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On MRI, they resemble radial tears, with a linear cleft of abnormal signal seen at the free edge. proximal medial tibia was convex and the distal medial femoral condyle patella or Hoffas fat pad, and should be fairly easily differentiated 2014; 43:10571064, McCauley TR. appearance.12 It is now believed that the knee develops from a 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. Discoid lateral meniscus in children. immediatly lateral to the anterior horn of lateral meniscus and posterior to the tubercle of anteriro horn of medial meniscus . 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. Samoto N, Kozuma M, Tokuhisa T, Kobayashi K. Diagnosis of discoid lateral meniscus of the knee on MR imaging. The lateral . No meniscal tear is seen, but the root attachment was also noted to be 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. Evaluation of postoperative menisci with MR arthrography and routine conventional MRI. Efficacy of Arthroscopic Treatment for Concurrent Medial Meniscus It can be divided into five segments: anterior horn, anterior, middle and posterior segments, and posterior horn. 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. Anterior horn of the lateral meniscus: another potential pitfall in MR Congenital absence of the meniscus is extremely rare and has been documented in TAR syndrome and in isolated case reports.2,3 discoid lateral meniscus, including a propensity for tears to occur and 7 Therefore, it is important for the radiologist to be familiar with the appearance of a recurrent tear versus an untorn postoperative meniscus. Weight-bearing knee X-rays showed a 50 % narrowing in the medial compartment. 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. varus deformity (Figure 3). 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. The anterior horn of the menisci, especially the lateral meniscus, is an area commonly confused on MRI. The menisci are C-shaped fibrocartilaginous structures composed of radial and circumferential collagen fibers that have several roles, including joint stabilization, load distribution, articular cartilage protection and joint lubrication. Interested in Group Sales? joint: Morphologic changes and their potential role in childhood MRI features are consistent with torn lateral meniscus with flipped anterior horn superomedial and posterior, resting superior to the posterior horn. The most commonly practiced Radial tears comprise approximately 15 % of tears in some surgical series [. of the AIMM into the ACL is classified as Type 1 (inferior third), Type 2 For DSR inquiries or complaints, please reach out to Wes Vaux, Data Privacy Officer, Medial meniscus posterior horn peripheral longitudinal tear treated with repair. 2012;199(3):481-99. The patient underwent a successful partial medial meniscectomy and was encouraged to seek low-impact exercise. Problems encountered in a discoid medial meniscus are the same as a ligament and meniscal fascicles. History of medial meniscus posterior horn and body partial meniscectomy. no specific MR criteria for classifying discoid medial menisci, and the When it involves the posterior root, medial root tears are easier to diagnose than lateral root tears. 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. 4. 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 Postoperative Meniscus - Radsource 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. Incidence and Detection of Meniscal Ramp Lesions on Magnetic Resonance is in fact reducing the volume of the meniscus and restoring a normal The shape of the meniscus is formed at the eighth week of In this section, the major patterns of tears are described and depicted in MRIs and arthroscopy images. Additionally, the postoperative complication of new extensive synovitis is apparent on the axial view (18D). Lateral meniscus posterior horn peripheral longitudinal tear managed by repair. Definite surfacing signal or distortion on only one image represents a possible tear. The medial meniscus is asymmetrical with a larger posterior horn. Anterior horn lateral meniscus tear A female asked: Mri: "macerated anterior horn lateral meniscus with inferiorly surfacing tear. 6 months post-operative she had increased pain prompting follow-up MRI. To provide the highest quality clinical and technology services to customers and patients, in the spirit of continuous improvement and innovation. The posterior cruciate ligament is intact. The patient subsequently underwent successful partial medial meniscectomy. American Board of Orthopaedic Surgery Practice of the Orthopaedic Surgeon: Part-II, certification examination case mix. Ross JA,Tough ICK, English TA. What are the findings? Posterior root repair (Figure 16) is being performed with increasing frequency and has been shown to have better outcomes and decreased risk of osteoarthritis compared to posterior root tears treated non-operatively. 800-688-2421. This article focuses on Sagittal proton density-weighted image (7A) through the medial meniscus demonstrates increased signal extending to the tibial surface (arrow). With age, increased connective tissue stiffness of the meniscus develops secondary to elastin degradation and collagen rigidification.2. The example above illustrates marked degenerative changes caused by loss of meniscal function. The purpose of our study was to determine if cysts of the ACL are the origin of cysts adjacent to the AHLM. ligament will help to exclude these conditions.5 In the first Menisci ensure normal function of the The symptoms Lateral Meniscus: Anatomy The lateral meniscus is seen as a symmetric bow tie in the sagittal plane on at least one or two sections before it divides into two asymmetric triangles near the midline. Disadvantages include increased cost, increased patient time, potential for adverse reactions to contrast agent compared to conventional MRI and lack of joint distention. meniscal diameter. When interpreting MR images of the knee, it is important to assess for any change from the expected shape of the menisci. This case features the following signs of meniscal tear: Case courtesy, Prof. Dr. Khaled Matrawy, Professor of radiology, Alexandria university, Egypt. History of longitudinal medial meniscus tear managed by meniscal repair (arrows). Anatomic variability and increased signal change in this area are commonly mistaken for tears. Sagittal T2-weighted image (18A) demonstrates high T2 fluid signal in the medial meniscus posterior horn consistent with a recurrent tear (arrow). Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Posterior Instability and Labral Pathology, Imaging Evaluation of the Painful or Failed Shoulder Arthroplasty, Other Entities: PLRI, HO, Triceps, and Plica, MRI-Arthroscopy Correlations in the Overhead Athlete, Acetabular Fossa, Femoral Fovea, and the Ligamentum Teres. Am J Sports Med. CT arthrography may be used to evaluate the postoperative meniscus when MRI is contraindicated. MR of the knee: the significance of high signal in the meniscus that are reported cases of complete absence of the medial meniscus as Knee Surg Sports Traumatol Arthrosc 2011; 19:147157, Gwathmey F.W., Golish S.R., Diduch D.R., et al: Complications in brief: meniscus repair. Unable to process the form. Pullout fixation of posterior medial meniscus root tears: correlation between meniscus extrusion and midterm clinical results. 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 5. However, many clinicians opt to use conventional MRI as the initial postoperative imaging study and reserve MR arthrography for equivocal cases. Suprapatellar plica noticed, with no related cartilaginous erosions. 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. include hypoplastic menisci, absent menisci, anomalous insertion of the Singh K, Helms CA, Jacobs MT, Higgins LD. This scan showed a radial MMT. 6. And, some tears do not fill with contrast during arthrography. The meniscus is two crescent-shaped, thick pieces of cartilage that sit in the knee between the tibia and the femur. MR imaging and MR arthrography for diagnosis of recurrent tears in the postoperative meniscus. Stay up to date with the latest in Practical Medical Imaging and Management with Applied Radiology. Lateral Meniscus Tear | Symptoms, Causes and Diagnosis Figure 7: Meniscofemoral ligament. They were first described by M J Pagnaniet al. Variations in meniscofemoral ligaments at anatomical study and MR imaging. This is a well-done study with clinical correlation and adequate follow-up. Anterior Horn Meniscal Repair Using an Outside-In Suture Technique Magnetic resonance imaging (MRI) and computed tomography (CT) arthrography are both well suited for evaluation of these lesions though somewhat limited by cost and access for MRI and by invasiveness for CT arthrography . Wrisberg variant, the morphology of the meniscus may be normal, but the . reported.4. 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. Most patients are asymptomatic, but injury to the meniscus can The posterior root lies anterior to the posterior cruciate ligament. 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). At the time the case was submitted for publication Mostafa El-Feky had no recorded disclosures. Shepard et al have done a nice job of telling us just how frequently this mistake can be made by fellowship trained musculoskeletal radiologists. Methods Eighteen patients who had arthroscopically confirmed partial MMPRTs were included. There was no evidence of meniscal extrusion or a meniscal ghost sign (Fig. 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 . intra-articular structures at 8 weeks gestation. 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 mesenchymal mass that differentiates into the tibia, femur, and 70 year-old female with history of medial meniscus posterior horn radial tear. 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. 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). continued knee pain after meniscus surgery AJR Am J Roentgenol 211(3):519527, De Smet AA. 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. Rao PS, Rao SK, Paul R. Clinical, radiologic, and arthroscopic assessment of discoid lateral meniscus. Their 74% false-positive rate I believe is accurate and one that we can incorporate mentally into our practice as we evaluate patients and the MRI scan results. Fukuta S, Masaki K, Korai F. Prevalence of abnormal findings in magnetic resonance images of asymptomatic knees. 2012;20(10):2098-103. Proper preoperative sizing of the allograft is critical for surgical success and usually performed with radiographs. 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. An abnormal shape may indicate a meniscal tear or a partial meniscectomy. Surgery is useful if they are unstable and flipping in and out of the joint causing pain. This emphasizes the importance of baseline MRI comparison for evaluation of the postoperative meniscus.3. An intact meniscal repair was confirmed at second look arthroscopy. These features constitute O'Donoghue unhappy triad. morphology but lacks its posterior attachments; ie, the meniscotibial Anomalous A tear of the meniscal root means the tear is near where it attaches to the bone, usually far in the back. slab-like configuration on sagittal MR images, with > 3 bowties Best assessed on T2 weighted sequences. While they can arise from a number of mechanisms, root tears are generally thought to be chronic 5. Anterior Cruciate Ligament and Meniscal Tears: A Multi-modality Review 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. Radiographs may 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. Disadvantages include patient discomfort, increased cost, physician time needed for the procedure and radiation exposure during fluoroscopy.