History of a longitudinal medial meniscus tear managed by repair and concurrent ACL reconstruction. snapping knee due to hypermobility. The patient underwent a successful partial medial meniscectomy and was encouraged to seek low-impact exercise. The condition is typically asymptomatic and, therefore, is infrequently diagnosed.14 The tear was treated by partial meniscectomy at second surgery. At the time the case was submitted for publication Mostafa El-Feky had no recorded disclosures. However, the use of MRI arthrography should be considered for post-operative menisci with equivocal findings on conventional MRI as the presence of high gadolinium-like signal within the meniscus would allow for a definitive diagnosis of re-tear. Generally, ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. does not normally occur.13. 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. After failing conservative management with NSAIDs, PT, and activity modification, he underwent an MRI. Extension to the anterior cortex of . It can be divided into five segments: anterior horn, anterior, middle and posterior segments, and posterior horn. They maintain a relatively constant distance from the periphery of the meniscus [. Meniscal tears are common and often associated with knee pain. Kim SJ, Choi CH. measurements of the posterior horn of the medial meniscus may vary, but When bilateral, they are usually symmetric. Mechanical rasping or trephination of the torn meniscus ends and parameniscal synovium is used to promote bleeding and vascular healing. 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. Complex or deep radial tears were found in three of five cases of lateral meniscus extrusion and normal root. The MRI revealed a vertical flap (oblique) tear of the medial meniscus. Anatomic variability and increased signal change in this area are commonly mistaken for tears. Stay up to date with the latest in Practical Medical Imaging and Management with Applied Radiology. appearance.12 It is now believed that the knee develops from a Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Posterior Instability and Labral Pathology, Imaging Evaluation of the Painful or Failed Shoulder Arthroplasty, Other Entities: PLRI, HO, Triceps, and Plica, MRI-Arthroscopy Correlations in the Overhead Athlete, Acetabular Fossa, Femoral Fovea, and the Ligamentum Teres. The congenitally absent meniscus appears to influence the development 7 Therefore, it is important for the radiologist to be familiar with the appearance of a recurrent tear versus an untorn postoperative meniscus. MRI features are consistent with torn lateral meniscus with flipped anterior horn superomedial and posterior, resting superior to the posterior horn. Type Tachibana Y, Yamazaki Y, Ninomiya S. Discoid medial meniscus. There was no evidence of meniscal extrusion or a meniscal ghost sign (Fig. ligament, and the posterior horn may translate or rotate due to For partial meniscectomies involving 25% or more, conventional MRI has lower accuracy. 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. The meniscus is two crescent-shaped, thick pieces of cartilage that sit in the knee between the tibia and the femur. With age, increased connective tissue stiffness of the meniscus develops secondary to elastin degradation and collagen rigidification.2. For DSR inquiries or complaints, please reach out to Wes Vaux, Data Privacy Officer, 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. MR criteria for discoid lateral menisci are used for discoid medial What is a Lateral Meniscus Tear? pretzels dipped in sour cream. It is believed that discoid It has been calculated that the lateral meniscus absorbs about 70% of the forces across the lateral compartment of the knee. At 1 year, 5 of 6 were completely asymptomatic with the remaining patient minimally painful with no suggestion of meniscal symptoms. 3. 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. A recurrent tear was proved at second look arthroscopy. 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. This scan showed a radial MMT. Youderian A, Chmell S, Stull MA. In this case, we can determine that there is a new tear in a different location. Radiographs are usually not diagnostic, but they may show a 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. This case features the following signs of meniscal tear: Case courtesy, Prof. Dr. Khaled Matrawy, Professor of radiology, Alexandria university, Egypt. 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. It is often explained by fibers of the anterior cruciate ligament and the covering synovium . Lee, J.W. Knee Surg Sports Traumatol Arthrosc 2011; 19:147157, Gwathmey F.W., Golish S.R., Diduch D.R., et al: Complications in brief: meniscus repair. History of longitudinal medial meniscus tear managed by meniscal repair (arrows). an adult), and approximately twice the size of the anterior horn on Another MRI was later performed due to worsening symptoms, and demonstrated a bucket-handle tear with complete anterior luxation of the posterior horn of the left lateral meniscus (Figs. MR imaging evaluation of the postoperative knee. 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). The medial meniscus is asymmetrical with a larger posterior horn. Because there is less pressure on the meniscus there, it is difficult to evaluate the anterior region of the meniscus. The sutures are tied over a cortical fixation device or Endobutton (short arrow) with the knee flexed at 90 to secure the root repair. The diagnosis of tears of the anterior horn of the meniscus by magnetic resonance imaging (MRI) is sometimes different from that obtained by arthroscopic examination. In children, sometimes an increased signal is seen within meniscus due to increased vascularity, but usually the signal does not contact articular surface. The trusted source for healthcare information and CONTINUING EDUCATION. ligaments and menisci causing severe knee dysplasia in TAR syndrome. small meniscus is also seen in the wrist joint. The most frequent symptom is pain that usually begins with a minor 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"}. Relevant clinical history, prior imaging and use of operative reports will significantly improve accuracy of post-operative interpretations. hypoplastic meniscus was not the cause of the patients pain, suggesting The insertion site A meta-analysis of 44 trials. Meniscal root tear. 2006; 187:W565568. The MRI sign of a radial tear is a linear, vertical cleft of abnormal high signal at the free edge (Fig. Sagittal proton density-weighted image (10A) demonstrates increased signal extending to the articular surface consistent with granulation tissue. Thompson WO, Thaete FL, Fu FH, Dye SF. Bilateral discoid medial menisci: Case report. ADVERTISEMENT: Supporters see fewer/no ads. Discoid medial menisci are much less common than discoid lateral menisci,24 and they may be bilateral. be misinterpreted for more significant pathology on MRI. patella or Hoffas fat pad, and should be fairly easily differentiated 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. to the base of the ACL or the intercondylar notch. 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 [. Intensity of signal contacting meniscal surface in recurrent tears on MR arthrography compared with that of contrast material. History of medial meniscus posterior horn and body partial meniscectomy. MR arthrogram fat-suppressed sagittal T1-weighted image (11C) shows no gadolinium in the repair. treatment for stable complete or incomplete types of discoid lateral This article focuses on Examination of the knee showed a mild effusion, 1+ Lachman, positive Pivot shift, and mild tenderness to both medial and lateral joint lines. Meniscal transplants can fail at the implantation site by avulsion, failure of bone plug incorporation or bone bridge fracture. Presentation - Middle-older aged individuals, non-traumatic, progressive onset of pain. 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. Tear between 1-4 cm vertical tear red-red meniscal root <40 yo Maybe concominant ACL surgery . There Comparison of Postoperative Antibiotic Regimens for Complex Appendicitis: Is Two Days as Good as Five Days? {"url":"/signup-modal-props.json?lang=us"}, Weerakkody Y, Baba Y, Knipe H, et al. We hope you found our articles Unable to process the form. Radiology. of the anterior horn of the medial meniscus, an inferior patella plica, Menisci ensure normal function of the Weight-bearing knee X-rays showed a 50 % narrowing in the medial compartment. Clin Orthop Relat Res 2013; 471: pp. Sometimes T2 signal in a healed tear may look similar to fluid. (middle third), or Type 3 (superior third; intercondylar notch) (Figure A displaced longitudinal tear is a "bucket handle" tear. Singh K, Helms CA, Jacobs MT, Higgins LD. 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. Conventional MRI imaging of the postop meniscus offers a noninvasive evaluation of the knee, but postoperative changes can mimic a recurrent or residual meniscus tear. 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? Anterior tibial marrow edema and organized trabecular fracture measuring 16 mm AP, 18 mm transverse. is affected. 2005; 234:5361. However, few studies have directly compared the medial and lateral root tears. However, many clinicians opt to use conventional MRI as the initial postoperative imaging study and reserve MR arthrography for equivocal cases. noted to be diminutive, with the posterior horn measuring 7 mm to 8 mm. Both the healed peripheral tear and the new central tear were proved at second look arthroscopy. The meniscal repair is intact. Arthroscopy evaluation found a lateral meniscus peripheral (red-white zone) longitudinal tear. To assess the prevalence of meniscal extrusion and its . The lateral . A new longitudinal tear has occurred more centrally in the meniscus (arrowhead) with linear high signal extending to the tibial and femoral surfaces as well as fluid signal and gadolinium contrast in the defect. 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. > 20% ratio of meniscus to tibia on the coronal image; Minimum diameter 14-15 mm on a midcoronal image; 75% And, some tears do not fill with contrast during arthrography. 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. RESULTS. Magnetic resonance imaging of the postoperative meniscus: resection, repair, and replacement. ligament and meniscal fascicles. that this rare condition is also clinically asymptomatic. Forty-five of the remaining patients did not undergo surgery but did undergo clinical follow-up and interview at a minimum of 1 year after the MRI to determine if they had any residual symptoms or if they received further medical treatment. 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. Media community. 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 surgery is common and requires accurate post-operative imaging interpretation to guide the treatment approach. A 2003 systematic review of the literature, in which 29 publications met strict inclusion criteria, demonstrated pooled weighted sensitivity and specificity of 93.3 % and 88.4 % for the medial meniscus and 79.3 % and 95.7 % for the lateral meniscus, respectively [, Most meniscal tears are visible and best seen on sagittal images. Cho JM, Suh JS, Na JB, et al. The torn edges are aligned, and stable fixation applied with sutures or bioabsorbable implants at approximately 5 mm intervals. Discoid lateral meniscus in children. In the previously reported cases, as well as in this case, the Case study, Radiopaedia.org (Accessed on 04 Mar 2023) https://doi.org/10.53347/rID-75066. Normal The symptoms 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. Meniscal root tears are a form of radial tear that involves the central attachment of the meniscus (12a). (Figure 1). Sagittal proton density-weighted image (5A) through the medial meniscus at age 12 shows the initial horizontal tear in the posterior horn (arrow) subsequently treated with partial meniscectomy. The lateral meniscus is produced by the varus tension and tibial IR. Normal menisci. Variations in meniscofemoral ligaments at anatomical study and MR imaging. Because this is a relatively new procedure, few studies have been dedicated to MRI evaluation of postoperative root repair. slab-like configuration on sagittal MR images, with > 3 bowties 2a, 2b, 2c). Lateral meniscus extrusion was present in six (23%) of 26 LMRTs and five (2.2%) of 231 patients with normal meniscus roots ( P < .001). They are most frequently seen at the posterior horn of the medial meniscus. On examination, the patient had medial joint line tenderness with positive McMurray test. Tears in the red zone have the potential to heal and are more amenable to repair. frequently. Longitudinal lateral meniscus tear status post repair (arrow). MRI features are consistent with torn lateral meniscus with flipped anterior horn superomedial and posterior, resting superior to the posterior horn. meniscal injury. Volunteerism and Sports Medicine: Where do We Stand? Pagnani M, Cooper D, Warren R. Extrusion of the 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 ].