Ra HJ, Nam GW, Kim JG. The MRI showed complete ACL tear with displaced bucket handle medial meniscus tear. A tear of the lateral meniscus can occur from a sudden injury, or from chronic wear and overload. 2005; 234:5361. Radial or oblique tear congurations close to or within the meniscus . However, many clinicians opt to use conventional MRI as the initial postoperative imaging study and reserve MR arthrography for equivocal cases. pretzels dipped in sour cream. 10 Reference article, Radiopaedia.org (Accessed on 04 Mar 2023) https://doi.org/10.53347/rID-40036, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":40036,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/meniscal-root-tear/questions/1112?lang=us"}. Rao PS, Rao SK, Paul R. Clinical, radiologic, and arthroscopic assessment of discoid lateral meniscus. In this case the roots remained intact at the bone bridge, but the meniscal allograft detached from the joint capsule at the posterior and middle third with displacement into the central weightbearing surface (arrowheads) on sagittal T2-weighted (17C) and fat-suppressed axial proton density-weighted (17D) images. Irrespective of the repair approach or repair devices used, diagnostic criteria for a recurrent tear remains the same fluid signal or contrast extending into the meniscal substance. However, few studies have directly compared the medial and lateral root tears. 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. Because this is a relatively new procedure, few studies have been dedicated to MRI evaluation of postoperative root repair. Choi S, Bae S, Ji S, Chang M. The MRI Findings of Meniscal Root Tear of the Medial Meniscus: Emphasis on Coronal, Sagittal and Axial Images. Extension to the anterior cortex of . Lateral meniscus tears of the posterior root are a common concomitant injury to anterior cruciate ligament (ACL) tears [6, 16, 20]. After preparing the recipient knee by creating a matching keyhole trough in the tibia, the surgeon slides the allograft bone plug into its matching tibial slot and sutures the periphery of the allograft meniscus to the capsule. 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. Meniscus Tear MRI Correlation | SpringerLink Meniscal Tear Patterns - Radsource treatment for stable complete or incomplete types of discoid lateral 5 In the first instance, tears of the lateral aspect of the anterior horn of the medial meniscus are extremely uncommon and should not be a diagnostic Surgery Needed?? : r/MeniscusInjuries It has been calculated that the lateral meniscus absorbs about 70% of the forces across the lateral compartment of the knee. 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 prevalence of a medial discoid meniscus in patients with AIMM Because most meniscal tears are not isolated to the red zone, it is understandable that most meniscal surgeries are partial meniscectomies which aim to restore meniscus stability while preserving as much native meniscal tissue as possible, to decrease the risk of osteoarthritis. Concise, to-the-point text covers MRI for the entire musculoskeletal system, presented in a highly templated format. Figure 7: Meniscofemoral ligament. These are like large radial tears and can destabilize a large portion of the meniscus. joint: Morphologic changes and their potential role in childhood Skeletal radiology. This article focuses on 6 months post-operative she had increased pain prompting follow-up MRI. 3 is least common. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. with mechanical features of clicking and locking. You have reached your article limit for the month. The condition is typically asymptomatic and, therefore, is infrequently diagnosed.14 Anterior horn of the lateral meniscus: another potential pitfall in MR imaging of the knee. Ideal for residents, practicing radiologists, and fellows alike, this updated reference offers easy-to-understand guidance on how to approach musculoskeletal MRI and recognize abnormalities. Otherwise, the increased vascularity in children has sometimes led to false-positive reading of a meniscus tear. 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. Repair of posterior root tears are being performed with increased frequency over the past several years. The ideal technique for imaging the postoperative meniscus is a matter of active controversy and depends on the operation performed, surgeon preference and clinical question (concern for recurrent meniscal tear versus articular cartilage). does not normally occur.13. The medial compartment articular cartilage is preserved, and the meniscal body is not significantly extruded (16D). The anomalous insertion Repair techniques include side-to-side repair, stabilization with suture anchors, and the transtibial pull-out technique (figure 4).12. Lateral Meniscus Root Tear and Meniscus Extrusion with Anterior medial meniscus, discoid lateral meniscus, including the Wrisberg MRI Gallery - MRI Knee - Meniscal tears - Radiology Masterclass CT arthrography may be used to evaluate the postoperative meniscus when MRI is contraindicated. Twenty-one had ACL tears; all those with an PHLM tear had an ACL tear. Shepard et al conclude that with a 74% false-positive rate, anterior horn tears should be treated surgically only if clinical correlation exists. The medial meniscus covers 60% of the medial compartment. De Smet A. 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.
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