anterior horn lateral meniscus tear: mri
Sagittal proton density (PD) images through normal medial (, The medial meniscus is larger, more oblong, and normally has a larger posterior horn than anterior horn in cross section. 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. 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. has shown that 41% of patients with a surgically confirmed torn post-operative meniscus had signal intensity within the meniscus extending into the articular surface which was lower than the signal intensity of gadolinium contrast.14 Like the presence of a line of intermediate T2 signal extending into the articular surface on conventional MRI, diagnosis of a torn post-operative meniscus on MRI arthrography is challenging when the intra-meniscal signal intensity is not as bright as gadolinium contrast. AJR Am J Roentgenol 211(3):519527, De Smet AA. (as previously described), meniscal cyst,26 discoid lateral meniscus in the same knee (Figure 9),25 and pathologic medial patella plica.27. 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. It is believed that discoid It splits into two bands at the PCL, named Humphry(anterior to the PCL) and Wrisberg (posterior to the PCL). Type CT arthrography is recommended for patients with MRI contraindications or when extensive susceptibility artifact from hardware obscures the meniscus. Sagittal PD (. 17. The most important clinical concern at the time of MRI imaging is often high-grade articular cartilage loss. The main functions Disadvantages include risks associated with joint injection, radiation exposure and lower contrast resolution compared to MRI, particularly in the extraarticular soft tissues. 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 Discoid lateral meniscus was originally believed to result from an Generally, What is a Lateral Meniscus Tear? Brody J, Lin H, Hulstyn M, Tung G. Lateral Meniscus Root Tear and Meniscus Extrusion with Anterior Cruciate Ligament Tear. How I Diagnose Meniscal Tears on Knee MRI. {"url":"/signup-modal-props.json?lang=us"}, El-Feky M, Flipped meniscus - anterior horn lateral meniscus. A tear of the lateral meniscus can occur from a sudden injury, or from chronic wear and overload. The superior, middle and inferior geniculate arteries are the main vascular supply to the menisci. congenital absence of the cruciate ligaments. 4. Lee, J.W. 9 The lateral meniscus is more loosely attached than the medial and can translate approximately 11mm with normal knee motion. 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. These are like large radial tears and can destabilize a large portion of the meniscus. When interpreting MR images of the knee, it is important to assess for any change from the expected shape of the menisci. 1. However, this conjecture and others pre- highest.13,27,34,42 Tear locations, such as the posterior sented in literature are mostly speculative. Clin Orthop Relat Res 2012; 470: pp. These findings are also frequently associated with genu 2014; 43:10571064, McCauley TR. 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. 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). MR imaging evaluation of the postoperative knee. 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. 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. Cho JM, Suh JS, Na JB, et al. It is important to know the age of the patient when interpreting the MRI. attachment of the posterior horn is the Wrisberg meniscofemoral Discoid lateral meniscus in children. {"url":"/signup-modal-props.json?lang=us"}, Weerakkody Y, Baba Y, Knipe H, et al. On imaging alone, the radiologist may not be able to distinguish a residual tear (failed repair) from a recurrent tear in the same location. Anterior lateral cysts extended . tissue only persists at the edges, where differentiation into the The MRI showed complete ACL tear with displaced bucket handle medial meniscus tear. A preliminary report, Principles and decision making in meniscal surgery, The Anterior Meniscofemoral Ligament of the Medial Meniscus, Accurate patient history including site and duration of symptoms, Garrett WE Jr, Swiontkowski MF, Weinstein JN, et al. Create a new print or digital subscription to Applied Radiology. Results: Arthroscopic examination of the anterior horn of the lateral meniscus in all 22 patients was normal. ; Lee, S.H. diminutive (1 mm) with no increased signal to suggest root attachment 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. However, clinically significant tears that can mechanically impinge were unlikely to have been missed. 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. Lateral meniscus tears of the posterior root are a common concomitant injury to anterior cruciate ligament (ACL) tears [6, 16, 20]. A 23-year-old female presented with a 2-month history of catching and pain in the knee when arising from a squatting position. Thompson WO, Thaete FL, Fu FH, Dye SF. frequently. On the proton density-weighted image (12A) persistent high signal extends to the tibial and femoral surfaces (arrow). The lateral meniscus is more circular, and its anterior and posterior horns are nearly equivalent in size in cross section. A Normal 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. (PubMed: 17114506), BakerJC, FriedmanMV, RubinDA (2018) Imaging the postoperative knee meniscus: an evidence-based review. Presentation - Middle-older aged individuals, non-traumatic, progressive onset of pain. 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. However, many clinicians opt to use conventional MRI as the initial postoperative imaging study and reserve MR arthrography for equivocal cases. Papalia R, Vasta S, Franceschi F, D'Adamio S, Maffulli N, Denaro V. Meniscal Root Tears: From Basic Science to Ultimate Surgery. 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. reported.4. An intact meniscal repair was confirmed at second look arthroscopy. this may extend to to the mid body." is this a bucket tear? Definite surfacing signal or distortion on only one image represents a possible tear. MRI: When you tear your meniscus, a magnetic resonance imaging (MRI) scan will show the injury as white lines on black. Considered a feature of knee osteoarthritis. On MR arthrography, (12B), gadolinium extends through the repair site indicating a tear. 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. . collapse and widening of the medial joint space (Figure 7). 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. We look forward to having you as a long-term member of the Relias Biologic augmentation with application of exogenous fibrin clot or growth factors may be combined with the repair to promote healing. Magnetic resonance imaging (MRI), was performed in another facility and, showed normal medial and lateral menisci except for the absence of a medial posterior root insertion both on coronal and on sagittal images. Discoid meniscus in children: Magnetic resonance imaging characteristics. A tear of the anterior horn of the lateral meniscus is damage to the front part of one of the two structures that act as shock absorbers between the thigh bone and the lower leg, explains The Steadman Clinic. sagittal magnetic resonance (MR) images. The MRI revealed a vertical flap (oblique) tear of the medial meniscus. Lateral meniscal variant with absence of the posterior coronary ligament. discoid lateral meniscus, including a propensity for tears to occur and Am J Sports Med 2016; 44:625632, De Smet AA, Horak DM, Davis KW, Choi JJ. The shape of the meniscus is formed at the eighth week of Diagnosis of recurrent meniscal tears: prospective evaluation of conventional MR imaging, indirect MR arthrography, and direct MR arthrography. A slightly overweight 44-year-old male sought evaluation for medial knee pain that persisted for months after running on the beach. is affected. 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. 2012;199(3):481-99. 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. Case 9: posterior root of medial meniscus, View Yuranga Weerakkody's current disclosures, see full revision history and disclosures, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, Ahlback classification system in assessing osteoarthritis of the knee joint, Kellgren and Lawrence system for classification of osteoarthritis, anterior cruciate ligament mucoid degeneration, MRI grading system for meniscal signal intensity, shortening or absence of the root on sagittal images, vertical fluid cleft on coronal fluid-sensitive (T2) images. The example above demonstrates the importance of baseline MRI comparison when evaluating the postoperative meniscus. The lateral meniscus is more circular, and its anterior and posterior horns are nearly equivalent in size in cross section. Problems encountered in a discoid medial meniscus are the same as a the rare ring-shaped meniscus, to the classification. The lateral meniscus is one of two fibrocartilaginous menisci of the knee. Disadvantages include patient discomfort, increased cost, physician time needed for the procedure and radiation exposure during fluoroscopy. Learn more. Meniscal root tears are a type of meniscal tear in the knee where the tear extends to either the anterior or posterior meniscal root attachment to the central tibial plateau. measurements of the posterior horn of the medial meniscus may vary, but the intercondylar notch, most commonly to the mid ACL, and less commonly The medial meniscus is asymmetrical with a larger posterior horn. The MFL was not observed in five (19%) of 26 studies of an LMRT. 22 year-old male with a history of ACL and MCL reconstruction and medial meniscus posterior root repair. A 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). Meniscal root tearsare a type of meniscal tearin the knee where the tear extends to either the anterior or posterior meniscal root attachment to the central tibial plateau. 3 is least common. the medial meniscus. However, the tear changes plane of orientation over its course. The most widely used diagnostic modalities to assess the ligament injuries are arthroscopy and Magnetic Resonance Imaging (MRI). 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. In Conventional MRI is useful for evaluation of posterior root morphology at the tibial tunnel fixation site, meniscal extrusion and articular cartilage. Lee S, Jee W, Kim J. hypoplastic meniscus was not the cause of the patients pain, suggesting Stein T, Mehling AP, Welsch F, von EisenhartRothe R, Jger A. The trusted source for healthcare information and CONTINUING EDUCATION. 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. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. RESULTS. The condition is typically asymptomatic and, therefore, is infrequently diagnosed.14 show cupping of the medial tibial plateau, proximal medial tibial physis : Complications in brief: arthroscopic partial meniscectomy. ADVERTISEMENT: Supporters see fewer/no ads. Become a Gold Supporter and see no third-party ads. 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 ]. There was no evidence of meniscal extrusion or a meniscal ghost sign (Fig. The patient had a recent new injury with increased pain. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. On MRI, they exhibit abnormal horizontal linear signal contacting the inferior articular surface near the free edge or less commonly the superior surface. 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.
