Meniscal root tear. (as previously described), meniscal cyst,26 discoid lateral meniscus in the same knee (Figure 9),25 and pathologic medial patella plica.27. Discoid lateral meniscus in children. Repair techniques include side-to-side repair, stabilization with suture anchors, and the transtibial pull-out technique (figure 4).12. Continuous meniscal tissue bridged the anterior and posterior horns of the lateral meniscus on 3 consecutive sagittal slices (Figure 1B). 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. PRIME PubMed | Posterior horn lateral meniscal tears simulating pretzels dipped in sour cream. 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. Meniscal root tear | Radiology Reference Article - Radiopaedia These tears are usually degenerative in nature and usually not associated with a discrete injury [. Extension to the anterior cortex of . 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. There is no telling how much this error rate will change for radiologists less experienced with MRI. 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. Tear between 1-4 cm vertical tear red-red meniscal root <40 yo Maybe concominant ACL surgery . At least one meniscofemoral ligament is present in 7093 % Of knees There is no universally accepted system for classifying meniscal tear patterns. Description. Kim EY, Choi SH, Ahn JH, Kwon JW. 2. The patient underwent an all-inside lateral meniscus repair. bilaterally absent menisci reported by Tolo et al,3 the separate the cavity. Fukuta S, Masaki K, Korai F. Prevalence of abnormal findings in magnetic resonance images of asymptomatic knees. 2006;239(3):805-10. Footballer's Lateral Meniscus: Anterior Horn Tears of the Lateral published a case series of anterior horn tears of the lateral meniscus in 14 soccer players (mean age 20.2 years). Normal . least common is complete congenital absence of the menisci. 6. The patient had a recent new injury with increased pain. Meniscal disorders: Normal, discoid, and cysts. Heron, D, Bonnard C, Moraine C,Toutain A. Agenesis of cruciate High signal close to fluid intensity contacts the tibial surface on the sagittal T2-weighted image (11B) and is equivocal. in this case were attributed to an anterior cruciate ligament tear Longitudinal medial meniscus tear managed by repair (arrow). 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. Kelly BT, Green DW. Medial meniscus posterior horn peripheral longitudinal tear (arrow) seen on the sagittal proton density-weighted image (15A) and managed by repair. When bilateral, they are usually symmetric. What are the findings? The discoid lateral-meniscus syndrome. slab-like configuration on sagittal MR images, with > 3 bowties The most widely used diagnostic modalities to assess the ligament injuries are arthroscopy and Magnetic Resonance Imaging (MRI). The common insertion of the anterior cruciate ligament (ACL) and the AHLM root may provide a pathway for disease. 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. Midterm results in active patients. Kijowski et al. Clin Orthop Relat Res 2013; 471: pp. PDF Coronal extrusion of the lateral meniscus does not increase after 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. Dr. Michael Gabor answered Diagnostic Radiology 35 years experience No,: It doesn't sound like a bucket handle tear 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. Congenital absence of the meniscus is extremely rare and has been documented in TAR syndrome and in isolated case reports.2,3 menisci occurs. discoid meniscus, although discoid medial menisci can occur much less 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. On sagittal proton-density and T2-weighted images, this lesion was demonstrated by sensitive but nonspecific signs, such as the flipped meniscus . Absence of the meniscus results in a 200 to 300% increase in contact stresses on the articular surfaces.8The meniscus has a heterogeneous cellular composition with regional and zonal variation, with high proteoglycan content at the thin free edge where compressive forces predominate and low proteoglycan content at the thicker peripheral region where circumferential tensile loads predominate. Surgery is useful if they are unstable and flipping in and out of the joint causing pain. 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. The medial meniscus is asymmetrical with a larger posterior horn. Kim SJ, Moon SH, Shin SJ. An intact meniscal repair was confirmed at second look arthroscopy. According to these authors, increased signal to the surface on only one slice should be interpreted as a possible tear. Cases of only one abnormal slice correlated to tears at arthroscopy 55 % of the time for the medial meniscus and 30 % for the lateral [, Accuracy of diagnosing meniscus tear with these criteria has been good. The patient subsequently underwent successful partial medial meniscectomy. 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. 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. Of the 54 participants, 5 had PHLM tears and 49 were normal. MRI c spine / head jxn - they can have stenosis of foramen magnum . 7 Therefore, it is important for the radiologist to be familiar with the appearance of a recurrent tear versus an untorn postoperative meniscus. Anterior horn lateral meniscus tear A female asked: Mri: "macerated anterior horn lateral meniscus with inferiorly surfacing tear. MRI appearance of Wrisberg variant of discoid lateral meniscus. If a meniscus tear shows up on a MRI, it is considered a Grade 3. 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. Meniscus tears, indicated by MRI, are classified in three grades. the menisci of the knees. The posterior cruciate ligament is intact. 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. Weight-bearing knee X-rays showed a 50 % narrowing in the medial compartment. The LaPrade classification systemof meniscal root tears has become commonly used in arthroscopy, and there is evidence that this system can be to some extent translated to MRI assessment of these tears ref. The meniscus can separate from the joint capsule or tear through the allograft. Suprapatellar plica noticed, with no related cartilaginous erosions. sagittal magnetic resonance (MR) images. However, the tear changes plane of orientation over its course. Meniscal extrusion. Medical search. Web Bilateral hypoplasia of the medial meniscus has also been and ACL tears can be mistaken for AIMM, but carefully tracing the History of a longitudinal medial meniscus tear managed by repair and concurrent ACL reconstruction. Anterior horn of the lateral meniscus: another potential pitfall in MR Figure 8: Medial oblique menisco-meniscal . CT arthrography may be used to evaluate the postoperative meniscus when MRI is contraindicated. 4). Am J Sports Med 2010; 38:15421548, LaPrade RF, Matheny LM, Moulton SG, James EW, Dean CS. Flipped meniscus - anterior horn lateral meniscus | Radiology Case tissue only persists at the edges, where differentiation into the As a result, the accuracy rate of diagnosis by MRI is 83.3%. Arthroscopy: The Journal of Arthroscopic & Related Surgery. MR arthrogram fat-suppressed sagittal T1-weighted image (11C) shows no gadolinium in the repair. 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. small meniscus is also seen in the wrist joint. Br Med Bull. In some patients, hyperintense signal may persist at the repair site on conventional MRI for several years and is thought to represent granulation tissue. collapse and widening of the medial joint space (Figure 7). Am J Sports Med. immediatly lateral to the anterior horn of lateral meniscus and posterior to the tubercle of anteriro horn of medial meniscus . continued knee pain after meniscus surgery They maintain a relatively constant distance from the periphery of the meniscus [. Conventional MRI is useful for evaluation of posterior root morphology at the tibial tunnel fixation site, meniscal extrusion and articular cartilage. the posterior horn is usually much larger than the anterior horn (the 2059-2066, Kinsella S.D., and Carey J.L. Long-term outcome after arthroscopic meniscal repair versus arthroscopic partial meniscectomy for traumatic meniscal tears. of the AIMM into the ACL is classified as Type 1 (inferior third), Type 2 What is your diagnosis? At 1 year, 5 of 6 were completely asymptomatic with the remaining patient minimally painful with no suggestion of meniscal symptoms. This injury is biomechanically comparable to a total meniscectomy, leading to compromised hoop stressesresulting in decreased tibiofemoral contact area and increased contact pressures in the involved compartment.These changes are detrimental to the articular cartilage and . in 19916. The lateral meniscus is more circular, and its anterior and posterior horns are nearly equivalent in size in cross section. This emphasizes the importance of meniscal repair over meniscectomy when possible and the need for meniscal preservation when a partial meniscectomy is necessary. The insertion site However, recognizing these variants is important, as they can Which meniscus is more likely to tear? The patient failed conservative management of aspiration and cortisone injection. MR imaging evaluation of the postoperative knee. The anterior meniscofemoral ligament (Humphrey ligament) attaches proximally on the medial femoral condyle, inferior to the PCL insertion. Lateral Meniscus Tear | New Health Advisor By continuing to use our site, you consent to the use of cookies outlined in our Privacy Policy. 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. Anterior horn of the lateral meniscus: another potential - PubMed Samoto N, Kozuma M, Tokuhisa T, Kobayashi K. Diagnosis of discoid lateral meniscus of the knee on MR imaging. MR of the knee: the significance of high signal in the meniscus that History of medial meniscus posterior horn and body partial meniscectomy. Because this is a relatively new procedure, few studies have been dedicated to MRI evaluation of postoperative root repair. Normal menisci. 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. Discoid lateral meniscus of the knee joint: Nature, mechanism, and operative treatment. The anterior horn of the menisci, especially the lateral meniscus, is an area commonly confused on MRI. The anomalous insertion The lateral . : Complications in brief: arthroscopic partial meniscectomy. The tear was treated by partial meniscectomy at second surgery. [emailprotected]. 1 ). Lateral Meniscus - ProScan Education - MRI Online The anterior horn of the menisci, especially the lateral meniscus, is an area commonly confused on MRI. It affects 4% to 5% of the patient population,6-9 with a much higher incidence, up to 13%, in the Asian patient population.10 It is the most common meniscal variant in children.11 On this page: Article: Epidemiology Pathology Radiographic features History and etymology partly divides a joint cavity, unlike articular discs, which completely Am J Sports Med 2016; 44:625632, De Smet AA, Horak DM, Davis KW, Choi JJ. 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. no specific MR criteria for classifying discoid medial menisci, and the 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 Shepard et al have done a nice job of telling us just how frequently this mistake can be made by fellowship trained musculoskeletal radiologists. A displaced longitudinal tear is a "bucket handle" tear. 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. Objectives: Low-field MRI at 0.55 Tesla (T) with deep learning image reconstruction has recently become commercially available. Pinar H, Akseki D, Karaoglan O, et al. The Wrisberg variant may present with a The anterior and posterior sutures are shuttled down the tibial tunnel (arrowhead). These findings are also frequently associated with genu Magnetic resonance imaging of the postoperative meniscus: resection, repair, and replacement. Synopsis: In a consecutive series of nearly 1000 knee MRIs, there was a 74% false-positive rate for the diagnosis of anterior horn meniscal tears. tear. 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. Diagnosis of recurrent meniscal tears: prospective evaluation of conventional MR imaging, indirect MR arthrography, and direct MR arthrography. 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). AJR Am J Roentgenol 211(3):519527, De Smet AA. The example above illustrates marked degenerative changes caused by loss of meniscal function. Collagen fibers are arranged for transferring compressive loads into circumferential hoop stresses, secured by radially oriented tie fibers. The symptoms On MR arthrography, (12B), gadolinium extends through the repair site indicating a tear. Efficacy of Arthroscopic Treatment for Concurrent Medial Meniscus 2014; 43:10571064, McCauley TR. Anterior horn lateral meniscus tear | HealthTap Online Doctor Lee S, Jee W, Kim J. While this test will show a tear up to 90% of the time, it does not always. Because there is less pressure on the meniscus there, it is difficult to evaluate the anterior region of the meniscus. Symptomatic anomalous insertion of the 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. as at no time in development does the meniscus have a discoid . It is often explained by fibers of the anterior cruciate ligament and the covering synovium . In cases like this, MR arthrography is quite helpful. 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. 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.