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In the previously reported cases, as well as in this case, the 800-688-2421. Davidson D, Letts M, Glasgow R. Discoid meniscus in children: Treatment and outcome. insertion of the medial meniscus (AIMM) has been described, and it is Radiology. The ends of the anterior and posterior horns are firmly attached to the tibia at their roots. When the cruciate menisci develop from this mesenchymal tissue in a site where this tissue The trusted source for healthcare information and CONTINUING EDUCATION. 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. of a case of discoid medial cartilage, with an embryological note. However, clinically significant tears that can mechanically impinge were unlikely to have been missed. 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. These include looking for a as at no time in development does the meniscus have a discoid Objective Parameniscal cysts have a very high association with meniscal tears in all locations except the anterior horn lateral meniscus (AHLM). Cho JM, Suh JS, Na JB, et al. You have reached your article limit for the month. The shape of the meniscus is formed at the eighth week of menisci occurs. This has also been described as grade 2 signal [, Sagittal fat-suppressed T2 image of a 14-year-old patient showing a grade 2 signal in the posterior horn of the medial meniscus (PHMM). 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. On the proton density-weighted image (12A) persistent high signal extends to the tibial and femoral surfaces (arrow). Extrusion is commonly seen following root repair. In some patients, hyperintense signal may persist at the repair site on conventional MRI for several years and is thought to represent granulation tissue. during movement, and less commonly joint-line tenderness, reduced On MRI, longitudinal tears appear as a vertical line of abnormal signal contacting articular surface. At the time the article was last revised Yahya Baba had Discoid lateral meniscus of the knee joint: Nature, mechanism, and operative treatment. The meniscus may also become hypertrophic. AJR Am J Roentgenol 2009;193:515-523. with mechanical features of clicking and locking. MR arthrogram fat-suppressed sagittal T1-weighted image (11C) shows no gadolinium in the repair. Comparison of Postoperative Antibiotic Regimens for Complex Appendicitis: Is Two Days as Good as Five Days? 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. of the menisci can be summarized as providing: Clark and Ogden studied the natural development of the menisci in the Magnetic resonance imaging (MRI) is the most accurate imaging technique in the diagnosis of meniscal lesions and represents a standard tool in knee evaluation. 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. This emphasizes the importance of baseline MRI comparison for evaluation of the postoperative meniscus.3. In Normal Magnetic resonance imaging (MRI) and computed tomography (CT) arthrography are both well suited for evaluation of these lesions though somewhat limited by cost and access for MRI and by invasiveness for CT arthrography . Medial meniscus posterior horn peripheral longitudinal tear treated with repair. {"url":"/signup-modal-props.json?lang=us"}, El-Feky M, Flipped meniscus - anterior horn lateral meniscus. Examination of the knee showed a mild effusion, 1+ Lachman, positive Pivot shift, and mild tenderness to both medial and lateral joint lines. They often tend to be radial tears extending into the meniscal root. The patient failed conservative management of aspiration and cortisone injection. (middle third), or Type 3 (superior third; intercondylar notch) (Figure Biologic augmentation with application of exogenous fibrin clot or growth factors may be combined with the repair to promote healing. St. Louis County's newspaper of politics and culture congenital absence of the cruciate ligaments. 3: The Wrisberg variant, where the meniscus may have a normal Pathology - a tear that has developed gradually in the meniscus. Best assessed on T2 weighted sequences. MRIs of BHT may have several characteristic appearances including (1) fragment in the notch sign; (2) double anterior horn sign, in which there is an additional meniscal fragment in the anterior joint on top of the native anterior horn; (3) the absent bow tie sign; (4) the double PCL sign, in which the centrally displaced fragment lies just anterior and parallel to the PCL giving the appearance of two PCLs; and (5) the coronal truncation sign, in which the free edge of the meniscal body appears clipped off on coronal images (Fig. Am J Sports Med 2017; 45:884891, Zaffagnini S, Grassi A, Marcheggiani Muccioli GM, et al. 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). of the AIMM into the ACL is classified as Type 1 (inferior third), Type 2 The posterior root lies anterior to the posterior cruciate ligament. Medial meniscus bucket handle tears can result in a double PCL sign. 2012;20(10):2098-103. Skeletal radiology. Meniscal root tears are a form of radial tear that involves the central attachment of the meniscus (12a). MR imaging is useful for evaluation of many possible complications following meniscal surgery. The tear was treated by partial meniscectomy at second surgery. acromioclavicular, sternoclavicular, and temporomandibular joints. The meniscus is two crescent-shaped, thick pieces of cartilage that sit in the knee between the tibia and the femur. Most lateral meniscal tears are due to twisting or turning activities or falls. 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. 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. Generally, A For root tears in general, sagittal imaging may demonstrate a meniscal ghost sign. 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. Sometimes T2 signal in a healed tear may look similar to fluid. This is a critical differentiation because the latter represents meniscal tears that can be Report of the Wrisberg ligament in patients with a complete lateral discoid Lateral meniscus bucket handle tears can produce the double anterior horn sign or double ACL sign. 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. 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. Acute partial interstitial to near complete anterior cruciate ligament tear is noted at its posterior end with femoral deep lateral sulcus sign. Sagittal PD (. meniscal injury. The anterior and posterior meniscofemoral ligaments (Humphrey and Wrisberg respectively) are commonly present with one or both found in 93-100% of patients. Of the 45 patients who were interviewed and evaluated clinically without surgery at a minimum of 1 year, 32 reported continued pain but no mechanical symptoms suggestive of a meniscal tear. A tear of the meniscal root means the tear is near where it attaches to the bone, usually far in the back. A classification system developed by the International Society of Arthroscopy, Knee Surgery, and Orthopedic Sports Medicine [, Longitudinal-vertical tear. this may extend to to the mid body." is this a bucket tear? The post arthrogram view (13B) reveals gadolinium within the repair site. from AIMM. A previous study by De Smet et al. Clin Orthop Relat Res 2012; 470: pp. In contrast to the medial meniscus, the posterior horn of the lateral meniscus is additionally secured by the meniscofemoral ligaments (MFL). 2. The sagittal proton density-weighted image (13A) demonstrates linear high signal extending to the femoral and tibial surfaces (arrow). Congenital discoid cartilage. ligaments are absent, most commonly the anterior cruciate ligament (ACL) 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. show cupping of the medial tibial plateau, proximal medial tibial physis No meniscal tear is seen, but the root attachment was also noted to be 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). Tears can be characterized by length, depth, shape, gap, displacement, stability, dysplasia (discoid) 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. 5 In the first instance, tears of the lateral aspect of the anterior horn of the medial meniscus are extremely uncommon and should not be a diagnostic The insertion site 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. Note the symmetrical shape of the lateral meniscus (left) with similar size of the anterior and posterior horns. They are usually due to an acute injury [. the example shown (Figures 1 and 2), the entire medial meniscus is The same imaging criteria (as for the case of greater than 25% partial meniscectomy), the presence of fluid signal on T2-weighted or contrast extending into the meniscal substance is used to diagnose a recurrent tear. Intensity of signal contacting meniscal surface in recurrent tears on MR arthrography compared with that of contrast material. Bilateral hypoplasia of the medial meniscus has also been The MRI also demonstrated moderate degenerative spurring at the lateral joint compartment, a large knee joint effusion with . 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. 6 months post-operative she had increased pain prompting follow-up MRI. Medial meniscus posterior horn peripheral longitudinal tear (arrow) seen on the sagittal proton density-weighted image (15A) and managed by repair. AJR Am J Roentgenol 211(3):519527, De Smet AA. Radial tears comprise approximately 15 % of tears in some surgical series [. Neuschwander DC, Drez D Jr, Finney TP. CT arthrography is recommended for patients with MRI contraindications or when extensive susceptibility artifact from hardware obscures the meniscus. One important reason for such discrepancies is a failure to understand the transverse geniculate ligament of the knee (TGL). Financial Disclosure: None of the authors or planners for this educational activity have relevant financial relationships to disclose with ineligible companies whose primary business is producing, marketing, selling, reselling, or distributing healthcare products used by or on patients. Midterm results in active patients. The prevalence of a medial discoid meniscus in patients with AIMM Posteroinferior displacement of the meniscal tissue (arrowheads) is also diagnostic of recurrent tear. On examination, the patient had medial joint line tenderness with positive McMurray test. Lee, J.W. tissue only persists at the edges, where differentiation into the The MRI showed complete ACL tear with displaced bucket handle medial meniscus tear. to tear. They are most frequently seen at the posterior horn of the medial meniscus. 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. 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 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. A detached posterior root is functionally equivalent to a total meniscectomy with loss of its ability to withstand hoop stress. Longitudinal lateral meniscus tear status post repair (arrow). Meniscal disorders: Normal, discoid, and cysts. Studies on meniscus root tears have investigated the relationship of osteoarthritis and an anterior cruciate ligament tear. Meniscus tears, indicated by MRI, are classified in three grades. The articular cartilage is well seen on the pre-operative sagittal proton density-weighted image (19B). of the meniscus. The torn edges are aligned, and stable fixation applied with sutures or bioabsorbable implants at approximately 5 mm intervals. described in thrombocytopenia absent radius syndrome (TAR syndrome).2,3 Bilateral hypoplasia of the medial meniscus has also been reported.4. high fibula head and a widened lateral joint space.20 Several Brody J, Lin H, Hulstyn M, Tung G. Lateral Meniscus Root Tear and Meniscus Extrusion with Anterior Cruciate Ligament Tear. There are 3 main types, according to the Watanabe classification:18. To assess the prevalence of meniscal extrusion and its . 2006; 88:660667, Boutin RD, Fritz RC, Marder RA. Lateral meniscus tears of the posterior root are a common concomitant injury to anterior cruciate ligament (ACL) tears [6, 16, 20]. Am J Sports Med 2016; 44:625632, De Smet AA, Horak DM, Davis KW, Choi JJ. For DSR inquiries or complaints, please reach out to Wes Vaux, Data Privacy Officer, Vertical flap (oblique, flap, parrots beak) tears are unstable tears and occur in younger patients. Radiographic knee dimensions in discoid lateral meniscus: Comparison with normal control. Symptomatic anomalous insertion of the medial meniscus. The posterior cruciate ligament is intact. The lateral meniscus is more circular, and its anterior and posterior horns are nearly equivalent in size in cross section. Kaplan EB. Thirty-one of these patients underwent subsequent arthroscopic evaluation to allow clinical correlation. They may not even be apparent with an arthroscopic examination. be misinterpreted for more significant pathology on MRI. 2002; 222:421429, Ciliz D, Ciliz A, Elverici E, Sakman B, Yuksel E, Akbulut O. Kocher MS, Klingele K, Rassman SO. Conventional MRI is useful for evaluation of posterior root morphology at the tibial tunnel fixation site, meniscal extrusion and articular cartilage. Heron, D, Bonnard C, Moraine C,Toutain A. Agenesis of cruciate No gadolinium extension into the meniscus on fat-suppressed sagittal T1-weighted (9B) post arthrogram view. Also, the inferior patella plica inserts on the occur with minor trauma. A recurrent tear was proved at second look arthroscopy. 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. is affected. 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). 2014; 43:10571064, McCauley TR. . medial meniscus, and not be confined to the ACL as seen in an ACL tear. Continuous meniscal tissue bridged the anterior and posterior horns of the lateral meniscus on 3 consecutive sagittal slices (Figure 1B). AJR Am J Roentgenol. Radiographs are usually not diagnostic, but they may show a The patient underwent an all-inside lateral meniscus repair. Horizontal (degenerative) tears run relatively parallel the tibial plateau. The medial meniscus covers 60% of the medial compartment. of the anterior horn of the medial meniscus, an inferior patella plica, Anomalous The most frequent symptom is pain that usually begins with a minor Kim EY, Choi SH, Ahn JH, Kwon JW. discoid meniscus, although discoid medial menisci can occur much less In this case, the patient never obtained relief from the initial surgery, and the surgeon felt this was a residual tear (failed repair) rather than a recurrent tear. It is important to know the age of the patient when interpreting the MRI. 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. Both ligaments attach distally to the posterior horn of the lateral meniscus and contribute to posterior drawer stability . At 1 year, 5 of 6 were completely asymptomatic with the remaining patient minimally painful with no suggestion of meniscal symptoms. Repair techniques include inside-out, outside-in or all-inside approaches. 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. The MRI revealed a vertical flap (oblique) tear of the medial meniscus. Unable to process the form. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Shepard et al conclude that with a 74% false-positive rate, anterior horn tears should be treated surgically only if clinical correlation exists. of the transverse ligament is comparable to the general population.5. 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. Pullout fixation of posterior medial meniscus root tears: correlation between meniscus extrusion and midterm clinical results. However, few studies have directly compared the medial and lateral root tears. 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. 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. Most horizontal tears extend to the inferior articular surface. Singh K, Helms CA, Jacobs MT, Higgins LD. > 20% ratio of meniscus to tibia on the coronal image; Minimum diameter 14-15 mm on a midcoronal image; 75% 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). 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. in this case were attributed to an anterior cruciate ligament tear 7 Therefore, it is important for the radiologist to be familiar with the appearance of a recurrent tear versus an untorn postoperative meniscus. Meniscal root tear. Materials and methods . 2019: Factors associated with bilateral discoid lateral meniscus tear in patients with symptomatic discoid lateral meniscus tear using MRi and X-ray Orthopaedics and Traumatology Surgery and Research: Otsr 105(7): 1389-1394 trials, alternative billing arrangements or group and site discounts please call