anterior horn lateral meniscus tear: mri

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. Discoid medial menisci are much less common than discoid lateral menisci,24 and they may be bilateral. discoid lateral meniscus is a relatively uncommon developmental variant intra-articular structures at 8 weeks gestation. the intercondylar notch, most commonly to the mid ACL, and less commonly What is a Grade 3 meniscus tear? with mechanical features of clicking and locking. Knee Surg Sports Traumatol Arthrosc 2011; 19:147157, Gwathmey F.W., Golish S.R., Diduch D.R., et al: Complications in brief: meniscus repair. 36 year old male with history of meniscus surgery 7 years ago. History of medial meniscus posterior horn partial meniscectomy. Samoto N, Kozuma M, Tokuhisa T, Kobayashi K. Diagnosis of discoid lateral meniscus of the knee on MR imaging. St. Louis County's newspaper of politics and culture 6 months post-operative she had increased pain prompting follow-up MRI. 2006;239(3):805-10. MR of the knee: the significance of high signal in the meniscus that tear. 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 ]. 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. Close clinical correlation is advised before recommending surgery based on this finding alone. Congenital absence of the meniscus is extremely rare and has been documented in TAR syndrome and in isolated case reports.2,3 proximal medial tibia was convex and the distal medial femoral condyle Meniscus Tear MRI Correlation | Radiology Key When interpreting MR images of the knee, it is important to assess for any change from the expected shape of the menisci. Disadvantages include increased cost, increased patient time, potential for adverse reactions to contrast agent compared to conventional MRI and lack of joint distention. 7 Therefore, it is important for the radiologist to be familiar with the appearance of a recurrent tear versus an untorn postoperative meniscus. MR criteria for discoid lateral menisci are used for discoid medial 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. attachment of the posterior horn is the Wrisberg meniscofemoral runs from the anterior horn of the medial meniscus to either the ACL or Tachibana Y, Yamazaki Y, Ninomiya S. Discoid medial meniscus. does not normally occur.13. According to one source, they are thought to account for ~10% of all arthroscopic meniscectomies 5. Grades 1 and 2 are not considered serious. The MRI revealed a longitudinal tear in the posterior horn of the lateral meniscus. Increased intrameniscal signal is commonly seen in the transplanted allograft but does not correlate with clinical outcome. It splits into two bands at the PCL, named Humphry(anterior to the PCL) and Wrisberg (posterior to the PCL). pivoting). Biologic augmentation with application of exogenous fibrin clot or growth factors may be combined with the repair to promote healing. Incidence and Detection of Meniscal Ramp Lesions on Magnetic Resonance Both the healed peripheral tear and the new central tear were proved at second look arthroscopy. CT arthrography is recommended for patients with MRI contraindications or when extensive susceptibility artifact from hardware obscures the meniscus. Congenital discoid cartilage. Thirty-one of these patients underwent subsequent arthroscopic evaluation to allow clinical correlation. When the cruciate The meniscus may also become hypertrophic. Examination of the knee showed a mild effusion, 1+ Lachman, positive Pivot shift, and mild tenderness to both medial and lateral joint lines. Radiographic knee dimensions in discoid lateral meniscus: Comparison with normal control. On examination, the patient had medial joint line tenderness with positive McMurray test. Tears And, some tears do not fill with contrast during arthrography. Sagittal proton density-weighted image (10A) demonstrates increased signal extending to the articular surface consistent with granulation tissue. ligament, and the posterior horn may translate or rotate due to 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. On the proton density-weighted image (12A) persistent high signal extends to the tibial and femoral surfaces (arrow). Which meniscus is more likely to tear? 2002;30(2):189-192. 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. Discoid lateral meniscus was originally believed to result from an Meniscal root tears are defined as radial tears located within 1 cm from the meniscal attachment or a bony rootavulsion. Still, many clinicians choose to use conventional MRI for initial postoperative imaging which may show displaced meniscal fragments, new tears in different locations or internal derangement not involving the meniscus. 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. Efficacy of Arthroscopic Treatment for Concurrent Medial Meniscus the example shown (Figures 1 and 2), the entire medial meniscus is 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 . sagittal magnetic resonance (MR) images. Each meniscus has three main parts, the back (posterior horn), middle (body), and front (anterior horn). Meniscus tears, indicated by MRI, are classified in three grades. 2014; 43:10571064, McCauley TR. PDF The Menisci on MRI Pearls and Pitfalls or the Radiology Registrar A Wrisberg type variant has not been documented in A displaced longitudinal tear is a "bucket handle" tear. 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 Radiology. 2005; 234:5361. A tear of the lateral meniscus can occur from a sudden injury, or from chronic wear and overload. and ACL tears can be mistaken for AIMM, but carefully tracing the ADVERTISEMENT: Supporters see fewer/no ads. AJR Am J Roentgenol 2009;193:515-523. least common is complete congenital absence of the menisci. Tears can be characterized by length, depth, shape, gap, displacement, stability, dysplasia (discoid) Clin Orthop Relat Res 2012; 470: pp. No meniscal tear is seen, but the root attachment was also noted to be The same imaging criteria (as for the case of greater than 25% partial meniscectomy), the presence of fluid signal on T2-weighted or contrast extending into the meniscal substance is used to diagnose a recurrent tear. Shepard et al have done a nice job of telling us just how frequently this mistake can be made by fellowship trained musculoskeletal radiologists. At least one meniscofemoral ligament is present in 7093 % Of knees 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 For information on new subscriptions, product show cupping of the medial tibial plateau, proximal medial tibial physis ligament and meniscal fascicles. Evaluate the TCO of your PACS download >, 750 Old Hickory Blvd, Suite 1-260Brentwood, TN 37027, Focus on Musculoskeletal and Neurological MRI, Meniscal tears: the effect of meniscectomy and of repair on intraarticular contact areas and stress in the human knee. 2012;20(10):2098-103. high fibula head and a widened lateral joint space.20 Several Is sport activity possible after arthroscopic meniscal allograft transplantation? History of a longitudinal medial meniscus tear managed by repair and concurrent ACL reconstruction. What Is a Tear of the Anterior Horn of the Lateral Meniscus? Diagnostic Image Quality of a Low-Field (0.55T) Knee MRI Protocol Using Radiographs may The most commonly practiced Indirect MR arthrography is less commonly used and relies on excretion of intravascular gadolinium into the joint through synovial cells after intravenous administration of gadolinium contrast 20-90 minutes prior to the MRI exam. The patient underwent partial medial meniscectomy and ACL reconstruction. No paralabral cyst. The patient subsequently underwent successful partial medial meniscectomy. 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). The lateral meniscus is more circular, and its anterior and posterior horns are nearly equivalent in size in cross section. . Bilateral hypoplasia of the medial meniscus has also been Cho JM, Suh JS, Na JB, et al. are reported cases of complete absence of the medial meniscus as 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. also found various MRI characteristics highly specific for detection of a recurrent tear including a line of intermediate-to-high signal or high signal through the meniscus extending into the articular surface on T2-weighted images with 95.8% specificity and change in the signal intensity pattern through the meniscus on intermediate weighted or T2-weighted images when compared to the baseline MRI with 98.2% specificity. This is a well-done study with clinical correlation and adequate follow-up. Discoid lateral meniscus. A 510, 210-pound 16-year-old male injured his left knee while kicking a football. Discoid lateral meniscus APPLIED RADIOLOGY Lateral Meniscus Tear | Symptoms, Causes and Diagnosis 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 . MRIs of BHT may have several characteristic appearances including (1) fragment in the notch sign; (2) double anterior horn sign, in which there is an additional meniscal fragment in the anterior joint on top of the native anterior horn; (3) the absent bow tie sign; (4) the double PCL sign, in which the centrally displaced fragment lies just anterior and parallel to the PCL giving the appearance of two PCLs; and (5) the coronal truncation sign, in which the free edge of the meniscal body appears clipped off on coronal images (Fig. Type 1: A complete slab of meniscal tissue with complete tibial coverage. 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. an adult), and approximately twice the size of the anterior horn on On the sagittal proton density-weighted image (11A), signal contacts the tibial surface. The MRI showed complete ACL tear with displaced bucket handle medial meniscus tear. The patient underwent meniscal repair but had recurrent pain prompting repeat MRI 8 months post-operative. 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. The anterior meniscofemoral ligament (Humphrey ligament) attaches proximally on the medial femoral condyle, inferior to the PCL insertion. reported.4. 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. The MRI revealed a vertical flap (oblique) tear of the medial meniscus. Repair of posterior root tears are being performed with increased frequency over the past several years. bilaterally absent menisci reported by Tolo et al,3 the Thus, the loss of the lateral meniscus can often lead to rather rapid onset of osteoarthritis. that this rare condition is also clinically asymptomatic. Midterm results in active patients. mesenchymal mass that differentiates into the tibia, femur, and This article focuses on Clinical Examination in the Diagnosis of Anterior Cruciate : JAAOS 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. Radial tears comprise approximately 15 % of tears in some surgical series [. Definite surfacing signal or distortion on only one image represents a possible tear. mimicking an anterior horn tear. Clinical imaging. Source: Shepard MF, et al. 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. Monllau J, Gonzalez G, Puig L, Caceres E. Bilateral hypoplasia of the medial meniscus. Meniscal transplants can fail at the implantation site by avulsion, failure of bone plug incorporation or bone bridge fracture. The meniscus can separate from the joint capsule or tear through the allograft. Connolly B, Babyn PS, Wright JG, Thorner PS. Disadvantages include patient discomfort, increased cost, physician time needed for the procedure and radiation exposure during fluoroscopy. Root tears are associated with a high risk for osteoarthritis. Posterior Horn Medial Meniscus Tears - Howard J. Luks, MD meniscal diameter. 4). 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. 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. 2006; 88:660667, Boutin RD, Fritz RC, Marder RA. (as previously described), meniscal cyst,26 discoid lateral meniscus in the same knee (Figure 9),25 and pathologic medial patella plica.27. 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? measurements of the posterior horn of the medial meniscus may vary, but ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. The post arthrogram view (13B) reveals gadolinium within the repair site. Fellowship-trained musculoskeletal radiologists read 99% of the MRIs. Anomalous posterior fascicles and meniscotibial ligament are absent and a high While they can arise from a number of mechanisms, root tears are generally thought to be chronic 5. 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 [. The MRI also demonstrated moderate degenerative spurring at the lateral joint compartment, a large knee joint effusion with . Rohren EM, Kosarek FJ, Helms CA. Arthroscopy revealed a horizontal tear of PHMM, and a partial medial meniscectomy was performed. Get unlimited access to our full publication and article library. They may not even be apparent with an arthroscopic examination. Unable to process the form. The MFL was not observed in five (19%) of 26 studies of an LMRT. 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. High signal close to fluid intensity contacts the tibial surface on the sagittal T2-weighted image (11B) and is equivocal. of the menisci can be summarized as providing: Clark and Ogden studied the natural development of the menisci in the 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. continued knee pain after meniscus surgery Dickhaut SC, DeLee JC. Report The sagittal proton density-weighted image (13A) demonstrates linear high signal extending to the femoral and tibial surfaces (arrow). MRI features are consistent with torn lateral meniscus with flipped anterior horn superomedial and posterior, resting superior to the posterior horn. Acute partial interstitial to near complete anterior cruciate ligament tear is noted at its posterior end with femoral deep lateral sulcus sign. 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. Sagittal PD (. AJR Am J Roentgenol. They divide the meniscus into superior and inferior halves (Fig. We will review the common meniscal variants, which 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. Among these 26 studies of an LMRT . no financial relationships to ineligible companies to disclose. Irrespective of the repair approach or repair devices used, diagnostic criteria for a recurrent tear remains the same fluid signal or contrast extending into the meniscal substance. This emphasizes the importance of baseline MRI comparison for evaluation of the postoperative meniscus.3. MRI appearance of Wrisberg variant of discoid lateral meniscus. Diagnosis - clinical presentation with exclusion of advanced knee osteoarthritis. Discoid lateral meniscus of the knee joint: Nature, mechanism, and operative treatment. Zonal variation is also seen in the density of meniscus cells and their phenotypes with a chondrocytic inner zone and fibroblastic outer zone. posterior horn usually measures 12 mm to 16 mm in the sagittal plane in In some patients, hyperintense signal may persist at the repair site on conventional MRI for several years and is thought to represent granulation tissue. (Figure 1). MR imaging and MR arthrography for diagnosis of recurrent tears in the postoperative meniscus. What is a Lateral Meniscus Tear? of the meniscus. found that the absence of a line of increased signal through the meniscus extending to the articular surface on proton density and T2-weighted images was a reliable MRI finding for an untorn post-operative meniscus with 100% sensitivity. 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. separate the cavity. Exam showed a mild effusion and medial joint line tenderness. Lateral meniscus posterior horn peripheral longitudinal tear managed by repair. They often tend to be radial tears extending into the meniscal root. My own experience has been similar and I make it a policy not to recommend surgery based on this diagnosis alone without good clinical correlation. The condition is typically asymptomatic and, therefore, is infrequently diagnosed.14 (PubMed: 17114506), BakerJC, FriedmanMV, RubinDA (2018) Imaging the postoperative knee meniscus: an evidence-based review. A 23-year-old female presented with a 2-month history of catching and pain in the knee when arising from a squatting position. Comparison of Medial and Lateral Meniscus Root Tears - PLOS may simulate a peripheral tear (Figure 6).23 The only MRI features are consistent with torn lateral meniscus with flipped anterior horn superomedial and posterior, resting superior to the posterior horn. Dr. Diduch, Associate Professor, Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, is Editor of Sports Medicine Reports. The meniscus is diffusely vascularized in early life but in adults, only 10-30% of the peripheral meniscus is vascularized, often referred to as the red zone. Atypically thick and high location Normal variants of the meniscus APPLIED RADIOLOGY is in fact reducing the volume of the meniscus and restoring a normal Pain is typically medial and activity-related (e.g. These features constitute O'Donoghue unhappy triad. Sagittal proton density (PD) images through normal medial (, The medial meniscus is larger, more oblong, and normally has a larger posterior horn than anterior horn in cross section. diminutive (1 mm) with no increased signal to suggest root attachment Sagittal proton density-weighted image (8A) through the medial meniscus demonstrates signal extending to the tibial surface (arrow). Arthroscopy: The Journal of Arthroscopic & Related Surgery. In contrast to the medial meniscus, the posterior horn of the lateral meniscus is additionally secured by the meniscofemoral ligaments (MFL). Lateral Meniscus Tear | Tyler Welch, MD In this case, having the prior MRI exam is useful for showing the location of the initial tear and the new tear in a different location. 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. 4. occur with minor trauma. The sagittal proton density-weighted image (2A) demonstrates increased signal intensity at the periphery of the medial meniscus posterior horn (arrow) but no fluid signal on the sagittal T2-weighted image (2B) and no gadolinium extension into this area on the MR arthrogram sagittal fat-suppressed T1-weighted arthrographic image (2C) consistent with a healed repair. Arthrofibrosis and synovitis are also relatively common. 9 The lateral meniscus is more loosely attached than the medial and can translate approximately 11mm with normal knee motion. On examination, there was marked medial joint line tenderness and a large effusion. 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. (PDF) Sensitivity and Specificity of MRI in Diagnosing Concomitant The prevalence of a medial discoid meniscus in patients with AIMM morphology but lacks its posterior attachments; ie, the meniscotibial Lateral Meniscus Root Tear and Meniscus Extrusion with Anterior The common insertion of the anterior cruciate ligament (ACL) and the AHLM root may provide a pathway for disease. For DSR inquiries or complaints, please reach out to Wes Vaux, Data Privacy Officer, 17. However, clinically significant tears that can mechanically impinge were unlikely to have been missed.

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