anterior horn lateral meniscus tear: mri

Methods Eighteen patients who had arthroscopically confirmed partial MMPRTs were included. congenital anomalies affect the lateral meniscus, most commonly a Samoto N, Kozuma M, Tokuhisa T, Kobayashi K. Diagnosis of discoid lateral meniscus of the knee on MR imaging. The congenitally absent meniscus appears to influence the development In some patients, hyperintense signal may persist at the repair site on conventional MRI for several years and is thought to represent granulation tissue. MRI plays a critical role in influencing the treatment decision and enables information that would obviate unnecessary surgery including diagnostic arthroscopy. Longitudinal (longitudinal, peripheral-vertical) tears run parallel to the circumference of the meniscus along its longitudinal axis, separating the meniscus into central and peripheral portions (Fig. Skeletal radiology. an adult), and approximately twice the size of the anterior horn on 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. The meniscus may also become hypertrophic. For root tears in general, sagittal imaging may demonstrate a meniscal ghost sign. Pullout fixation of posterior medial meniscus root tears: correlation between meniscus extrusion and midterm clinical results. The medial compartment articular cartilage is preserved, and the meniscal body is not significantly extruded (16D). Radiology. The common insertion of the anterior cruciate ligament (ACL) and the AHLM root may provide a pathway for disease. 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 [. The MFL was not observed in five (19%) of 26 studies of an LMRT. There is no universally accepted system for classifying meniscal tear patterns. are reported cases of complete absence of the medial meniscus as Anterior Cruciate Ligament and Meniscal Tears: A Multi-modality Review Get unlimited access to our full publication and article library. (1A) Proton density-weighted, (1B) T2-weighted, and (1C) fat-suppressed T1-weighted MR arthrographic sagittal images are provided. Definite surfacing signal or distortion on only one image represents a possible tear. meniscal diameter. 7.2 Medial and Lateral Menisci Medial meniscus is larger than the lateral meniscus and is more "open" (=less C-like) and less wide. Both the healed peripheral tear and the new central tear were proved at second look arthroscopy. The meniscal body is firmly attached to the deep portion of the medial collateral ligament complex via the meniscotibial ligament. As a result, the accuracy rate of diagnosis by MRI is 83.3%. At 1 year, 5 of 6 were completely asymptomatic with the remaining patient minimally painful with no suggestion of meniscal symptoms. Anomalous insertion of anterior and posterior horns of medial meniscus An athletic 52-year-old male, who was an avid runner all his adult life, presented with medial pain and a popping sensation in knee. This is because most tears occur in the posterior horns [, Whether a torn meniscus is reparable depends on the type or pattern of tear, its location, and the quality of the meniscal tissue. 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 Diagnostic accuracy of MRI knee in reference to - ScienceDirect You have reached your article limit for the month. Lateral Meniscus - ProScan Education - MRI Online 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. They may not even be apparent with an arthroscopic examination. The fat-suppressed sagittal T1-weighted post arthrogram view (7C) demonstrates gadolinium extending into the meniscal substance. Longitudinal medial meniscus tear managed by repair (arrow). This article focuses on 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. Br Med Bull. The anterior root of the medial meniscus attaches to the anterior midline of the tibial plateau or sometimes the anterior surface of the tibia just below the plateau. The posterior root of the lateral meniscus (PRLM) attaches along the posterior aspect of the intercondylar eminence of the tibia (Fig. For information on new subscriptions, product PDF The Menisci on MRI Pearls and Pitfalls or the Radiology Registrar signal fluid cleft interposed between the posterior horn and the capsule Problems encountered in a discoid medial meniscus are the same as a 1 ). During an arthroscopy, we have the choice of either repairing the meniscus tear or removing the torn piece. This arises from the posterior horn of the lateral meniscus and attaches to the lateral aspect of the medial femoral condyle. 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. Posteroinferior displacement of the meniscal tissue (arrowheads) is also diagnostic of recurrent tear. Extension to the anterior cortex of . discoid lateral meniscus, including a propensity for tears to occur and Figure 8: Medial oblique menisco-meniscal . 2012;199(3):481-99. 17. The post arthrogram view (13B) reveals gadolinium within the repair site. As visualized on sagittal MR images, the anterior horn of the medial meniscus is shorter than the posterior horn, whereas the anterior and posterior horns of the lateral meniscus are of equal length. during movement, and less commonly joint-line tenderness, reduced Meniscal disorders: Normal, discoid, and cysts. 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. MRI appearance of Wrisberg variant of discoid lateral meniscus. 6 months post-operative she had increased pain prompting follow-up MRI. noted to be diminutive, with the posterior horn measuring 7 mm to 8 mm. MR arthrogram fat-suppressed sagittal T1-weighted image (11C) shows no gadolinium in the repair. An intact meniscal repair was confirmed at second look arthroscopy. The lateral . Increased intrameniscal signal is commonly seen in the transplanted allograft but does not correlate with clinical outcome. Repair techniques include inside-out, outside-in or all-inside approaches. Rao PS, Rao SK, Paul R. Clinical, radiologic, and arthroscopic assessment of discoid lateral meniscus. Examination showed lateral joint line tenderness and a positive McMurray sign. Discoid lateral meniscus. > 20% ratio of meniscus to tibia on the coronal image; Minimum diameter 14-15 mm on a midcoronal image; 75% horn of the lateral meniscus, and oblique tear orientation In the present study, the patients analyzed came from the have been the most difficult for imaging planes to visualize same geographical area . 2006;239(3):805-10. Criteria for a recurrent tear after greater than 25% meniscectomy Definite surfacing T2 fluid signal (or high T1 signal isointense to intra-articular gadolinium on MR arthrography) on 2 or more images or displaced meniscal fragment.17 Definite surfacing fluid signal on only one image represents a possible tear. What are the findings? This is a well-done study with clinical correlation and adequate follow-up. They maintain a relatively constant distance from the periphery of the meniscus [. of these meniscal variants is the discoid lateral meniscus, and the Posterior meniscal root repairs: outcomes of an anatomic transtibial pull-out technique. The patient had a recent new injury with increased pain. Of these 45 patients, there was an average of 3.74 additional pathological conditions noted on the MRI scan, mainly including degenerative arthrosis or patellar chondromalacia to explain the patients continued pain. Pagnani M, Cooper D, Warren R. Extrusion of the Medial Meniscus. When the cruciate 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. In contrast to the medial meniscus, the posterior horn of the lateral meniscus is additionally secured by the meniscofemoral ligaments (MFL). Association of Parameniscal Cysts With Underlying Meniscal Tears as Symptoms of anterior horn tears were very similar to those of meniscal tears of the midbody or posterior horn, including catching, pain with knee flexion, and swelling. Am J Sports Med 2016; 44:625632, De Smet AA, Horak DM, Davis KW, Choi JJ. This scan showed a radial MMT. normal knee. They often tend to be radial tears extending into the meniscal root. 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. pretzels dipped in sour cream. On MRI, they resemble radial tears, with a linear cleft of abnormal signal seen at the free edge. may simulate a peripheral tear (Figure 6).23 The only Reporting knee meniscal tears: technical aspects, typical pitfalls and The discoid lateral-meniscus syndrome. The condition is typically asymptomatic and, therefore, is infrequently diagnosed.14 2002; 222:421429, Ciliz D, Ciliz A, Elverici E, Sakman B, Yuksel E, Akbulut O. 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 They were first described by M J Pagnaniet al. 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. Disadvantages include increased cost, increased patient time, potential for adverse reactions to contrast agent compared to conventional MRI and lack of joint distention. 2014; 43:10571064, McCauley TR. If the tear does not show, it is considered a Grade 1 or 2 and is not as serious. 4. Sagittal proton density-weighted image (7A) through the medial meniscus demonstrates increased signal extending to the tibial surface (arrow). How I Diagnose Meniscal Tears on Knee MRI. Incidence and Detection of Meniscal Ramp Lesions on Magnetic Resonance Arthrofibrosis and synovitis are also relatively common. 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. 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 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. We use cookies to create a better experience. Posterior Horn Lateral Meniscus Tear | Knee Specialist | Minnesota Proper preoperative sizing of the allograft is critical for surgical success and usually performed with radiographs. Of the 14 athletes, 8 repairs were performed, 5 patients . Normal shape and signal of the horns of the medial meniscus, with no evidence of tears or degenerations seen. Close clinical correlation is advised before recommending surgery based on this finding alone. 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. We will review the common meniscal variants, which Torn lateral meniscus with superomedial and posterior flipped anterior horn. Connolly B, Babyn PS, Wright JG, Thorner PS. meniscus are not uncommon; they include an anomalous insertion of the small meniscus is also seen in the wrist joint. MRI has high sensitivity and specificity for detecting meniscus tears in patients without prior knee surgery. Bucket-handle tear of the lateral meniscus: Flipped meniscus sign 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. Following partial meniscectomy, the knee is at increased risk for osteoarthritis. joint, and they also protect the hyaline cartilage. Unable to process the form. A slightly overweight 44-year-old male sought evaluation for medial knee pain that persisted for months after running on the beach. slab-like configuration on sagittal MR images, with > 3 bowties Stay up to date with the latest in Practical Medical Imaging and Management with Applied Radiology. menisci (Figure 8). Of those 31 patients who underwent arthroscopic examination, there were only 8 true anterior horn tears (26% true positive rate) and 18 had normal or intact menisci in all zones. Shepard et al have done a nice job of telling us just how frequently this mistake can be made by fellowship trained musculoskeletal radiologists. 2002;30(2):189-192. How I Diagnose Meniscal Tears on Knee MRI : American Journal of The Journal of bone and joint surgery American volume. Diagnosis of recurrent meniscal tears: prospective evaluation of conventional MR imaging, indirect MR arthrography, and direct MR arthrography. It is important to know the age of the patient when interpreting the MRI. 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. proximal medial tibia was convex and the distal medial femoral condyle Clin Orthop Relat Res 2012; 470: pp. Tears Radiology. It can be divided into five segments: anterior horn, anterior, middle and posterior segments, and posterior horn. Dr. Michael Gabor answered Diagnostic Radiology 35 years experience No,: It doesn't sound like a bucket handle tear Sagittal T2-weighted image (18A) demonstrates high T2 fluid signal in the medial meniscus posterior horn consistent with a recurrent tear (arrow). Tears in the red zone have the potential to heal and are more amenable to repair. to the base of the ACL or the intercondylar notch. They are usually due to an acute injury [. Discoid meniscus in children: Magnetic resonance imaging characteristics. 5. Kim EY, Choi SH, Ahn JH, Kwon JW. AJR American journal of roentgenology. 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). ligaments are absent, most commonly the anterior cruciate ligament (ACL) On MRI, longitudinal tears appear as a vertical line of abnormal signal contacting articular surface. What is a Lateral Meniscus Tear? 300). . Objectives: Low-field MRI at 0.55 Tesla (T) with deep learning image reconstruction has recently become commercially available. The anterior and posterior sutures are shuttled down the tibial tunnel (arrowhead). sagittal magnetic resonance (MR) images. 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). morphology. Meniscal root tear | Radiology Reference Article - Radiopaedia Discoid lateral meniscus in children. Anatomic variability and increased signal change in this area are commonly mistaken for tears. Thus, the loss of the lateral meniscus can often lead to rather rapid onset of osteoarthritis. Radiographs are usually not diagnostic, but they may show a Heron, D, Bonnard C, Moraine C,Toutain A. Agenesis of cruciate : Complications in brief: arthroscopic partial meniscectomy. Singh K, Helms CA, Jacobs MT, Higgins LD. What Is a Tear of the Anterior Horn of the Lateral Meniscus? | 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. Meniscal transplants can fail at the implantation site by avulsion, failure of bone plug incorporation or bone bridge fracture. Discoid lateral meniscus (DLM) is a common anatomic variant in the knee typically presented in young populations, with a greater incidence in the Asian population than in other populations. 3. A tear was found and the repair was revised at second look arthroscopy. Discoid medial meniscus. Am J Sports Med 2010; 38:15421548, LaPrade RF, Matheny LM, Moulton SG, James EW, Dean CS. There is a medial and a lateral meniscus. Anterior horn of the lateral meniscus: another potential pitfall in MR Medial meniscus bucket handle tears can result in a double PCL sign. 2006; 88:660667, Boutin RD, Fritz RC, Marder RA. 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. No gadolinium extension into the meniscus on fat-suppressed sagittal T1-weighted (9B) post arthrogram view. 3 is least common. Lateral Meniscus Root Tear and Meniscus Extrusion with Anterior MRI Findings: Medial meniscus: Tear of the posterior horn seen to the inferior articular surface continuing into the posterior body and becoming more vertical. 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. Healed peripheral medial meniscus posterior horn repair and new longitudinal tear in a different location. 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. Check for errors and try again. varus deformity (Figure 3). Analytical, Diagnostic and Therapeutic Techniques and Equipment 13. When interpreting MR images of the knee, it is important to assess for any change from the expected shape of the menisci. with mechanical features of clicking and locking. of the distal femur and proximal tibia, and in the case report of PDF ssslideshare.com The self-reported complication rate for partial meniscectomy is 2.8% and meniscus repair is 7.6%. That reported case was also associated with FSE T2-weighted images, with a slab-like appearance on coronal images. At the time the article was created Yuranga Weerakkody had no recorded disclosures. Stein T, Mehling AP, Welsch F, von EisenhartRothe R, Jger A. CT arthrography is a recommended alternative for patients who are not MR eligible. Intensity of signal contacting meniscal surface in recurrent tears on MR arthrography compared with that of contrast material. Description. 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. Meniscus Tear MRI Correlation | SpringerLink Repair techniques include side-to-side repair, stabilization with suture anchors, and the transtibial pull-out technique (figure 4).12. trials, alternative billing arrangements or group and site discounts please call The medial meniscus is more tightly anchored than the lateral meniscus, allowing for approximately 5mm of anterior-posterior translation. structure on sagittal images on T1, proton density, and fat-saturated Meniscal surgery is common and requires accurate post-operative imaging interpretation to guide the treatment approach. The most widely used diagnostic modalities to assess the ligament injuries are arthroscopy and Magnetic Resonance Imaging (MRI). Congenital discoid cartilage. medial meniscus, and not be confined to the ACL as seen in an ACL tear. Ross JA,Tough ICK, English TA. 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. posterior fascicles and meniscotibial ligament are absent and a high Grade 3 is a true meniscus tear and an arthroscope is close to 100 percent accurate in diagnosing this tear. of a case of discoid medial cartilage, with an embryological note. Sagittal T2-weighted (8B) and fat-suppressed coronal T2-weighted (8C) images reveal fluid signal (arrows) extending into the meniscal substance indicating a recurrent tear which was confirmed at second look arthroscopy. Tachibana Y, Yamazaki Y, Ninomiya S. Discoid medial meniscus. A meniscal allograft transplant frequently leads to significant improvements in pain and activity level and hastens the return to sport for most amateur and professional athletes.13 A common method of meniscal allograft transplant includes a cadaveric meniscus (fresh or frozen) attached by its anterior and posterior roots to a bone bridge with a trapezoidal shape harvested from a donor tibia. of the transverse ligament is comparable to the general population.5. Dickhaut SC, DeLee JC. 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. Surgical Outcomes Lysholm Score The knee is a complex synovial joint that can be affected by a range of pathologies: ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. The articular cartilage is well seen on the pre-operative sagittal proton density-weighted image (19B). the example shown (Figures 1 and 2), the entire medial meniscus is A 2003 systematic review of the literature, in which 29 publications met strict inclusion criteria, demonstrated pooled weighted sensitivity and specificity of 93.3 % and 88.4 % for the medial meniscus and 79.3 % and 95.7 % for the lateral meniscus, respectively [, Most meniscal tears are visible and best seen on sagittal images. 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. A tear of the ACL should also, in practice, not be a meniscal injury. They often tend to be radial tears extending into the meniscal root. History of a longitudinal medial meniscus tear managed by repair and concurrent ACL reconstruction. no specific MR criteria for classifying discoid medial menisci, and the It has been calculated that the lateral meniscus absorbs about 70% of the forces across the lateral compartment of the knee. Most horizontal tears extend to the inferior articular surface. Papalia R, Vasta S, Franceschi F, D'Adamio S, Maffulli N, Denaro V. Meniscal Root Tears: From Basic Science to Ultimate Surgery. Studies on meniscus root tears have investigated the relationship of osteoarthritis and an anterior cruciate ligament tear. In children, sometimes an increased signal is seen within meniscus due to increased vascularity, but usually the signal does not contact articular surface. posterior horn usually measures 12 mm to 16 mm in the sagittal plane in asymptomatic, although there is a greater propensity for discoid menisci Both horns of the medial meniscus are triangular with sharp points. The reported prevalence is 0.06% to 0.3%.25 An abnormal shape may indicate a meniscal tear or a partial meniscectomy. Create a new print or digital subscription to Applied Radiology. Media community. Lateral meniscus tears of the posterior root are a common concomitant injury to anterior cruciate ligament (ACL) tears [6, 16, 20]. pivoting). posterior horn of the medial meniscus include a triangular hypointense 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 example above illustrates marked degenerative changes caused by loss of meniscal function. The shape of the meniscus is formed at the eighth week of

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