Indications for a partial meniscectomy include meniscal tears not amenable to repair which includes non-peripheral tears with a horizontal, oblique or complex tear pattern and nontraumatic tears in older patients. Surgery is useful if they are unstable and flipping in and out of the joint causing pain. 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 . ligament will help to exclude these conditions.5 In the first My own experience has been similar and I make it a policy not to recommend surgery based on this diagnosis alone without good clinical correlation. While this test will show a tear up to 90% of the time, it does not always. the rare ring-shaped meniscus, to the classification. This is a critical differentiation because the latter represents meniscal tears that can be 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. 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. Am J Sports Med. Interested in Group Sales? Torn lateral meniscus with superomedial and posterior flipped anterior horn. No paralabral cyst. morphology. menisci (Figure 8). The patient subsequently underwent successful partial medial meniscectomy. Arthroscopy for Medial Meniscus Tears The decision to repair or remove the torn portion is made at the time of surgery. A meniscus is a crescent-shaped fibrocartilaginous structure that In The articular cartilage is well seen on the pre-operative sagittal proton density-weighted image (19B). varus deformity (Figure 3). may simulate a peripheral tear (Figure 6).23 The only 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. Papalia R, Vasta S, Franceschi F, D'Adamio S, Maffulli N, Denaro V. Meniscal Root Tears: From Basic Science to Ultimate Surgery. De Smet A. This patient had relief after the initial repair surgery, then had a second injury with recurrent symptoms, which is why the surgeon felt this was a recurrent tear. 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. St. Louis County's newspaper of politics and culture Meniscus tears, indicated by MRI, are classified in three grades. That reported case was also associated with Radiology. 4. [emailprotected]. 2008;191(1):81-5. Arthroscopy is considered gold standard in the diagnosis of knee ligament injuries, with diagnostic accuracy up to 94% [1], [2]; and can be used therapeutically as well. View Mostafa El-Feky's current disclosures, see full revision history and disclosures, Flipped meniscus - anterior horn lateral meniscus, Disproportionate posterior horn sign (meniscal tear). show cupping of the medial tibial plateau, proximal medial tibial physis the medial meniscus. Clinical imaging. 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. 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. Get unlimited access to our full publication and article library. The remaining 42 cases were located in the red zone (19 cases) or the red-white zone. At the time the case was submitted for publication Mostafa El-Feky had no recorded disclosures. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Lateral meniscal variant with absence of the posterior coronary ligament. Biologic augmentation with application of exogenous fibrin clot or growth factors may be combined with the repair to promote healing. 1427-143. Schwenke M, Singh M, Chow B Anterior Cruciate Ligament and Meniscal Tears: A Multi-modality Review. The MFL was not observed in five (19%) of 26 studies of an LMRT. Discoid lateral meniscus. The sensitivity of mri in detecting meniscal tears is generally good, ranging from 70-98%, with specificity in the same range in many studies. joint: Morphologic changes and their potential role in childhood 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. 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. Direct MR arthrography requires intraarticular injection of 20-50 mL of dilute gadolinium contrast prior to imaging which distends the joint capsule and offers a high signal to noise ratio on T1-weighted images with contrast extension into the meniscal substance indicating a recurrent tear or an unhealed repair. 2006;239(3):805-10. Fellowship-trained musculoskeletal radiologists read 99% of the MRIs. Most horizontal tears extend to the inferior articular surface. hypoplastic meniscus was not the cause of the patients pain, suggesting Comparison of Postoperative Antibiotic Regimens for Complex Appendicitis: Is Two Days as Good as Five Days? The meniscus is two crescent-shaped, thick pieces of cartilage that sit in the knee between the tibia and the femur. Examination of the knee showed a mild effusion, 1+ Lachman, positive Pivot shift, and mild tenderness to both medial and lateral joint lines. 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. The post arthrogram view (13B) reveals gadolinium within the repair site. On sagittal proton-density and T2-weighted images, this lesion was demonstrated by sensitive but nonspecific signs, such as the flipped meniscus . anterior horn of the medial meniscus into the anterior cruciate ligament Knee Surg Sports Traumatol Arthrosc. A 23-year-old female presented with a 2-month history of catching and pain in the knee when arising from a squatting position. Extrusion is commonly seen following root repair. Generally, 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). Pinar H, Akseki D, Karaoglan O, et al. The posterior cruciate ligament is intact. 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. After failing conservative management with NSAIDs, PT, and activity modification, he underwent an MRI. A displaced longitudinal tear is a "bucket handle" tear. Sagittal proton density-weighted image (9A) demonstrates no high signal abnormality. normal knee. Meniscal disorders: Normal, discoid, and cysts. described in thrombocytopenia absent radius syndrome (TAR syndrome).2,3 Bilateral hypoplasia of the medial meniscus has also been reported.4. 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. He presented after a few months with symptoms of instability. 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 The congenitally absent meniscus appears to influence the development 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 [. 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. Type 1: A complete slab of meniscal tissue with complete tibial coverage. How I Diagnose Meniscal Tears on Knee MRI. Tibial meniscal dynamics using three-dimensional reconstruction of magnetic resonance images. be misinterpreted for more significant pathology on MRI. The Journal of bone and joint surgery American volume. Type (PubMed: 17114506), BakerJC, FriedmanMV, RubinDA (2018) Imaging the postoperative knee meniscus: an evidence-based review. The medial meniscus is asymmetrical with a larger posterior horn. 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. Following partial meniscectomy, the knee is at increased risk for osteoarthritis. Longitudinal medial meniscus tear managed by repair (arrow). Discoid lateral meniscus of the knee joint: Nature, mechanism, and operative treatment. The patient underwent a successful partial medial meniscectomy and was encouraged to seek low-impact exercise. Anatomic variability and increased signal change in this area are commonly mistaken for tears. Analytical, Diagnostic and Therapeutic Techniques and Equipment 13. On this page: Article: Epidemiology Pathology Radiographic features History and etymology Check for errors and try again. Meniscal tears are common and often associated with knee pain. > 20% ratio of meniscus to tibia on the coronal image; Minimum diameter 14-15 mm on a midcoronal image; 75% 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. Discoid medial menisci are much less common than discoid lateral menisci,24 and they may be bilateral. In cases like this, MR arthrography is quite helpful. Repair devices including arrows, darts and sutures are used to approximate the torn edges of the meniscus. MRI plays a critical role in influencing the treatment decision and enables information that would obviate unnecessary surgery including diagnostic arthroscopy. Sometimes T2 signal in a healed tear may look similar to fluid. 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 The meniscus is diffusely vascularized in early life but in adults, only 10-30% of the peripheral meniscus is vascularized, often referred to as the red zone. meniscus is partial meniscal excision, leaving a 6- to 7-mm peripheral When interpreting MR images of the knee, it is important to assess for any change from the expected shape of the menisci. patella or Hoffas fat pad, and should be fairly easily differentiated and ACL tears can be mistaken for AIMM, but carefully tracing the There was no history of a specific knee injury. There was no evidence of meniscal extrusion or a meniscal ghost sign (Fig. Anterior horn of the lateral meniscus: another potential pitfall in MR imaging of the knee. 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. An intact meniscal repair was confirmed at second look arthroscopy. Sagittal proton density-weighted image (8A) through the medial meniscus demonstrates signal extending to the tibial surface (arrow). Media community. Recent evidence suggests that decreased extrusion may correlate to better clinical outcomes.18. Radial or oblique tear congurations close to or within the meniscus . Evaluation of postoperative menisci with MR arthrography and routine conventional MRI. Dr. Michael Gabor answered Diagnostic Radiology 35 years experience No,: It doesn't sound like a bucket handle tear 2a, 2b, 2c). Unable to process the form. Among these 26 studies of an LMRT . 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. 5. Renew or update your current subscription to Applied Radiology. Synopsis: In a consecutive series of nearly 1000 knee MRIs, there was a 74% false-positive rate for the diagnosis of anterior horn meniscal tears.
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