anterior horn lateral meniscus tear: mri

Sagittal proton density-weighted image (9A) demonstrates no high signal abnormality. 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. ADVERTISEMENT: Supporters see fewer/no ads. It has been calculated that the lateral meniscus absorbs about 70% of the forces across the lateral compartment of the knee. The lateral . The trusted source for healthcare information and CONTINUING EDUCATION. 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. Grade II hyperintense horizontal signal of posterior horn of medial meniscus is noted. joint: Morphologic changes and their potential role in childhood Meniscus tears, indicated by MRI, are classified in three grades. the menisci of the knees. Kim SJ, Choi CH. 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. 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. The incidence of lateral meniscus posterior root tears was approximately 4 times higher than of medial meniscus posterior root tears in both primary (12.2% vs 3.2%) and revision (20.5% vs 5.6%) ACLRs. The lateral meniscus is produced by the varus tension and tibial IR. 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 . 2059-2066, Kinsella S.D., and Carey J.L. Extrusion is commonly seen following root repair. Again, this emphasizes the importance of accurate history, prior imaging and operative reports. 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 most frequent symptom is pain that usually begins with a minor 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. Special thanks to David Rubin, MD for providing several cases used in this web clinic. There was no history of a specific knee injury. What is your diagnosis? A Fukuta S, Masaki K, Korai F. Prevalence of abnormal findings in magnetic resonance images of asymptomatic knees. Cho JM, Suh JS, Na JB, et al. RESULTS. 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. 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 ]. 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. Menisci ensure normal function of the high fibula head and a widened lateral joint space.20 Several The camera can visualize the meniscus and other structures within the knee. High signal close to fluid intensity contacts the tibial surface on the sagittal T2-weighted image (11B) and is equivocal. There is no universally accepted system for classifying meniscal tear patterns. Connolly B, Babyn PS, Wright JG, Thorner PS. typically into the anterior cruciate ligament. Root tears are associated with a high risk for osteoarthritis. bilaterally absent menisci reported by Tolo et al,3 the Radiographs may 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 [. On MRI, they exhibit abnormal horizontal linear signal contacting the inferior articular surface near the free edge or less commonly the superior surface. Examination showed lateral joint line tenderness and a positive McMurray sign. Recent evidence suggests that decreased extrusion may correlate to better clinical outcomes.18. 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. MR imaging evaluation of the postoperative knee. slab-like configuration on sagittal MR images, with > 3 bowties While they can arise from a number of mechanisms, root tears are generally thought to be chronic 5. The patient underwent partial medial meniscectomy and ACL reconstruction. In contrast to the medial meniscus, the posterior horn of the lateral meniscus is additionally secured by the meniscofemoral ligaments (MFL). 6. Monllau et al in 1998 proposed adding a fourth type, Otherwise, the increased vascularity in children has sometimes led to false-positive reading of a meniscus tear. 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. ligaments are absent, most commonly the anterior cruciate ligament (ACL) Materials and methods . Check for errors and try again. With age, increased connective tissue stiffness of the meniscus develops secondary to elastin degradation and collagen rigidification.2. 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"}. A meta-analysis of 44 trials. Radial tears comprise approximately 15 % of tears in some surgical series [. It can be divided into five segments: anterior horn, anterior, middle and posterior segments, and posterior horn. 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. Clin Orthop Relat Res 2012; 470: pp. 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? 2002; 222:421429, Ciliz D, Ciliz A, Elverici E, Sakman B, Yuksel E, Akbulut O. Biologic augmentation with application of exogenous fibrin clot or growth factors may be combined with the repair to promote healing. Radiology. ligament, and the posterior horn may translate or rotate due to 1 ). . The lateral meniscus is more circular, and its anterior and posterior horns are nearly equivalent in size in cross section. 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. If a meniscus tear shows up on a MRI, it is considered a Grade 3. As a result, the accuracy rate of diagnosis by MRI is 83.3%. menisci occurs. (Tr. Disadvantages include risks associated with joint injection, radiation exposure and lower contrast resolution compared to MRI, particularly in the extraarticular soft tissues. meniscus are not uncommon; they include an anomalous insertion of the structure on sagittal images on T1, proton density, and fat-saturated published a case series of anterior horn tears of the lateral meniscus in 14 soccer players (mean age 20.2 years). MR imaging is useful for evaluation of many possible complications following meniscal surgery. {"url":"/signup-modal-props.json?lang=us"}, El-Feky M, Flipped meniscus - anterior horn lateral meniscus. However, recognizing these variants is important, as they can 17. The anterior and posterior sutures are shuttled down the tibial tunnel (arrowhead). Sagittal T2-weighted (8B) and fat-suppressed coronal T2-weighted (8C) images reveal fluid signal (arrows) extending into the meniscal substance indicating a recurrent tear which was confirmed at second look arthroscopy. 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. This has also been described as grade 2 signal [, Sagittal fat-suppressed T2 image of a 14-year-old patient showing a grade 2 signal in the posterior horn of the medial meniscus (PHMM). Grades 1 and 2 are not considered serious. hypermobility. Tears Renew or update your current subscription to Applied Radiology. 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 ]. On examination, there was marked medial joint line tenderness and a large effusion. Fellowship-trained musculoskeletal radiologists read 99% of the MRIs. Presentation - Middle-older aged individuals, non-traumatic, progressive onset of pain. Monllau J, Gonzalez G, Puig L, Caceres E. Bilateral hypoplasia of the medial meniscus. 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 Lee S, Jee W, Kim J. History of medial meniscus posterior horn and body partial meniscectomy. 4). of the menisci can be summarized as providing: Clark and Ogden studied the natural development of the menisci in the Repair devices including arrows, darts and sutures are used to approximate the torn edges of the meniscus. AJR American journal of roentgenology. Arthroscopy for Medial Meniscus Tears The decision to repair or remove the torn portion is made at the time of surgery. Wrisberg variant, the morphology of the meniscus may be normal, but the There is a medial and a lateral meniscus. The posterior cruciate ligament is intact. 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. There was no evidence of meniscal extrusion or a meniscal ghost sign (Fig. Comparison of Postoperative Antibiotic Regimens for Complex Appendicitis: Is Two Days as Good as Five Days? meniscus. 3 is least common. CT arthrography may be used to evaluate the postoperative meniscus when MRI is contraindicated. appearance.12 It is now believed that the knee develops from a By continuing to use our site, you consent to the use of cookies outlined in our Privacy Policy. Direct MR arthrography requires intraarticular injection of 20-50 mL of dilute gadolinium contrast prior to imaging which distends the joint capsule and offers a high signal to noise ratio on T1-weighted images with contrast extension into the meniscal substance indicating a recurrent tear or an unhealed repair. Clinical imaging. 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 [. 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. Pullout fixation of posterior medial meniscus root tears: correlation between meniscus extrusion and midterm clinical results. 2008;191(1):81-5. Dr. Michael Gabor answered Diagnostic Radiology 35 years experience No,: It doesn't sound like a bucket handle tear The most commonly practiced At the time the article was last revised Yahya Baba had The anterior meniscofemoral ligament (Humphrey ligament) attaches proximally on the medial femoral condyle, inferior to the PCL insertion. 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 Kelly BT, Green DW. both enjoyable and insightful. At the time the article was created Yuranga Weerakkody had no recorded disclosures. Discoid meniscus in children: Magnetic resonance imaging characteristics. 2002;30(2):189-192. of a case of discoid medial cartilage, with an embryological note. AJR Am J Roentgenol 2009;193:515-523. 1). 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. Forty-five of the remaining patients did not undergo surgery but did undergo clinical follow-up and interview at a minimum of 1 year after the MRI to determine if they had any residual symptoms or if they received further medical treatment. At the time the case was submitted for publication Mostafa El-Feky had no recorded disclosures. snapping knee due to hypermobility. They often tend to be radial tears extending into the meniscal root. . Variations in meniscofemoral ligaments at anatomical study and MR imaging. for the ratio of the sum of the width of the anterior and posterior Copy. is affected. 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. These include looking for a Knee Surg Sports Traumatol Arthrosc. 3. A tear of the meniscal root means the tear is near where it attaches to the bone, usually far in the back. It is believed that discoid 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. Mechanical rasping or trephination of the torn meniscus ends and parameniscal synovium is used to promote bleeding and vascular healing. Discoid lateral meniscus in children. Sagittal proton density-weighted image (6A) through the medial meniscus following partial meniscectomy and debridement of the inferior articular surface shows increased PD signal contacting the inferior articular surface (arrow) but no T2 fluid signal at the surgical site (6B) and no gadolinium signal in the meniscus (6C). This arises from the posterior horn of the lateral meniscus and attaches to the lateral aspect of the medial femoral condyle. 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. 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. The meniscus is two crescent-shaped, thick pieces of cartilage that sit in the knee between the tibia and the femur. Discoid lateral meniscus and the frequency of meniscal tears. 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. Fat suppressed sagittal T1-weighted MR arthrogram (5C) demonstrates gadolinium within the tear (arrow). ligament and meniscal fascicles. posterior horn usually measures 12 mm to 16 mm in the sagittal plane in Magn Reson Imaging Clin N Am 2014;22(4): 517555, White LM, Schweitzer ME, Weishaupt D, Kramer J, Davis A, Marks PH. Figure 7: Meniscofemoral ligament. A tear of the ACL should also, in practice, not be a AJR Am J Roentgenol. intra-articular structures at 8 weeks gestation. For root tears in general, sagittal imaging may demonstrate a meniscal ghost sign. The superior, middle and inferior geniculate arteries are the main vascular supply to the menisci. The most common Symptomatic anomalous insertion of the medial meniscus. Schwenke M, Singh M, Chow B Anterior Cruciate Ligament and Meniscal Tears: A Multi-modality Review. Sagittal T2-weighted (16A), fat-suppressed proton density-weighted sagittal (16B) and coronal (16C, D) images demonstrate findings of a posterior root transtibial pullout repair with visualization of the tibial tunnel (arrow), susceptibility artifact caused by the endobutton (asterisk) and fraying of the posterior root (arrowhead) but no tear. > 20% ratio of meniscus to tibia on the coronal image; Minimum diameter 14-15 mm on a midcoronal image; 75% 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. trials, alternative billing arrangements or group and site discounts please call 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. In the U.S., intraarticular injection of gadolinium-based contrast is off label. Klingele KE, Kocher MS, Hresko MT, et al. It is usually seen near the lateral meniscus central attachment site. mimicking an anterior horn tear. 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. Anatomic variability and increased signal change in this area are commonly mistaken for tears. And, some tears do not fill with contrast during arthrography. The MRI sign of a radial tear is a linear, vertical cleft of abnormal high signal at the free edge (Fig. Best assessed on T2 weighted sequences. Meniscal root tearsare a type of meniscal tearin the knee where the tear extends to either the anterior or posterior meniscal root attachment to the central tibial plateau.

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