anterior horn lateral meniscus tear: mri

MRI has high sensitivity and specificity for detecting meniscus tears in patients without prior knee surgery. There are meniscal diameter. CT arthrography is a recommended alternative for patients who are not MR eligible. 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. Papalia R, Vasta S, Franceschi F, D'Adamio S, Maffulli N, Denaro V. Meniscal Root Tears: From Basic Science to Ultimate Surgery. Following partial meniscectomy, the knee is at increased risk for osteoarthritis. MRI Findings: Medial meniscus: Tear of the posterior horn seen to the inferior articular surface continuing into the posterior body and becoming more vertical. typically into the anterior cruciate ligament. is in fact reducing the volume of the meniscus and restoring a normal Meniscal tears were found on MRI or arthroscopy in all 28 patients with a lateral cyst overlying the body or posterior horn of the lateral meniscus, whereas a tear was found on MRI or arthroscopy in only 14 (64%) of 22 patients with cysts adjacent to or extending to the lateral meniscus anterior horn (p = 0.006). Am J Sports Med 2016; 44:625632, De Smet AA, Horak DM, Davis KW, Choi JJ. acromioclavicular, sternoclavicular, and temporomandibular joints. Lateral meniscus bucket handle tears can produce the double anterior horn sign or double ACL sign. asymptomatic, although there is a greater propensity for discoid menisci Figure 7: Meniscofemoral ligament. In contrast to the medial meniscus, the posterior horn of the lateral meniscus is additionally secured by the meniscofemoral ligaments (MFL). 9 The lateral meniscus is more loosely attached than the medial and can translate approximately 11mm with normal knee motion. Anatomic variability and increased signal change in this area are commonly mistaken for tears. With age, increased connective tissue stiffness of the meniscus develops secondary to elastin degradation and collagen rigidification.2. Materials and methods . Youderian A, Chmell S, Stull MA. 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. MRI features are consistent with torn lateral meniscus with flipped anterior horn superomedial and posterior, resting superior to the posterior horn. Results: Arthroscopic examination of the anterior horn of the lateral meniscus in all 22 patients was normal. include hypoplastic menisci, absent menisci, anomalous insertion of the The ideal technique for imaging the postoperative meniscus is a matter of active controversy and depends on the operation performed, surgeon preference and clinical question (concern for recurrent meniscal tear versus articular cartilage). One important reason for such discrepancies is a failure to understand the transverse geniculate ligament of the knee (TGL). Indications for a partial meniscectomy include meniscal tears not amenable to repair which includes non-peripheral tears with a horizontal, oblique or complex tear pattern and nontraumatic tears in older patients. Brody J, Lin H, Hulstyn M, Tung G. Lateral Meniscus Root Tear and Meniscus Extrusion with Anterior Cruciate Ligament Tear. joint: Morphologic changes and their potential role in childhood 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. Zonal variation is also seen in the density of meniscus cells and their phenotypes with a chondrocytic inner zone and fibroblastic outer zone. In this section, the major patterns of tears are described and depicted in MRIs and arthroscopy images. And, some tears do not fill with contrast during arthrography. 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. 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. The symptoms 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. 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. Objective Parameniscal cysts have a very high association with meniscal tears in all locations except the anterior horn lateral meniscus (AHLM). Grade II hyperintense horizontal signal of posterior horn of medial meniscus is noted. On MRI, longitudinal tears appear as a vertical line of abnormal signal contacting articular surface. When it involves the posterior root, medial root tears are easier to diagnose than lateral root tears. 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 [. Both horns of the medial meniscus are triangular with sharp points. Create a new print or digital subscription to Applied Radiology. (as previously described), meniscal cyst,26 discoid lateral meniscus in the same knee (Figure 9),25 and pathologic medial patella plica.27. Sagittal T2-weighted image (10B) reveals no fluid at the repair site. Diagnosis - clinical presentation with exclusion of advanced knee osteoarthritis. A recurrent tear was proved at second look arthroscopy. The example above illustrates marked degenerative changes caused by loss of meniscal function. On this page: Article: Epidemiology Pathology Radiographic features History and etymology Grades 1 and 2 are not considered serious. 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. partly divides a joint cavity, unlike articular discs, which completely 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. intra-articular structures at 8 weeks gestation. They found that 76 (8%) of these indicated a tear of the anterior horn of either the medial or lateral meniscus. is much greater than in a discoid lateral meniscus, and the prevalence Sagittal proton density-weighted image (7A) through the medial meniscus demonstrates increased signal extending to the tibial surface (arrow). hypermobility. Anterior horn lateral meniscus tear A female asked: Mri: "macerated anterior horn lateral meniscus with inferiorly surfacing tear. A meniscus is a crescent-shaped fibrocartilaginous structure that Root tears are associated with a high risk for osteoarthritis. bilaterally absent menisci reported by Tolo et al,3 the The camera can visualize the meniscus and other structures within the knee. Because this is a relatively new procedure, few studies have been dedicated to MRI evaluation of postoperative root repair. 22 year-old male with a history of ACL and MCL reconstruction and medial meniscus posterior root repair. Increased intrameniscal signal is commonly seen in the transplanted allograft but does not correlate with clinical outcome. Dr. Michael Gabor answered Diagnostic Radiology 35 years experience No,: It doesn't sound like a bucket handle tear the rare ring-shaped meniscus, to the classification. De Smet A. On imaging alone, the radiologist may not be able to distinguish a residual tear (failed repair) from a recurrent tear in the same location. 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. Indications for meniscal repair typically include posttraumatic peripheral (red zone) longitudinal tears located near the joint capsule, ideally in younger patients (less than 40). Kim SJ, Moon SH, Shin SJ. Methods Eighteen patients who had arthroscopically confirmed partial MMPRTs were included. of a case of discoid medial cartilage, with an embryological note. Both ligaments attach distally to the posterior horn of the lateral meniscus and contribute to posterior drawer stability . Connolly B, Babyn PS, Wright JG, Thorner PS. Vertical flap (oblique, flap, parrots beak) tears are unstable tears and occur in younger patients. menisci (Figure 8). A Wrisberg type variant has not been documented in There is no universally accepted system for classifying meniscal tear patterns. 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. 1427-143. Meniscal disorders: Normal, discoid, and cysts. 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. varus deformity (Figure 3). This emphasizes the importance of meniscal repair over meniscectomy when possible and the need for meniscal preservation when a partial meniscectomy is necessary. MR criteria are used to make the diagnosis. The lateral meniscus is more circular, and its anterior and posterior horns are nearly equivalent in size in cross section. Skeletal radiology. 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. 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. The MRI sign of a radial tear is a linear, vertical cleft of abnormal high signal at the free edge (Fig. Another finding is the abnormal size or shape of the meniscus, which would indicate damaged surfaces [, To provide a greater degree of accuracy, De Smet advocated the two-slice-touch rule. To call a definite tear, one should see increased signal contacting the articular surface of the menisci on at least two images (sagittal or coronal). 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. 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. 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. Fellowship-trained musculoskeletal radiologists read 99% of the MRIs. The remaining 42 cases were located in the red zone (19 cases) or the red-white zone. They may not even be apparent with an arthroscopic examination. 3. 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 ]. Thus, the loss of the lateral meniscus can often lead to rather rapid onset of osteoarthritis. 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. Magnetic Resonance Imaging Arthroscopy Orthodontic Extrusion Anterior Cruciate Ligament Reconstruction Arthroscopes Suture Anchors Tissue Culture Techniques Tissue Engineering Injections, Intra-Articular Range of Motion, Articular Arthrography Hardness Tests Orthopedic Procedures 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. Conventional MRI is the least invasive modality for evaluation of a meniscal repair but has lower sensitivity, specificity and accuracy than direct or indirect arthrographic MRI. no financial relationships to ineligible companies to disclose. A reported.4. 2059-2066, Kinsella S.D., and Carey J.L. Findings indicate an intact meniscus following partial meniscectomy with normal intrameniscal signal. Discoid lateral meniscus: Prevalence of peripheral rim instability. Magnetic resonance imaging of the postoperative meniscus: resection, repair, and replacement. diminutive (1 mm) with no increased signal to suggest root attachment The main functions 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. 3 is least common. The superior, middle and inferior geniculate arteries are the main vascular supply to the menisci. The Journal of bone and joint surgery American volume. is affected. for the ratio of the sum of the width of the anterior and posterior 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. Anatomic variability and increased signal change in this area are commonly mistaken for tears. Neuschwander DC, Drez D Jr, Finney TP. meniscus. Magnetic resonance imaging (MRI) is the most accurate imaging technique in the diagnosis of meniscal lesions and represents a standard tool in knee evaluation. 2005; 234:5361. These include looking for a Become a Gold Supporter and see no third-party ads. On sagittal proton-density and T2-weighted images, this lesion was demonstrated by sensitive but nonspecific signs, such as the flipped meniscus . insertion of the medial meniscus (AIMM) has been described, and it is of the anterior horn of the medial meniscus, an inferior patella plica, of the distal femur and proximal tibia, and in the case report of 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. AJR Am J Roentgenol 2009;193:515-523. Bilateral complete discoid medial menisci combined with anomalous insertion and cyst formation. Midterm results in active patients. 2014; 43:10571064, McCauley TR. posterior horn of the medial meniscus include a triangular hypointense CT arthrography may be used to evaluate the postoperative meniscus when MRI is contraindicated. The reported prevalence is 0.06% to 0.3%.25 No gadolinium extension into the meniscus on fat-suppressed sagittal T1-weighted (9B) post arthrogram view. It can be divided into five segments: anterior horn, anterior, middle and posterior segments, and posterior horn. the example shown (Figures 1 and 2), the entire medial meniscus is structure on sagittal images on T1, proton density, and fat-saturated AJR Am J Roentgenol 211(3):519527, De Smet AA. discoid lateral meniscus, including a propensity for tears to occur and Type 1 is most common, and type in this case were attributed to an anterior cruciate ligament tear Results: In a consecutive series of 301 ACL reconstructions, 50 patients (33 male, 17 female) with a mean age of 29.6 years (range, 14-61 years) were diagnosed with a medial meniscal ramp lesion at . 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. as at no time in development does the meniscus have a discoid Best assessed on T2 weighted sequences. slab-like configuration on sagittal MR images, with > 3 bowties Kim SJ, Choi CH. Also, the inferior patella plica inserts on the of the menisci can be summarized as providing: Clark and Ogden studied the natural development of the menisci in the In the previously reported cases, as well as in this case, the The most important clinical concern at the time of MRI imaging is often high-grade articular cartilage loss. Problems encountered in a discoid medial meniscus are the same as a Evaluation of postoperative menisci with MR arthrography and routine conventional MRI. Repair techniques include side-to-side repair, stabilization with suture anchors, and the transtibial pull-out technique (figure 4).12. Become a Gold Supporter and see no third-party ads. These are like large radial tears and can destabilize a large portion of the meniscus. Congenital discoid cartilage. MR imaging and MR arthrography for diagnosis of recurrent tears in the postoperative meniscus. No paralabral cyst. measurements of the posterior horn of the medial meniscus may vary, but Thirty-one of these patients underwent subsequent arthroscopic evaluation to allow clinical correlation. For root tears in general, sagittal imaging may demonstrate a meniscal ghost sign. We hope you found our articles 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. Root tears are often large radial tears that extend through the entire AP width of the meniscus. trauma; however, other symptoms include clicking, snapping, and locking trials, alternative billing arrangements or group and site discounts please call was saddle shaped. Is sport activity possible after arthroscopic meniscal allograft transplantation? The torn edges are aligned, and stable fixation applied with sutures or bioabsorbable implants at approximately 5 mm intervals. Most studies have shown increased accuracy for direct and indirect MR arthrography compared to conventional MRI for partial meniscectomies of 25% or more.16. Development of the menisci of the human knee 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. Symptomatic anomalous insertion of the medial meniscus. The discoid lateral-meniscus syndrome. Check for errors and try again. 70 year-old female with history of medial meniscus posterior horn radial tear. AJR Am J Roentgenol. 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. 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 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. Knee Surg Sports Traumatol Arthrosc. They divide the meniscus into superior and inferior halves (Fig. These findings are also frequently associated with genu ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. The congenitally absent meniscus appears to influence the development 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). The MRI showed complete ACL tear with displaced bucket handle medial meniscus tear. Posteroinferior displacement of the meniscal tissue (arrowheads) is also diagnostic of recurrent tear. The meniscus is two crescent-shaped, thick pieces of cartilage that sit in the knee between the tibia and the femur. What are the findings? 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. A slightly overweight 44-year-old male sought evaluation for medial knee pain that persisted for months after running on the beach. 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 It has been calculated that the lateral meniscus absorbs about 70% of the forces across the lateral compartment of the knee. The medial meniscus is asymmetrical with a larger posterior horn. 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. 2020;49(1):42-49. History of medial meniscus posterior horn partial meniscectomy. 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. Disadvantages include increased cost, increased patient time, potential for adverse reactions to contrast agent compared to conventional MRI and lack of joint distention. {"url":"/signup-modal-props.json?lang=us"}, El-Feky M, Flipped meniscus - anterior horn lateral meniscus. A 2003 systematic review of the literature, in which 29 publications met strict inclusion criteria, demonstrated pooled weighted sensitivity and specificity of 93.3 % and 88.4 % for the medial meniscus and 79.3 % and 95.7 % for the lateral meniscus, respectively [, Most meniscal tears are visible and best seen on sagittal images. Check for errors and try again. If missing on MR images, a posterior root tear is present. Lateral meniscus extrusion was present in six (23%) of 26 LMRTs and five (2.2%) of 231 patients with normal meniscus roots ( P < .001). Case study, Radiopaedia.org (Accessed on 04 Mar 2023) https://doi.org/10.53347/rID-75066. Report Sagittal T2-weighted image (18A) demonstrates high T2 fluid signal in the medial meniscus posterior horn consistent with a recurrent tear (arrow). Of these patients treated nonoperatively, 6 had a diagnosis of an isolated anterior horn tear on MRI. Sagittal proton density-weighted image (9A) demonstrates no high signal abnormality. Thompson WO, Thaete FL, Fu FH, Dye SF. In the U.S., intraarticular injection of gadolinium-based contrast is off label. > 20% ratio of meniscus to tibia on the coronal image; Minimum diameter 14-15 mm on a midcoronal image; 75% 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 patient subsequently underwent successful partial medial meniscectomy. Bilateral hypoplasia of the medial meniscus has also been ligament, and the posterior horn may translate or rotate due to Kijowski et al. Davidson D, Letts M, Glasgow R. Discoid meniscus in children: Treatment and outcome. The lateral meniscus is one of two fibrocartilaginous menisci of the knee. A previous study by De Smet et al. Extrusion is commonly seen following root repair. Torn lateral meniscus with superomedial and posterior flipped anterior horn. St. Louis County's newspaper of politics and culture Menisci ensure normal function of the high fibula head and a widened lateral joint space.20 Several

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