The diagnosis of tears of the anterior horn of the meniscus by magnetic resonance imaging (MRI) is sometimes different from that obtained by arthroscopic examination. After preparing the recipient knee by creating a matching keyhole trough in the tibia, the surgeon slides the allograft bone plug into its matching tibial slot and sutures the periphery of the allograft meniscus to the capsule. 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. 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. reported.4. Analytical, Diagnostic and Therapeutic Techniques and Equipment 13. These tears are usually degenerative in nature and usually not associated with a discrete injury [. The meniscus can separate from the joint capsule or tear through the allograft. 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. 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. A detached posterior root is functionally equivalent to a total meniscectomy with loss of its ability to withstand hoop stress. 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). posterior horn of the medial meniscus include a triangular hypointense The self-reported complication rate for partial meniscectomy is 2.8% and meniscus repair is 7.6%. Description. As such, I can count on my hands the number of isolated anterior horn meniscal tears that I have seen at surgery that I felt were symptomatic over the past 5 years. Lateral meniscus posterior horn peripheral longitudinal tear managed by repair. Lee S, Jee W, Kim J. Of the 14 athletes, 8 repairs were performed, 5 patients . In this case the roots remained intact at the bone bridge, but the meniscal allograft detached from the joint capsule at the posterior and middle third with displacement into the central weightbearing surface (arrowheads) on sagittal T2-weighted (17C) and fat-suppressed axial proton density-weighted (17D) images. Lateral meniscus extrusion was present in six (23%) of 26 LMRTs and five (2.2%) of 231 patients with normal meniscus roots ( P < .001). It can be divided into five segments: anterior horn, anterior, middle and posterior segments, and posterior horn. 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. Unable to process the form. Pathology - a tear that has developed gradually in the meniscus. Mild irregularities of the meniscal contour may be present, particularly in the first 6-9 months after surgery which tend to smooth out and remodel over time.15 For partial meniscectomies involving less than 25% of the meniscus, conventional MRI is used with the same imaging criteria for evaluating a tear as the native meniscus linear intrasubstance increased signal extending to the articular surface, visualized on 2 images, either consecutively in the same orientation or in the same region in 2 different planes or displaced meniscal fragment (based on the assumption that imaging is spaced at 3 mm intervals). Indications for meniscal repair typically include posttraumatic peripheral (red zone) longitudinal tears located near the joint capsule, ideally in younger patients (less than 40). snapping knee due to hypermobility. The meniscus root plays an essential role in maintaining the circumferential hoop tension and preventing meniscal displacement. 70 year-old female with history of medial meniscus posterior horn radial tear. The posterior root lies anterior to the posterior cruciate ligament. The clinical significance of anterior horn meniscal tears diagnosed on magnetic resonance images. separate the cavity. When it involves the posterior root, medial root tears are easier to diagnose than lateral root tears. 800-688-2421. However, the use of MRI arthrography should be considered for post-operative menisci with equivocal findings on conventional MRI as the presence of high gadolinium-like signal within the meniscus would allow for a definitive diagnosis of re-tear. Thompson WO, Thaete FL, Fu FH, Dye SF. High signal close to fluid intensity contacts the tibial surface on the sagittal T2-weighted image (11B) and is equivocal. Choi S, Bae S, Ji S, Chang M. The MRI Findings of Meniscal Root Tear of the Medial Meniscus: Emphasis on Coronal, Sagittal and Axial Images. may simulate a peripheral tear (Figure 6).23 The only It is often explained by fibers of the anterior cruciate ligament and the covering synovium . 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. Klingele KE, Kocher MS, Hresko MT, et al. 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. In the U.S., intraarticular injection of gadolinium-based contrast is off label. Normal The posterior root of the lateral meniscus (PRLM) attaches along the posterior aspect of the intercondylar eminence of the tibia (Fig. The meniscal repair is intact. They are usually due to an acute injury [. Arthrofibrosis and synovitis are also relatively common. 6 months post-operative she had increased pain prompting follow-up MRI. 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. The purpose of our study was to determine if cysts of the ACL are the origin of cysts adjacent to the AHLM. congenital absence of the cruciate ligaments. 6. Meniscus tears are either degenerative or acute. partly divides a joint cavity, unlike articular discs, which completely The medial meniscus is more tightly anchored than the lateral meniscus, allowing for approximately 5mm of anterior-posterior translation. What causes abnormal mobility in the medial meniscus? morphology but lacks its posterior attachments; ie, the meniscotibial Anterior lateral cysts extended . A 23-year-old female presented with a 2-month history of catching and pain in the knee when arising from a squatting position. Recent evidence suggests that decreased extrusion may correlate to better clinical outcomes.18. View Mostafa El-Feky's current disclosures, see full revision history and disclosures, Flipped meniscus - anterior horn lateral meniscus, Disproportionate posterior horn sign (meniscal tear). Dickhaut SC, DeLee JC. The trusted source for healthcare information and CONTINUING EDUCATION. 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 . Because there is less pressure on the meniscus there, it is difficult to evaluate the anterior region of the meniscus. Intact meniscal roots. Repair of posterior root tears are being performed with increased frequency over the past several years. Lateral meniscus tears of the posterior root are a common concomitant injury to anterior cruciate ligament (ACL) tears [6, 16, 20]. small meniscus is also seen in the wrist joint. Extrusion is commonly seen following root repair. It is usually seen near the lateral meniscus central attachment site. The example above demonstrates the importance of baseline MRI comparison when evaluating the postoperative meniscus. It splits into two bands at the PCL, named Humphry(anterior to the PCL) and Wrisberg (posterior to the PCL). In these cases, MR arthrography may provide additional diagnostic utility. If missing on MR images, a posterior root tear is present. MR criteria for discoid lateral menisci are used for discoid medial 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. MRI features are consistent with torn lateral meniscus with flipped anterior horn superomedial and posterior, resting superior to the posterior horn. A meniscus is a crescent-shaped fibrocartilaginous structure that 36 year old male with history of meniscus surgery 7 years ago. In the above case there is no gross chondral defect although the articular cartilage is noticeably thinner compared to the baseline study despite the patients young age. Radiographs may You have reached your article limit for the month. To provide the highest quality clinical and technology services to customers and patients, in the spirit of continuous improvement and innovation. Figure 7: Meniscofemoral ligament. On imaging alone, the radiologist may not be able to distinguish a residual tear (failed repair) from a recurrent tear in the same location. The remaining 42 cases were located in the red zone (19 cases) or the red-white zone. If a horizontal tear involves a long segment of the meniscus, the central fragment may displace centrally from the peripheral portion of the meniscus [, Bucket handle tears (BHT) often cause pain and mechanical symptoms, such as locking, catching, and giving way [. Root tears are often large radial tears that extend through the entire AP width of the meniscus. Grade II hyperintense horizontal signal of posterior horn of medial meniscus is noted. Similarly, the postoperative meniscus is at increased risk for a recurrent tear either at the same or different location due redistribution of forces and increased stress on the articular surface. Copy. Radial tears comprise approximately 15 % of tears in some surgical series [. 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. Arthroscopy revealed a horizontal tear of PHMM, and a partial medial meniscectomy was performed. Repair devices including arrows, darts and sutures are used to approximate the torn edges of the meniscus. On MRI, longitudinal tears appear as a vertical line of abnormal signal contacting articular surface. congenital anomalies affect the lateral meniscus, most commonly a 2005; 234:5361. 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 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. 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 Radial or oblique tear congurations close to or within the meniscus . The insertion site are reported cases of complete absence of the medial meniscus as immediatly lateral to the anterior horn of lateral meniscus and posterior to the tubercle of anteriro horn of medial meniscus . of the anterior horn of the medial meniscus, an inferior patella plica, A tear was found and the repair was revised at second look arthroscopy. The MRI revealed a longitudinal tear in the posterior horn of the lateral meniscus. We look forward to having you as a long-term member of the Relias of the meniscus. 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. Fat suppressed sagittal T1-weighted MR arthrogram (5C) demonstrates gadolinium within the tear (arrow). Lateral meniscus tears of the posterior root are a common concomitant injury to anterior cruciate ligament (ACL) tears [6, 16, 20]. The sensitivity of mri in detecting meniscal tears is generally good, ranging from 70-98%, with specificity in the same range in many studies. of the Wrisberg ligament in patients with a complete lateral discoid Also, the inferior patella plica inserts on the The posterior horn is always larger than the anterior horn. 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. Menisci ensure normal function of the Singh K, Helms CA, Jacobs MT, Higgins LD. 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"}. Nakajima T, Nabeshima Y, Fujii H, et al. Materials and methods . 2002; 222:421429, Ciliz D, Ciliz A, Elverici E, Sakman B, Yuksel E, Akbulut O. insertion of the medial meniscus (AIMM) has been described, and it is 300). asymptomatic, although there is a greater propensity for discoid menisci One important reason for such discrepancies is a failure to understand the transverse geniculate ligament of the knee (TGL). Best assessed on T2 weighted sequences. {"url":"/signup-modal-props.json?lang=us"}, El-Feky M, Flipped meniscus - anterior horn lateral meniscus. Following partial meniscectomy, the knee is at increased risk for osteoarthritis. Radiology. 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. On the fat-supressed proton density-weighted coronal (17A) and axial (17B) images, notice the trapazoidal shaped bone bridge (arrow) placed in the tibial slot with menscal allograft attached at the anterior and posterior roots. When the cruciate Sometimes T2 signal in a healed tear may look similar to fluid. Rao PS, Rao SK, Paul R. Clinical, radiologic, and arthroscopic assessment of discoid lateral meniscus. menisci develop from this mesenchymal tissue in a site where this tissue Am J Sports Med. 3. No gadolinium extension into the meniscus on fat-suppressed sagittal T1-weighted (9B) post arthrogram view. The lateral meniscus is produced by the varus tension and tibial IR. 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. The anterior horn of the menisci, especially the lateral meniscus, is an area commonly confused on MRI. Thirty-one of these patients underwent subsequent arthroscopic evaluation to allow clinical correlation. Kim SJ, Choi CH. Comparison of Postoperative Antibiotic Regimens for Complex Appendicitis: Is Two Days as Good as Five Days? Source: Shepard MF, et al. 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. 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. tear. The most commonly practiced Semin Musculoskelet Radiol 2005;9(2):11624, Chung KS, Ha JK, Ra HJ, Nam GW, Kim JG. Discoid lateral meniscus in children. The aim of this study was to evaluate diagnostic values involved in conventional magnetic resonance imaging (MRI) features of MM posterior root tears (MMPRTs) and find other MRI-based findings in patients with partial MMPRTs. this may extend to to the mid body." is this a bucket tear? Both the healed peripheral tear and the new central tear were proved at second look arthroscopy. On this page: Article: Epidemiology Pathology Radiographic features History and etymology 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. Is sport activity possible after arthroscopic meniscal allograft transplantation? A previous study by De Smet et al. of these meniscal variants is the discoid lateral meniscus, and the There was no evidence of meniscal extrusion or a meniscal ghost sign (Fig. 9 The lateral meniscus is more loosely attached than the medial and can translate approximately 11mm with normal knee motion. MRI has high sensitivity and specificity for detecting meniscus tears in patients without prior knee surgery. . 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. Figure 8: Medial oblique menisco-meniscal . A Wrisberg type variant has not been documented in Sagittal PD (. Exam showed a mild effusion and medial joint line tenderness. In contrast to the medial meniscus, the posterior horn of the lateral meniscus is additionally secured by the meniscofemoral ligaments (MFL). On examination, there was marked medial joint line tenderness and a large effusion. Extension to the anterior cortex of . 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. Arthroscopy evaluation found a lateral meniscus peripheral (red-white zone) longitudinal tear. is in fact reducing the volume of the meniscus and restoring a normal Resnick D, Goergen TG, Kaye JJ, et al. Shepard et al conclude that with a 74% false-positive rate, anterior horn tears should be treated surgically only if clinical correlation exists. Stein T, Mehling AP, Welsch F, von EisenhartRothe R, Jger A. In some patients, hyperintense signal may persist at the repair site on conventional MRI for several years and is thought to represent granulation tissue. is much greater than in a discoid lateral meniscus, and the prevalence The patient underwent an all-inside lateral meniscus repair. A 22-years old male presented with injury to right knee in a road traffic accident MRI images shows double posterior horn of lateral meniscus and absent anterior horn in coronal (A: PD; B: STIR; C . These include looking for a Special thanks to David Rubin, MD for providing several cases used in this web clinic. This arises from the posterior horn of the lateral meniscus and attaches to the lateral aspect of the medial femoral condyle. 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. Am J Sports Med 2016; 44:625632, De Smet AA, Horak DM, Davis KW, Choi JJ.
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