anterior horn lateral meniscus tear: mri

2002;30(2):189-192. appearance.12 It is now believed that the knee develops from a immediatly lateral to the anterior horn of lateral meniscus and posterior to the tubercle of anteriro horn of medial meniscus . Medial meniscus posterior horn peripheral longitudinal tear (arrow) seen on the sagittal proton density-weighted image (15A) and managed by repair. Sagittal proton density-weighted image (9A) demonstrates no high signal abnormality. to tear. The Postoperative Meniscus - Radsource The lateral meniscus is more circular with a shorter radius, covering 70% of the articular surface with the anterior and posterior horns approximately the same size. Radial Tear of the Medial Meniscal Root: Reliability and Accuracy of MRI for Diagnosis. is affected. Zonal variation is also seen in the density of meniscus cells and their phenotypes with a chondrocytic inner zone and fibroblastic outer zone. The meniscal body is firmly attached to the deep portion of the medial collateral ligament complex via the meniscotibial ligament. acromioclavicular, sternoclavicular, and temporomandibular joints. These include looking for a Surgery is useful if they are unstable and flipping in and out of the joint causing pain. The anterior horn of the menisci, especially the lateral meniscus, is an area commonly confused on MRI. Source: Shepard MF, et al. of a case of discoid medial cartilage, with an embryological note. The symptoms Fat supressed coronal proton density-weighted (19C, D) and sagittal proton density-weighted (19E) images demonstrate postoperative changes from interval posterior horn partial meniscectomy with a thin rim of posterior horn remaining (arrow) and subchondral fractures in the medial femoral condyle and medial tibial plateau (arrowheads) with marked progression of full-thickness chondral loss in the medial compartment and extruded meniscal tissue. Kaplan EB. A 23-year-old female presented with a 2-month history of catching and pain in the knee when arising from a squatting position. Torn lateral meniscus with superomedial and posterior flipped anterior horn. 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? PDF ssslideshare.com Root tears are associated with a high risk for osteoarthritis. ligaments are absent, most commonly the anterior cruciate ligament (ACL) Examination showed lateral joint line tenderness and a positive McMurray sign. 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 patient underwent meniscal repair but had recurrent pain prompting repeat MRI 8 months post-operative. Another MRI was later performed due to worsening symptoms, and demonstrated a bucket-handle tear with complete anterior luxation of the posterior horn of the left lateral meniscus (Figs. Examination of the knee showed a mild effusion, 1+ Lachman, positive Pivot shift, and mild tenderness to both medial and lateral joint lines. Objectives: Low-field MRI at 0.55 Tesla (T) with deep learning image reconstruction has recently become commercially available. {"url":"/signup-modal-props.json?lang=us"}, Weerakkody Y, Baba Y, Knipe H, et al. problem in practice. continued knee pain after meniscus surgery Diagnosis - clinical presentation with exclusion of advanced knee osteoarthritis. However, many clinicians opt to use conventional MRI as the initial postoperative imaging study and reserve MR arthrography for equivocal cases. It is important to know the age of the patient when interpreting the MRI. medial meniscus, discoid lateral meniscus, including the Wrisberg There is a medial and a lateral meniscus. of the anterior horn of the medial meniscus, an inferior patella plica, 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. 2020;49(1):42-49. Copy. 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. Knee Examination - Samarpan Physio mimicking an anterior horn tear. Anomalous pretzels dipped in sour cream. 2a, 2b, 2c). The lateral meniscus is produced by the varus tension and tibial IR. Anterior Horn Meniscal Tears — Fact or Fiction - Relias Media described in thrombocytopenia absent radius syndrome (TAR syndrome).2,3 Bilateral hypoplasia of the medial meniscus has also been reported.4. This case is almost identical to the previous case with a different clinical history. Radial tears comprise approximately 15 % of tears in some surgical series [. 2. 300). 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. No meniscal tear is seen, but the root attachment was also noted to be A meta-analysis of 44 trials. Meniscus tears, indicated by MRI, are classified in three grades. The examiner can test the entire posterior horn up to the middle segment of the meniscus using the IR of the tibia followed by an extension. Ross JA,Tough ICK, English TA. In cases like this, MR arthrography is quite helpful. The sensitivity of mri in detecting meniscal tears is generally good, ranging from 70-98%, with specificity in the same range in many studies. The posterior root of the medial meniscus attaches to the tibia, just anterior and medial to the posterior cruciate ligament (PCL). Close clinical correlation is advised before recommending surgery based on this finding alone. Objective Parameniscal cysts have a very high association with meniscal tears in all locations except the anterior horn lateral meniscus (AHLM). In some patients, hyperintense signal may persist at the repair site on conventional MRI for several years and is thought to represent granulation tissue. Resnick D, Goergen TG, Kaye JJ, et al. no specific MR criteria for classifying discoid medial menisci, and the It is usually seen near the lateral meniscus central attachment site. Learn more. 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. Meniscal root tears are defined as radial tears located within 1 cm from the meniscal attachment or a bony rootavulsion. Meniscus repair is superior to partial meniscectomy in preventing osteoarthritis and facilitating return to athletic activity.11 However, the period of postoperative immobilization and activity restriction associated with meniscus repair is longer than that associated with partial meniscectomy and requires a compliant, motivated patient to be successful. A detached posterior root is functionally equivalent to a total meniscectomy with loss of its ability to withstand hoop stress. FSE T2-weighted images, with a slab-like appearance on coronal images. snapping knee due to hypermobility. Reference article, Radiopaedia.org (Accessed on 04 Mar 2023) https://doi.org/10.53347/rID-40036, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":40036,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/meniscal-root-tear/questions/1112?lang=us"}. during movement, and less commonly joint-line tenderness, reduced ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 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. the medial meniscus. Sagittal proton density-weighted image (5A) through the medial meniscus at age 12 shows the initial horizontal tear in the posterior horn (arrow) subsequently treated with partial meniscectomy. 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. De Smet A. 2008;191(1):81-5. Anomalous insertion of anterior and posterior horns of medial meniscus 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. The torn edges are aligned, and stable fixation applied with sutures or bioabsorbable implants at approximately 5 mm intervals. 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. Fellowship-trained musculoskeletal radiologists read 99% of the MRIs. With age, increased connective tissue stiffness of the meniscus develops secondary to elastin degradation and collagen rigidification.2. You can use Radiopaedia cases in a variety of ways to help you learn and teach. Damaged meniscal tissue is removed with arthroscopic instruments including scissors, baskets and mechanical shavers until a solid tissue rim is reached with the meniscal remnant contoured, preserving of as much meniscal tissue as possible. On MR images of the knee it is sometimes impossible to determine with confidence if a focus of high signal in the meniscus is confined to the substance of the meniscus or if it extends to involve the surface. 1. Kijowski et al. (PubMed: 17114506), BakerJC, FriedmanMV, RubinDA (2018) Imaging the postoperative knee meniscus: an evidence-based review. Figure 7: Meniscofemoral ligament. A tear was found and the repair was revised at second look arthroscopy. An intact meniscal repair was confirmed at second look arthroscopy. published a case series of anterior horn tears of the lateral meniscus in 14 soccer players (mean age 20.2 years). For information on new subscriptions, product During an arthroscopy, we have the choice of either repairing the meniscus tear or removing the torn piece. The most common Weight-bearing knee X-rays showed a 50 % narrowing in the medial compartment. 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. Intact meniscal roots. Pullout fixation of posterior medial meniscus root tears: correlation between meniscus extrusion and midterm clinical results. Sagittal proton density-weighted image (10A) demonstrates increased signal extending to the articular surface consistent with granulation tissue. By continuing to use our site, you consent to the use of cookies outlined in our Privacy Policy. meniscus | Search | Radiopaedia.org Collagen fibers are arranged for transferring compressive loads into circumferential hoop stresses, secured by radially oriented tie fibers. discoid lateral meniscus, including a propensity for tears to occur and Long-term outcome after arthroscopic meniscal repair versus arthroscopic partial meniscectomy for traumatic meniscal tears. The medial compartment articular cartilage is preserved, and the meniscal body is not significantly extruded (16D). Pain is typically medial and activity-related (e.g. meniscus are not uncommon; they include an anomalous insertion of the Radial or oblique tear congurations close to or within the meniscus . Dr. Diduch, Associate Professor, Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, is Editor of Sports Medicine Reports. 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. A new longitudinal tear has occurred more centrally in the meniscus (arrowhead) with linear high signal extending to the tibial and femoral surfaces as well as fluid signal and gadolinium contrast in the defect. Forty-five of the remaining patients did not undergo surgery but did undergo clinical follow-up and interview at a minimum of 1 year after the MRI to determine if they had any residual symptoms or if they received further medical treatment. posterior horn of the medial meniscus include a triangular hypointense Longitudinal lateral meniscus tear status post repair (arrow). 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. An abnormal shape may indicate a meniscal tear or a partial meniscectomy. Tears Case study, Radiopaedia.org (Accessed on 04 Mar 2023) https://doi.org/10.53347/rID-75066. Surgical Outcomes Lysholm Score On examination, the patient had medial joint line tenderness with positive McMurray test. Development of the menisci of the human knee A tear of the ACL should also, in practice, not be a Klingele KE, Kocher MS, Hresko MT, 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. Arthrofibrosis and synovitis are also relatively common. 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. 2014; 43:10571064, McCauley TR. A meniscus is a crescent-shaped fibrocartilaginous structure that In this case, we can determine that there is a new tear in a different location. Results: Arthroscopic examination of the anterior horn of the lateral meniscus in all 22 patients was normal. Kim SJ, Moon SH, Shin SJ. Brody J, Lin H, Hulstyn M, Tung G. Lateral Meniscus Root Tear and Meniscus Extrusion with Anterior Cruciate Ligament Tear. What is your diagnosis? Grades 1 and 2 are not considered serious. The discoid lateral-meniscus syndrome. The anomalous insertion A previous study by De Smet et al. 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. this may extend to to the mid body." is this a bucket tear? A displaced longitudinal tear is a "bucket handle" tear. On this page: Article: Epidemiology Pathology Radiographic features History and etymology The anterior and posterior sutures are shuttled down the tibial tunnel (arrowhead). Radiographic knee dimensions in discoid lateral meniscus: Comparison with normal control. Posterior Horn Lateral Meniscus Tear | Knee Specialist | Minnesota 2006; 187:W565568. Volunteerism and Sports Medicine: Where do We Stand? This article focuses on as at no time in development does the meniscus have a discoid This scan showed a radial MMT. 22 year-old male with a history of ACL and MCL reconstruction and medial meniscus posterior root repair. One important reason for such discrepancies is a failure to understand the transverse geniculate ligament of the knee (TGL). hypermobility. Posteroinferior displacement of the meniscal tissue (arrowheads) is also diagnostic of recurrent tear. Stein T, Mehling AP, Welsch F, von EisenhartRothe R, Jger A. 5. 2005; 234:5361. Definite surfacing signal or distortion on only one image represents a possible tear. What Is a Tear of the Anterior Horn of the Lateral Meniscus? Sagittal proton density-weighted image (8A) through the medial meniscus demonstrates signal extending to the tibial surface (arrow). anterior horn of the medial meniscus into the anterior cruciate ligament The trusted source for healthcare information and CONTINUING EDUCATION. (as previously described), meniscal cyst,26 discoid lateral meniscus in the same knee (Figure 9),25 and pathologic medial patella plica.27. 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. signal fluid cleft interposed between the posterior horn and the capsule Discoid lateral meniscus: Prevalence of peripheral rim instability. Br Med Bull. An alternative way of fastening the allograft to the donor knee involves harvesting the meniscus with a small bone plug attached to each root and then securing the plugs within osseous tunnels drilled in the recipient tibia. The patient underwent an all-inside lateral meniscus repair. The anterior meniscofemoral ligament (Humphrey ligament) attaches proximally on the medial femoral condyle, inferior to the PCL insertion. Each meniscus attaches to the tibia bone in the back and front via the "meniscal roots." The primary role of the meniscus is to serve as a shock-absorber and protect the underlying articular cartilage and bone. 36 year old male with history of meniscus surgery 7 years ago. Meniscal root tear | Radiology Reference Article - Radiopaedia The medial meniscus covers 60% of the medial compartment. A Also, the inferior patella plica inserts on the 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. Clin Orthop Relat Res 2012; 470: pp. Because this is a relatively new procedure, few studies have been dedicated to MRI evaluation of postoperative root repair. morphology. Following a meniscal repair procedure, the meniscus can be categorized as healed if there is no fluid signal in the repair, partially healed if fluid signal extends into less than 50% of the repair site, or not healed if fluid signal extends into greater than 50% of the repair site. When interpreting MR images of the knee, it is important to assess for any change from the expected shape of the menisci. Kocher MS, Klingele K, Rassman SO. The common insertion of the anterior cruciate ligament (ACL) and the AHLM root may provide a pathway for disease. 2006; 88:660667, Boutin RD, Fritz RC, Marder RA. Anterior horn of the lateral meniscus: another potential - PubMed Arthroscopy revealed a horizontal tear of PHMM, and a partial medial meniscectomy was performed. The Wrisberg variant may present with a The incidence was calculated based on arthroscopic findings, and the potential secondary signs of meniscal ramp tears were evaluated on MRI. AJR Am J Roentgenol. tear. Sagittal T2-weighted (16A), fat-suppressed proton density-weighted sagittal (16B) and coronal (16C, D) images demonstrate findings of a posterior root transtibial pullout repair with visualization of the tibial tunnel (arrow), susceptibility artifact caused by the endobutton (asterisk) and fraying of the posterior root (arrowhead) but no tear. In the U.S., intraarticular injection of gadolinium-based contrast is off label. They found that 76 (8%) of these indicated a tear of the anterior horn of either the medial or lateral meniscus. We look forward to having you as a long-term member of the Relias Meniscal surgery is common and requires accurate post-operative imaging interpretation to guide the treatment approach. The MFL was not observed in five (19%) of 26 studies of an LMRT. What is a Lateral Meniscus Tear? The example above illustrates marked degenerative changes caused by loss of meniscal function. As a result, the accuracy rate of diagnosis by MRI is 83.3%. Shepard et al have done a nice job of telling us just how frequently this mistake can be made by fellowship trained musculoskeletal radiologists. Lateral meniscus posterior horn peripheral longitudinal tear managed by repair. congenital absence of the cruciate ligaments. 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. 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. 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. structure on sagittal images on T1, proton density, and fat-saturated MRI Gallery - MRI Knee - Meniscal tears - Radiology Masterclass What are the findings? American Board of Orthopaedic Surgery Practice of the Orthopaedic Surgeon: Part-II, certification examination case mix. varus deformity (Figure 3). normal knee. 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 ]. instance, tears of the lateral aspect of the anterior horn of the Most studies have shown increased accuracy for direct and indirect MR arthrography compared to conventional MRI for partial meniscectomies of 25% or more.16. MRI: When you tear your meniscus, a magnetic resonance imaging (MRI) scan will show the injury as white lines on black. Arthroscopy for Medial Meniscus Tears The decision to repair or remove the torn portion is made at the time of surgery. CT arthrography is a recommended alternative for patients who are not MR eligible. Bilateral complete discoid medial menisci combined with anomalous insertion and cyst formation. Bucket Handle Meniscal Tear - Diagnosis - MRI Online Fat suppressed sagittal T1-weighted MR arthrogram (5C) demonstrates gadolinium within the tear (arrow). Discoid medial meniscus. gestation, about the time when the knee joint is fully formed.1 Throughout fetal development, they found that the size of the lateral meniscus is highly variable, unlike the medial meniscus. Variations in meniscofemoral ligaments at anatomical study and MR imaging. 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. At surgery, the torn part of the meniscus was in the intercondylar notch and chewed up and not amenable to repair. It splits into two bands at the PCL, named Humphry(anterior to the PCL) and Wrisberg (posterior to the PCL). Schwenke M, Singh M, Chow B Anterior Cruciate Ligament and Meniscal Tears: A Multi-modality Review. Am J Sports Med 2016; 44:625632, De Smet AA, Horak DM, Davis KW, Choi JJ. Association of Parameniscal Cysts With Underlying Meniscal Tears as The ends of the anterior and posterior horns are firmly attached to the tibia at their roots. What is anterior horn of meniscus? - KnowledgeBurrow.com . No paralabral cyst. Of the 14 athletes, 8 repairs were performed, 5 patients . Disadvantages include increased cost, increased patient time, potential for adverse reactions to contrast agent compared to conventional MRI and lack of joint distention. The sagittal proton density-weighted image (13A) demonstrates linear high signal extending to the femoral and tibial surfaces (arrow). The posterior root lies anterior to the posterior cruciate ligament. of these meniscal variants is the discoid lateral meniscus, and the These features constitute O'Donoghue unhappy triad. 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. We will review the common meniscal variants, which Midterm results in active patients. Anterior Cruciate Ligament and Meniscal Tears: A Multi-modality Review Fukuta S, Masaki K, Korai F. Prevalence of abnormal findings in magnetic resonance images of asymptomatic knees. Anterior lateral cysts extended . On sagittal proton-density and T2-weighted images, this lesion was demonstrated by sensitive but nonspecific signs, such as the flipped meniscus . Figure 8: Medial oblique menisco-meniscal . A characteristic MRI finding to diagnose a partial tear of the medial Sagittal proton density-weighted image (5B) through the medial meniscus at age 17 reveals an incomplete tibial surface longitudinal tear (arrow) in a new location and orientation. Dickhaut SC, DeLee JC. diminutive (1 mm) with no increased signal to suggest root attachment 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. mesenchymal mass that differentiates into the tibia, femur, and 800-688-2421. Tolo VT. Congenital absence of the menisci and cruciate ligaments of the knee: A case report. MRI appearance of Wrisberg variant of discoid lateral meniscus. medial meniscus are extremely uncommon and should not be a diagnostic The reported prevalence is 0.06% to 0.3%.25 The insertion site of the meniscus. Methods Eighteen patients who had arthroscopically confirmed partial MMPRTs were included.

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