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. MR criteria are used to make the diagnosis. The sutures are tied over a cortical fixation device or Endobutton (short arrow) with the knee flexed at 90 to secure the root repair. AJR American journal of roentgenology. Following partial meniscectomy, the knee is at increased risk for osteoarthritis. of a case of discoid medial cartilage, with an embryological note. This arises from the posterior horn of the lateral meniscus and attaches to the lateral aspect of the medial femoral condyle.
Anterior horn of the lateral meniscus: another potential - PubMed 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. Bilateral hypoplasia of the medial meniscus has also been This emphasizes the importance of meniscal repair over meniscectomy when possible and the need for meniscal preservation when a partial meniscectomy is necessary. MR imaging and MR arthrography for diagnosis of recurrent tears in the postoperative meniscus. CT arthrography is recommended for patients with MRI contraindications or when extensive susceptibility artifact from hardware obscures the 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. On examination, the patient had medial joint line tenderness with positive McMurray test. The meniscus may also become hypertrophic. The condition is typically asymptomatic and, therefore, is infrequently diagnosed.14 Radial Tear of the Medial Meniscal Root: Reliability and Accuracy of MRI for Diagnosis. RESULTS. Sometimes T2 signal in a healed tear may look similar to fluid. The MRI sign of a radial tear is a linear, vertical cleft of abnormal high signal at the free edge (Fig. 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. Lateral meniscus tears of the posterior root are a common concomitant injury to anterior cruciate ligament (ACL) tears [6, 16, 20]. Special thanks to David Rubin, MD for providing several cases used in this web clinic. 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 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 ]. However, few studies have directly compared the medial and lateral root tears. At the time the article was created Yuranga Weerakkody had no recorded disclosures. MRI has high sensitivity and specificity for detecting meniscus tears in patients without prior knee surgery. 2005; 234:5361. Am J Sports Med. Conventional MRI imaging correlates well with arthroscopic evaluation of the transplants for tears of the posterior and middle thirds of the meniscus allograft with a high sensitivity, specificity and accuracy, but results were poor for evaluation of the anterior third with a low specificity and accuracy.16 Allograft shrinkage and meniscus extrusion are common findings on postoperative MRI but do not always correlate with patient pain and function. The menisci are C-shaped fibrocartilaginous structures composed of radial and circumferential collagen fibers that have several roles, including joint stabilization, load distribution, articular cartilage protection and joint lubrication. Dickhaut SC, DeLee JC. Kocher MS, Klingele K, Rassman SO. Singh K, Helms CA, Jacobs MT, Higgins LD.
O'Donoghue unhappy triad | Radiology Case | Radiopaedia.org Check for errors and try again. Suprapatellar plica noticed, with no related cartilaginous erosions. mimicking an anterior horn tear. We look forward to having you as a long-term member of the Relias Extension to the anterior cortex of .
Anterior Horn Meniscal Repair Using an Outside-In Suture Technique The lateral meniscus is one of two fibrocartilaginous menisci of the knee. Mechanical rasping or trephination of the torn meniscus ends and parameniscal synovium is used to promote bleeding and vascular healing. Bilateral discoid medial menisci: Case report. An intact meniscal repair was confirmed at second look arthroscopy. Lateral meniscus bucket handle tears can produce the double anterior horn sign or double ACL sign. Dr. Diduch, Associate Professor, Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, is Editor of Sports Medicine Reports. 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. Shepard and colleagues at UCLA specifically analyzed this by reviewing 947 consecutive MRIs. 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. 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. However, the tear changes plane of orientation over its course. asymptomatic, although there is a greater propensity for discoid menisci that this rare condition is also clinically asymptomatic. Both the healed peripheral tear and the new central tear were proved at second look arthroscopy. Magnetic resonance imaging (MRI) is the most accurate imaging technique in the diagnosis of meniscal lesions and represents a standard tool in knee evaluation. Discoid medial meniscus. The patient underwent partial medial meniscectomy and ACL reconstruction. It splits into two bands at the PCL, named Humphry(anterior to the PCL) and Wrisberg (posterior to the PCL). In the U.S., intraarticular injection of gadolinium-based contrast is off label.
Clinical Examination in the Diagnosis of Anterior Cruciate : JAAOS This article focuses on
How I Diagnose Meniscal Tears on Knee MRI : American Journal of Anterior horn of the lateral meniscus: another potential pitfall in MR and ACL tears can be mistaken for AIMM, but carefully tracing the 3 years later the sagittal proton density-weighted image (15B) shows a healed posterior horn (arrow) with a new flap tear in the medial meniscus anterior horn (arrowhead). We will review the common meniscal variants, which The insertion site Concise, to-the-point text covers MRI for the entire musculoskeletal system, presented in a highly templated format.
ISAKOS: 2023 Congress in Boston, USA : Abstract Analysis of Risk Congenital discoid cartilage. They divide the meniscus into superior and inferior halves (Fig. congenital anomalies affect the lateral meniscus, most commonly a 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. MRI appearance of Wrisberg variant of discoid lateral meniscus. The most important clinical concern at the time of MRI imaging is often high-grade articular cartilage loss. treatment for stable complete or incomplete types of discoid lateral Best assessed on T2 weighted sequences. 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. Both ligaments attach distally to the posterior horn of the lateral meniscus and contribute to posterior drawer stability . The main functions joint: Morphologic changes and their potential role in childhood This case features the following signs of meniscal tear: Case courtesy, Prof. Dr. Khaled Matrawy, Professor of radiology, Alexandria university, Egypt. A 23-year-old female presented with a 2-month history of catching and pain in the knee when arising from a squatting position. The meniscal body is firmly attached to the deep portion of the medial collateral ligament complex via the meniscotibial ligament. Surgical Outcomes Lysholm Score Radiographic knee dimensions in discoid lateral meniscus: Comparison with normal control. Pain is typically medial and activity-related (e.g. These tears are usually degenerative in nature and usually not associated with a discrete injury [. These findings are also frequently associated with genu 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. With age, increased connective tissue stiffness of the meniscus develops secondary to elastin degradation and collagen rigidification.2. Midterm results in active patients. the example shown (Figures 1 and 2), the entire medial meniscus is the intercondylar notch, most commonly to the mid ACL, and less commonly
Factors affecting meniscal extrusion: correlation with MRI, clinical For information on new subscriptions, product 70 year-old female with history of medial meniscus posterior horn radial tear. The meniscus is two crescent-shaped, thick pieces of cartilage that sit in the knee between the tibia and the femur. Become a Gold Supporter and see no third-party ads. problem in practice. 1991;7(3):297-300. Indirect MR arthrography is less commonly used and relies on excretion of intravascular gadolinium into the joint through synovial cells after intravenous administration of gadolinium contrast 20-90 minutes prior to the MRI exam. Each meniscus has three main parts, the back (posterior horn), middle (body), and front (anterior horn). 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. At the time the article was last revised Yahya Baba had Pullout fixation of posterior medial meniscus root tears: correlation between meniscus extrusion and midterm clinical results. Additionally, the postoperative complication of new extensive synovitis is apparent on the axial view (18D). Relevant clinical history, prior imaging and use of operative reports will significantly improve accuracy of post-operative interpretations. Presentation - Middle-older aged individuals, non-traumatic, progressive onset of pain. 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. sagittal magnetic resonance (MR) images. At least one meniscofemoral ligament is present in 7093 % Of knees ligaments are absent, most commonly the anterior cruciate ligament (ACL) The most commonly practiced 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). frequently. AJR Am J Roentgenol 211(3):519527, De Smet AA.
OITE 7 Flashcards | Chegg.com Recent evidence suggests that decreased extrusion may correlate to better clinical outcomes.18. Acute partial interstitial to near complete anterior cruciate ligament tear is noted at its posterior end with femoral deep lateral sulcus sign. Discoid lateral meniscus and the frequency of meniscal tears. Arthroscopy evaluation found a lateral meniscus peripheral (red-white zone) longitudinal tear. appearance.12 It is now believed that the knee develops from a 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. no specific MR criteria for classifying discoid medial menisci, and the is affected. However, recognizing these variants is important, as they can
PDF The Menisci on MRI Pearls and Pitfalls or the Radiology Registrar Sagittal proton density-weighted image (9A) demonstrates no high signal abnormality.
Diagnostic Image Quality of a Low-Field (0.55T) Knee MRI Protocol Using Renew or update your current subscription to Applied Radiology. Sagittal proton density-weighted image (10A) demonstrates increased signal extending to the articular surface consistent with granulation tissue. Papalia R, Vasta S, Franceschi F, D'Adamio S, Maffulli N, Denaro V. Meniscal Root Tears: From Basic Science to Ultimate Surgery. The discoid lateral-meniscus syndrome. Complete radial tears, root tears and large partial meniscectomies result in markedly increased contact forces at the articular surface; and in this case, full-thickness chondral loss and subchondral fractures on both sides of the joint. Figure 8: Medial oblique menisco-meniscal . Kijowski et al. Repair techniques include inside-out, outside-in or all-inside approaches.
Meniscal Roots: Current Concepts Review The medial meniscus is more tightly anchored than the lateral meniscus, allowing for approximately 5mm of anterior-posterior translation. discoid lateral meniscus is a relatively uncommon developmental variant In contrast to the medial meniscus, the posterior horn of the lateral meniscus is additionally secured by the meniscofemoral ligaments (MFL). In contrast to the medial meniscus, the posterior horn of the lateral meniscus is additionally secured by the meniscofemoral ligaments (MFL). ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Diagnosis of recurrent meniscal tears: prospective evaluation of conventional MR imaging, indirect MR arthrography, and direct MR arthrography. 15 year old patient with prior extensive lateral partial meniscectomy was treated with lateral chondroplasty and lateral meniscal allograft transplant with continued pain and clicking 6 weeks post-operative.
Coronal extrusion of the lateral meniscus does not increase after are reported cases of complete absence of the medial meniscus as {"url":"/signup-modal-props.json?lang=us"}, Weerakkody Y, Baba Y, Knipe H, et al. The medial meniscus covers 60% of the medial compartment. The patient underwent meniscal repair but had recurrent pain prompting repeat MRI 8 months post-operative. On MRI, they exhibit abnormal horizontal linear signal contacting the inferior articular surface near the free edge or less commonly the superior surface. 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.
Lateral Meniscus Tear | New Health Advisor Figure 7: Meniscofemoral ligament. horns to the meniscal diameter on a sagittal slice that shows a maximum
Meniscal extrusion. Medical search. Web 2012;20(10):2098-103. Bilateral complete discoid medial menisci combined with anomalous insertion and cyst formation.
Diagnostic accuracy of MRI knee in reference to - ScienceDirect Anatomic variability and increased signal change in this area are commonly mistaken for tears. 2002; 222:421429, Ciliz D, Ciliz A, Elverici E, Sakman B, Yuksel E, Akbulut O. The meniscus root plays an essential role in maintaining the circumferential hoop tension and preventing meniscal displacement. The patient underwent a successful partial medial meniscectomy and was encouraged to seek low-impact exercise.
continued knee pain after meniscus surgery of the Wrisberg ligament in patients with a complete lateral discoid Neuschwander DC, Drez D Jr, Finney TP. The posterior cruciate ligament is intact. 2014; 43:10571064, McCauley TR. does not normally occur.13. (as previously described), meniscal cyst,26 discoid lateral meniscus in the same knee (Figure 9),25 and pathologic medial patella plica.27. Tear between 1-4 cm vertical tear red-red meniscal root <40 yo Maybe concominant ACL surgery . Pinar H, Akseki D, Karaoglan O, et al. A tear of the lateral meniscus can occur from a sudden injury, or from chronic wear and overload. include hypoplastic menisci, absent menisci, anomalous insertion of the How I Diagnose Meniscal Tears on Knee MRI. A classification system developed by the International Society of Arthroscopy, Knee Surgery, and Orthopedic Sports Medicine [, Longitudinal-vertical tear. The post arthrogram view (13B) reveals gadolinium within the repair site. discoid lateral meniscus, including a propensity for tears to occur and Magnetic resonance imaging (MRI) of both knee joints showed an almost complete absence of the anterior and posterior horns of the medial meniscus, except for the peripheral portion, hypoplastic anterior horns and tears in the posterior horns of the lateral meniscus in both knees (Fig. 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 [. separate the cavity. There are occur with minor trauma. 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. Tibial meniscal dynamics using three-dimensional reconstruction of magnetic resonance images. Meniscal disorders: Normal, discoid, and cysts. Unable to process the form. Direct intraarticular injection of 20-50 mL of dilute iodinated contrast is performed with rapid image acquisition using multidetector CT with high spatial resolution and multiplanar reformatted images. Indications for meniscal repair typically include posttraumatic peripheral (red zone) longitudinal tears located near the joint capsule, ideally in younger patients (less than 40). Youderian A, Chmell S, Stull MA. The sensitivity of mri in detecting meniscal tears is generally good, ranging from 70-98%, with specificity in the same range in many studies.
Surgery Needed?? : r/MeniscusInjuries Diagnosis - clinical presentation with exclusion of advanced knee osteoarthritis. 10 By comparison, the complication rate for ACL reconstruction is 9% and PCL reconstruction is 20%.20 Potential complications associated with arthroscopic meniscal surgery include synovitis, arthrofibrosis, chondral damage, meniscal damage, MCL injury, nerve injury (saphenous, tibial, peroneal), vascular injury, deep venous thrombosis and infection.21 Progression of osteoarthritis and stress related bone changes are seen with increased frequency in the postoperative knee, particularly with larger partial meniscectomies. It is believed that discoid A meniscus is a crescent-shaped fibrocartilaginous structure that AJR Am J Roentgenol. On the sagittal fat-suppressed T2-weighted image (7B), fluid extends into the tear. Discoid lateral meniscus of the knee joint: Nature, mechanism, and operative treatment. Longitudinal lateral meniscus tear status post repair (arrow). MR imaging is useful for evaluation of many possible complications following meniscal surgery. In some patients, hyperintense signal may persist at the repair site on conventional MRI for several years and is thought to represent granulation tissue. As DLM is a congenital anomaly, the ultrastructural features and morphology differ from those of the normal meniscus, potentially leading to meniscal tears. posterior horn of the medial meniscus include a triangular hypointense MRI plays a critical role in influencing the treatment decision and enables information that would obviate unnecessary surgery including diagnostic arthroscopy. Resnick D, Goergen TG, Kaye JJ, et al. A meta-analysis of 44 trials. Zonal variation is also seen in the density of meniscus cells and their phenotypes with a chondrocytic inner zone and fibroblastic outer zone. snapping knee due to hypermobility. There is no universally accepted system for classifying meniscal tear patterns. CT arthrography may be used to evaluate the postoperative meniscus when MRI is contraindicated. 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. The anomalous insertion At 1 year, 5 of 6 were completely asymptomatic with the remaining patient minimally painful with no suggestion of meniscal symptoms. 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.
Bucket-handle tear of the lateral meniscus: Flipped meniscus sign Variations in meniscofemoral ligaments at anatomical study and MR imaging. Evaluation of postoperative menisci with MR arthrography and routine conventional MRI. Tolo VT. Congenital absence of the menisci and cruciate ligaments of the knee: A case report. It is possible that there could have been some tears missed at arthroscopy that were on the undersurface of the anterior horn, an area which is extremely difficultif not impossibleto visualize. posterior horn usually measures 12 mm to 16 mm in the sagittal plane in Pre-operative fat supressed coronal proton density-weighted image (19A) demonstates a posterior root radial tear (arrow). Menisci ensure normal function of the 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. 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. Wrisberg variant, the morphology of the meniscus may be normal, but the When interpreting MR images of the knee, it is important to assess for any change from the expected shape of the menisci. Normal course and intensity of both cruciate ligaments. structure on sagittal images on T1, proton density, and fat-saturated Lee, J.W. 1427-143. of the transverse ligament is comparable to the general population.5. The purpose of our study was to determine if cysts of the ACL are the origin of cysts adjacent to the AHLM. Generally, In this section, the major patterns of tears are described and depicted in MRIs and arthroscopy images. While this test will show a tear up to 90% of the time, it does not always. The avulsed anterior horn of the lateral meniscus is flipped over and situated above the posterior horn. 2013;106(1):91-115. Considered a feature of knee osteoarthritis. 300).
What is anterior horn of meniscus? - KnowledgeBurrow.com 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.