Atypically thick and high location 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). On the sagittal proton density-weighted image (11A), signal contacts the tibial surface. posterior fascicles and meniscotibial ligament are absent and a high MRI c spine / head jxn - they can have stenosis of foramen magnum . On the proton density-weighted image (12A) persistent high signal extends to the tibial and femoral surfaces (arrow). MR criteria for discoid lateral menisci are used for discoid medial Congenital discoid cartilage. What is your diagnosis? ; Lee, S.H. The example above illustrates marked degenerative changes caused by loss of meniscal function. The MRI revealed a vertical flap (oblique) tear of the medial meniscus. You can use Radiopaedia cases in a variety of ways to help you learn and teach. Complex or deep radial tears were found in three of five cases of lateral meniscus extrusion and normal root. Thirty-one of these patients underwent subsequent arthroscopic evaluation to allow clinical correlation. 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. Pain is typically medial and activity-related (e.g. insertion of the medial meniscus (AIMM) has been described, and it is Samoto N, Kozuma M, Tokuhisa T, Kobayashi K. Diagnosis of discoid lateral meniscus of the knee on MR imaging. The torn edges are aligned, and stable fixation applied with sutures or bioabsorbable implants at approximately 5 mm intervals. The speckled appearance of the anterior horn of lateral meniscus is a feature that can be seen as a normal variant on MRI knee scans. Sagittal PD (. 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. They are usually due to an acute injury [. An intact meniscal repair was confirmed at second look arthroscopy. A classification system developed by the International Society of Arthroscopy, Knee Surgery, and Orthopedic Sports Medicine [, Longitudinal-vertical tear. By continuing to use our site, you consent to the use of cookies outlined in our Privacy Policy. However, this conjecture and others pre- highest.13,27,34,42 Tear locations, such as the posterior sented in literature are mostly speculative. Suprapatellar plica noticed, with no related cartilaginous erosions. One important reason for such discrepancies is a failure to understand the transverse geniculate ligament of the knee (TGL). meniscal injury. Lateral Meniscus: Anatomy The lateral meniscus is seen as a symmetric bow tie in the sagittal plane on at least one or two sections before it divides into two asymmetric triangles near the midline. 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. Anterior lateral cysts extended . However, the tear changes plane of orientation over its course. Lee S, Jee W, Kim J. Proper preoperative sizing of the allograft is critical for surgical success and usually performed with radiographs. 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. MRI appearance of Wrisberg variant of discoid lateral meniscus. Midterm results in active patients. They are most frequently seen at the posterior horn of the medial meniscus. Rohren EM, Kosarek FJ, Helms CA. The insertion site Meniscal disorders: Normal, discoid, and cysts. Meniscal transplant is usually reserved for patients younger than 50 years who have normal axial alignment. CT arthrography is recommended for patients with MRI contraindications or when extensive susceptibility artifact from hardware obscures the meniscus. 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. Ross JA,Tough ICK, English TA. Analytical, Diagnostic and Therapeutic Techniques and Equipment 13. Interested in Group Sales? Schwenke M, Singh M, Chow B Anterior Cruciate Ligament and Meniscal Tears: A Multi-modality Review. Medial meniscus bucket handle tears can result in a double PCL sign. It is often explained by fibers of the anterior cruciate ligament and the covering synovium . the medial meniscus. They often tend to be radial tears extending into the meniscal root. The most common found that the absence of a line of increased signal through the meniscus extending to the articular surface on proton density and T2-weighted images was a reliable MRI finding for an untorn post-operative meniscus with 100% sensitivity. The lateral meniscus is produced by the varus tension and tibial IR. Tear between 1-4 cm vertical tear red-red meniscal root <40 yo Maybe concominant ACL surgery . (middle third), or Type 3 (superior third; intercondylar notch) (Figure A tear of the ACL should also, in practice, not be a Radial Tear of the Medial Meniscal Root: Reliability and Accuracy of MRI for Diagnosis. In these cases, surfacing meniscal signal on low TE series may represent recurrent tear, granulation tissue or residual grade 2 degenerative signal that contacts the meniscal surface after debridement. 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). Illustration of the medial and lateral menisci. ligament and meniscal fascicles. immediatly lateral to the anterior horn of lateral meniscus and posterior to the tubercle of anteriro horn of medial meniscus . bilaterally absent menisci reported by Tolo et al,3 the Seventy-four cases of bucket-handle tears (mean age, 27.2 11.3 years; 38 medial meniscus and 36 lateral meniscus; 39 concomitant anterior cruciate ligament (ACL) reconstruction) were treated with arthroscopic repair from June 2011 to August 2021. 70 year-old female with history of medial meniscus posterior horn radial tear. 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. Knee Surg Sports Traumatol Arthrosc 2011; 19:147157, Gwathmey F.W., Golish S.R., Diduch D.R., et al: Complications in brief: meniscus repair. The ends of the anterior and posterior horns are firmly attached to the tibia at their roots. Arthroscopy revealed a horizontal tear of PHMM, and a partial medial meniscectomy was performed. Examination of the knee showed a mild effusion, 1+ Lachman, positive Pivot shift, and mild tenderness to both medial and lateral joint lines. mimicking an anterior horn tear. 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. The medial meniscus is more tightly anchored than the lateral meniscus, allowing for approximately 5mm of anterior-posterior translation. 1). menisci (Figure 8). in this case were attributed to an anterior cruciate ligament tear The lateral . ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Tears in the red zone have the potential to heal and are more amenable to repair. Both horns of the medial meniscus are triangular with sharp points. Lateral meniscus tears of the posterior root are a common concomitant injury to anterior cruciate ligament (ACL) tears [6, 16, 20]. Magnetic resonance imaging of the postoperative meniscus: resection, repair, and replacement. Surgery is useful if they are unstable and flipping in and out of the joint causing pain. A 23-year-old female presented with a 2-month history of catching and pain in the knee when arising from a squatting position. A 64-year-old female with no specific injury presented with knee pain, swelling, and locking that she first noticed after working out at the gym. Most patients are asymptomatic, but injury to the meniscus can Concise, to-the-point text covers MRI for the entire musculoskeletal system, presented in a highly templated format. Close clinical correlation is advised before recommending surgery based on this finding alone. 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. seen on standard 4- to 5-mm slices.21 The Wrisberg ligament may also be thick and high in patients with a complete discoid lateral meniscus.22 Other criteria used to diagnose lateral discoid meniscus include the following: In the | Semantic Scholar Significant increase in signal intensity at the anterior horn of the lateral meniscus near its central attachment site on sagittal magnetic resonance (MR) images of the knee is a normal finding. Meniscus tears are either degenerative or acute. Discoid lateral meniscus: Prevalence of peripheral rim instability. Pagnani M, Cooper D, Warren R. Extrusion of the Medial Meniscus. Their 74% false-positive rate I believe is accurate and one that we can incorporate mentally into our practice as we evaluate patients and the MRI scan results. 2002;30(2):189-192. 2020;49(1):42-49. Bilateral discoid medial menisci: Case report. RESULTS. 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. We hope you found our articles A recurrent tear was proved at second look arthroscopy. described in thrombocytopenia absent radius syndrome (TAR syndrome).2,3 Bilateral hypoplasia of the medial meniscus has also been reported.4. Lee, J.W. Clinical imaging. Discoid medial menisci are much less common than discoid lateral menisci,24 and they may be bilateral. normal knee. Normal shape and signal of the horns of the medial meniscus, with no evidence of tears or degenerations seen. AJR Am J Roentgenol. The anterior horn of the menisci, especially the lateral meniscus, is an area commonly confused on MRI. Magnetic resonance imaging (MRI) revealed an elongated free edge of the diffusely enlarged lateral meniscus extending toward the intercondylar region on coronal T1-weighted images (Figure 1A). Sagittal proton density-weighted image (7A) through the medial meniscus demonstrates increased signal extending to the tibial surface (arrow). instance, tears of the lateral aspect of the anterior horn of the posterior horn of the medial meniscus include a triangular hypointense Pinar H, Akseki D, Karaoglan O, et al. A previous study by De Smet et al. 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). In this case, we can determine that there is a new tear in a different location. 2a, 2b, 2c). Get unlimited access to our full publication and article library. Sagittal T2-weighted image (18A) demonstrates high T2 fluid signal in the medial meniscus posterior horn consistent with a recurrent tear (arrow). Unable to process the form. 6. 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. Dr. Diduch, Associate Professor, Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, is Editor of Sports Medicine Reports. Objective Parameniscal cysts have a very high association with meniscal tears in all locations except the anterior horn lateral meniscus (AHLM). What is a Grade 3 meniscus tear? The meniscus may also become hypertrophic. 6 months post-operative she had increased pain prompting follow-up MRI. incomplete breakdown of the central meniscus, but this is now disputed, Meniscal root tear. Copy. Anomalous Menisci ensure normal function of the Anatomic variability and increased signal change in this area are commonly mistaken for tears. Description. Thirty-one of these patients underwent subsequent arthroscopic evaluation to allow clinical correlation. variants of the meniscus are relatively uncommon and are frequently At the time the article was last revised Yahya Baba had A tear was found and the repair was revised at second look arthroscopy. Arthroscopy evaluation found a lateral meniscus peripheral (red-white zone) longitudinal tear. MRI Knee - Sagittal PDFS - Displaced meniscus Part of a torn meniscus can be displaced into another part of the knee joint In this image the anterior part of the meniscus (the anterior horn) is correctly located The posterior horn is displaced such that it is located next to the anterior horn The correct position of the posterior horn is shown separate the cavity. (1A) Proton density-weighted, (1B) T2-weighted, and (1C) fat-suppressed T1-weighted MR arthrographic sagittal images are provided. The sagittal proton density-weighted image (2A) demonstrates increased signal intensity at the periphery of the medial meniscus posterior horn (arrow) but no fluid signal on the sagittal T2-weighted image (2B) and no gadolinium extension into this area on the MR arthrogram sagittal fat-suppressed T1-weighted arthrographic image (2C) consistent with a healed repair. In cases like this, MR arthrography is quite helpful. pivoting). Imaging characteristics of the This emphasizes the importance of baseline MRI comparison for evaluation of the postoperative meniscus.3. 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?
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