70 year-old female with history of medial meniscus posterior horn radial tear. Knee Surg Sports Traumatol Arthrosc. Again, this emphasizes the importance of accurate history, prior imaging and operative reports. Complex or deep radial tears were found in three of five cases of lateral meniscus extrusion and normal root. Considered a feature of knee osteoarthritis. The medial compartment articular cartilage is preserved, and the meniscal body is not significantly extruded (16D). 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. Lateral meniscus tears of the posterior root are a common concomitant injury to anterior cruciate ligament (ACL) tears [6, 16, 20]. The meniscus may also become hypertrophic. trauma; however, other symptoms include clicking, snapping, and locking Continuous meniscal tissue bridged the anterior and posterior horns of the lateral meniscus on 3 consecutive sagittal slices (Figure 1B). When interpreting MR images of the knee, it is important to assess for any change from the expected shape of the menisci. If a horizontal tear involves a long segment of the meniscus, the central fragment may displace centrally from the peripheral portion of the meniscus [, Bucket handle tears (BHT) often cause pain and mechanical symptoms, such as locking, catching, and giving way [. 300). 3. Radial tears comprise approximately 15 % of tears in some surgical series [. 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). The incidence of lateral meniscus posterior root tears was approximately 4 times higher than of medial meniscus posterior root tears in both primary (12.2% vs 3.2%) and revision (20.5% vs 5.6%) ACLRs. Pre-operative fat supressed coronal proton density-weighted image (19A) demonstates a posterior root radial tear (arrow). The camera can visualize the meniscus and other structures within the knee. A classification system developed by the International Society of Arthroscopy, Knee Surgery, and Orthopedic Sports Medicine [, Longitudinal-vertical tear. 4). The fat-suppressed sagittal T1-weighted post arthrogram view (7C) demonstrates gadolinium extending into the meniscal substance. Otherwise, the increased vascularity in children has sometimes led to false-positive reading of a meniscus tear. Sagittal PD (. 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. Results: Arthroscopic examination of the anterior horn of the lateral meniscus in all 22 patients was normal. However, few studies have directly compared the medial and lateral root tears. 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. Is sport activity possible after arthroscopic meniscal allograft transplantation? Medial meniscus bucket handle tears can result in a double PCL sign. A tear of the lateral meniscus can occur from a sudden injury, or from chronic wear and overload. meniscus are not uncommon; they include an anomalous insertion of the 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. With age, increased connective tissue stiffness of the meniscus develops secondary to elastin degradation and collagen rigidification.2. 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. 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. MRI Findings: Medial meniscus: Tear of the posterior horn seen to the inferior articular surface continuing into the posterior body and becoming more vertical. Methods Eighteen patients who had arthroscopically confirmed partial MMPRTs were included. 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 Comparison of Postoperative Antibiotic Regimens for Complex Appendicitis: Is Two Days as Good as Five Days? 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. The MRI showed complete ACL tear with displaced bucket handle medial meniscus tear. The congenitally absent meniscus appears to influence the development Arthroscopy revealed a horizontal tear of PHMM, and a partial medial meniscectomy was performed. The posterior cruciate ligament is intact. . When it involves the posterior root, medial root tears are easier to diagnose than lateral root tears. Type 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. 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. In the previously reported cases, as well as in this case, the However, many clinicians opt to use conventional MRI as the initial postoperative imaging study and reserve MR arthrography for equivocal cases. the medial meniscus. Clin Orthop Relat Res 2012; 470: pp. The meniscal repair is intact. In does not normally occur.13. Direct and indirect MR arthrography have been shown to be superior to conventional MRI for detection of recurrent meniscal tears in greater than 25% partial meniscectomies and meniscal repairs; however, conventional MRI is commonly used for initial evaluation of the postoperative meniscus with MR arthrography reserved for equivocal cases. problem in practice. Discoid medial meniscus. Anterior tibial marrow edema and organized trabecular fracture measuring 16 mm AP, 18 mm transverse. Meniscus repair is superior to partial meniscectomy in preventing osteoarthritis and facilitating return to athletic activity.11 However, the period of postoperative immobilization and activity restriction associated with meniscus repair is longer than that associated with partial meniscectomy and requires a compliant, motivated patient to be successful. Clark CR, Ogden JA. Most horizontal tears extend to the inferior articular surface. rim circumferentially, anteriorly, and posteriorly,19 which Among these 26 studies of an LMRT . Anomalous Lateral meniscus bucket handle tears can produce the double anterior horn sign or double ACL sign. MRI showed posterior horn of the medial meniscus (PHMM) horizontal tear with early degenerative changes. There is a medial and a lateral meniscus. Presentation - Middle-older aged individuals, non-traumatic, progressive onset of pain. The Wrisberg variant may present with a Sagittal proton density-weighted image (6A) through the medial meniscus following partial meniscectomy and debridement of the inferior articular surface shows increased PD signal contacting the inferior articular surface (arrow) but no T2 fluid signal at the surgical site (6B) and no gadolinium signal in the meniscus (6C). Copy. The most important clinical concern at the time of MRI imaging is often high-grade articular cartilage loss. Lee, J.W. asymptomatic, although there is a greater propensity for discoid menisci Rao PS, Rao SK, Paul R. Clinical, radiologic, and arthroscopic assessment of discoid lateral meniscus. An MRI of plaintiff's left knee conducted in May 2018 demonstrated a complex 7 tear of the posterior horn of the lateral meniscus and a suspected horizontal tear of the anterior horn of the lateral meniscus. Fat supressed coronal proton density-weighted (19C, D) and sagittal proton density-weighted (19E) images demonstrate postoperative changes from interval posterior horn partial meniscectomy with a thin rim of posterior horn remaining (arrow) and subchondral fractures in the medial femoral condyle and medial tibial plateau (arrowheads) with marked progression of full-thickness chondral loss in the medial compartment and extruded meniscal tissue. Disadvantages include patient discomfort, increased cost, physician time needed for the procedure and radiation exposure during fluoroscopy. You have reached your article limit for the month. 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. It is often explained by fibers of the anterior cruciate ligament and the covering synovium . include hypoplastic menisci, absent menisci, anomalous insertion of the 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. The anterior horn of the menisci, especially the lateral meniscus, is an area commonly confused on MRI. Disadvantages include increased cost, increased patient time, potential for adverse reactions to contrast agent compared to conventional MRI and lack of joint distention. Meniscal root tears are defined as radial tears located within 1 cm from the meniscal attachment or a bony rootavulsion. For DSR inquiries or complaints, please reach out to Wes Vaux, Data Privacy Officer, 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. 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. Lateral meniscus posterior horn peripheral longitudinal tear managed by repair. Tears instance, tears of the lateral aspect of the anterior horn of the In these cases, thin-section or well-placed axial images confirm that the tear is not a simple radial tear but rather a vertical flap tear (Fig. pivoting). Both horns of the medial meniscus are triangular with sharp points. A Study of Retrieved Allografts Used for ACL Surgery, Long-Term Results of Meniscus Allograft Transplantation with Concurrent ACL Reconstruction, Anterior Horn Meniscal Tears — Fact or Fiction, How Triathletes Can Use Cycling Cadence to Maximize Running Performance, Pharmacology Watch: HRT - Position Paper Places Benefits in Question, Clinical Briefs in Primary Care Supplement. Anterior horn of the lateral meniscus: another potential pitfall in MR imaging of the knee. Mechanical rasping or trephination of the torn meniscus ends and parameniscal synovium is used to promote bleeding and vascular healing. On MRI, they exhibit abnormal horizontal linear signal contacting the inferior articular surface near the free edge or less commonly the superior surface. The anterior and posterior meniscofemoral ligaments (Humphrey and Wrisberg respectively) are commonly present with one or both found in 93-100% of patients. Anatomic variability and increased signal change in this area are commonly mistaken for tears. Kim SJ, Moon SH, Shin SJ. The patient underwent a successful partial medial meniscectomy and was encouraged to seek low-impact exercise. Report At surgery, the torn part of the meniscus was in the intercondylar notch and chewed up and not amenable to repair. According to these authors, increased signal to the surface on only one slice should be interpreted as a possible tear. Cases of only one abnormal slice correlated to tears at arthroscopy 55 % of the time for the medial meniscus and 30 % for the lateral [, Accuracy of diagnosing meniscus tear with these criteria has been good. congenital absence of the cruciate ligaments. 2006; 88:660667, Boutin RD, Fritz RC, Marder RA. The intrameniscal ligament where it diverges from the back of the anterior horn of the lateral meniscus is also a common area misinterpreted as a tear. It affects 4% to 5% of the patient population,6-9 with a much higher incidence, up to 13%, in the Asian patient population.10 It is the most common meniscal variant in children.11 A slightly overweight 44-year-old male sought evaluation for medial knee pain that persisted for months after running on the beach. As a result, the accuracy rate of diagnosis by MRI is 83.3%. The tear was treated by partial meniscectomy at second surgery. Type 2: An incomplete slab of meniscal tissue with 80% coverage of the lateral tibial plateau. This emphasizes the importance of baseline MRI comparison for evaluation of the postoperative meniscus.3. reported.4. MRI has high sensitivity and specificity for detecting meniscus tears in patients without prior knee surgery. What is your diagnosis? Ross JA,Tough ICK, English TA. Anterior lateral cysts extended . 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. The incidence was calculated based on arthroscopic findings, and the potential secondary signs of meniscal ramp tears were evaluated on MRI. Problems encountered in a discoid medial meniscus are the same as a Youderian A, Chmell S, Stull MA. At second look arthroscopy, the posterior horn tear was healed and the anterior horn tear was found to be unstable and treated by partial meniscectomy. The ends of the anterior and posterior horns are firmly attached to the tibia at their roots. The anterior and posterior meniscofemoral ligaments (Humphrey and Wrisberg respectively) are commonly present with one or both found in 93-100% of patients.9 The lateral meniscus is more loosely attached than the medial and can translate approximately 11mm with normal knee motion.10. of a case of discoid medial cartilage, with an embryological note. 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 . Most lateral meniscal tears are due to twisting or turning activities or falls. 2014; 43:10571064, McCauley TR. It has been calculated that the lateral meniscus absorbs about 70% of the forces across the lateral compartment of the knee. Lateral meniscal variant with absence of the posterior coronary ligament. Increased intrameniscal signal is commonly seen in the transplanted allograft but does not correlate with clinical outcome. intra-articular structures at 8 weeks gestation. 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 This case is almost identical to the previous case with a different clinical history. There On the fat-supressed proton density-weighted coronal (17A) and axial (17B) images, notice the trapazoidal shaped bone bridge (arrow) placed in the tibial slot with menscal allograft attached at the anterior and posterior roots. The anterior horn inserts on the tibia and continues laterally to the anterior horn of the lateral meniscus via the transverse intermeniscal ligament. At 1 year, 5 of 6 were completely asymptomatic with the remaining patient minimally painful with no suggestion of meniscal symptoms. Fat suppressed sagittal T1-weighted MR arthrogram (5C) demonstrates gadolinium within the tear (arrow). Exam showed a mild effusion and medial joint line tenderness. MRI features are consistent with torn lateral meniscus with flipped anterior horn superomedial and posterior, resting superior to the posterior horn. Cho JM, Suh JS, Na JB, et al. show cupping of the medial tibial plateau, proximal medial tibial physis It can be divided into five segments: anterior horn, anterior, middle and posterior segments, and posterior horn.
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