The MRI showed complete ACL tear with displaced bucket handle medial meniscus tear. meniscal diameter. Extrusion is commonly seen following root repair. Thirty-one of these patients underwent subsequent arthroscopic evaluation to allow clinical correlation. 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. History of a longitudinal medial meniscus tear managed by repair and concurrent ACL reconstruction. 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. is affected. Lee S, Jee W, Kim J. On MR arthrography, (12B), gadolinium extends through the repair site indicating a tear. They are most frequently seen at the posterior horn of the medial meniscus. signal fluid cleft interposed between the posterior horn and the capsule 1427-143. 2005; 234:5361. 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. On MRI, longitudinal tears appear as a vertical line of abnormal signal contacting articular surface. Normal Comparison of Postoperative Antibiotic Regimens for Complex Appendicitis: Is Two Days as Good as Five Days? The medial meniscus is more tightly anchored than the lateral meniscus, allowing for approximately 5mm of anterior-posterior translation. Pain is typically medial and activity-related (e.g. 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. On MRI, they exhibit abnormal horizontal linear signal contacting the inferior articular surface near the free edge or less commonly the superior surface. meniscus is partial meniscal excision, leaving a 6- to 7-mm peripheral Heron, D, Bonnard C, Moraine C,Toutain A. Agenesis of cruciate Meniscal root tears are a type of meniscal tear in the knee where the tear extends to either the anterior or posterior meniscal root attachment to the central tibial plateau. MRI c spine / head jxn - they can have stenosis of foramen magnum . St. Louis County's newspaper of politics and culture AJR Am J Roentgenol 211(3):519527, De Smet AA. Long-term outcome after arthroscopic meniscal repair versus arthroscopic partial meniscectomy for traumatic meniscal tears. collapse and widening of the medial joint space (Figure 7). Meniscal transplant is usually reserved for patients younger than 50 years who have normal axial alignment. 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. Methods Eighteen patients who had arthroscopically confirmed partial MMPRTs were included. The aim of this study was to evaluate diagnostic values involved in conventional magnetic resonance imaging (MRI) features of MM posterior root tears (MMPRTs) and find other MRI-based findings in patients with partial MMPRTs. There was no history of a specific knee injury. Radiographs may 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. Tears The MFL was not observed in five (19%) of 26 studies of an LMRT. Become a Gold Supporter and see no third-party ads. medial meniscus, and not be confined to the ACL as seen in an ACL tear. 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. 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. Radial tears comprise approximately 15 % of tears in some surgical series [. Type 1: A complete slab of meniscal tissue with complete tibial coverage. 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. acromioclavicular, sternoclavicular, and temporomandibular joints. 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. The meniscus may also become hypertrophic. The patient underwent a successful partial medial meniscectomy and was encouraged to seek low-impact exercise. Proper preoperative sizing of the allograft is critical for surgical success and usually performed with radiographs. The lateral meniscus is produced by the varus tension and tibial IR. Discoid meniscus in children: Magnetic resonance imaging characteristics. There was no evidence of meniscal extrusion or a meniscal ghost sign (Fig. 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. Lateral meniscus tears of the posterior root are a common concomitant injury to anterior cruciate ligament (ACL) tears [6, 16, 20]. 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. 1. Clin Orthop Relat Res 2013; 471: pp. These features constitute O'Donoghue unhappy triad. At 1 year, 5 of 6 were completely asymptomatic with the remaining patient minimally painful with no suggestion of meniscal symptoms. No meniscal tear is seen, but the root attachment was also noted to be 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. 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. Kim EY, Choi SH, Ahn JH, Kwon JW. Sagittal proton density-weighted image (8A) through the medial meniscus demonstrates signal extending to the tibial surface (arrow). Tibial meniscal dynamics using three-dimensional reconstruction of magnetic resonance images. 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. MRI features are consistent with torn lateral meniscus with flipped anterior horn superomedial and posterior, resting superior to the posterior horn. 2019: Factors associated with bilateral discoid lateral meniscus tear in patients with symptomatic discoid lateral meniscus tear using MRi and X-ray Orthopaedics and Traumatology Surgery and Research: Otsr 105(7): 1389-1394 Am J Sports Med 2017; 45:884891, Zaffagnini S, Grassi A, Marcheggiani Muccioli GM, et al. The tear was treated by partial meniscectomy at second surgery. Evaluation of postoperative menisci with MR arthrography and routine conventional MRI. CT arthrography may be used to evaluate the postoperative meniscus when MRI is contraindicated. mimicking an anterior horn tear. 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 posterior root of the medial meniscus attaches to the tibia, just anterior and medial to the posterior cruciate ligament (PCL). MRI has high sensitivity and specificity for detecting meniscus tears in patients without prior knee surgery. pretzels dipped in sour cream. Meniscal root tears are defined as radial tears located within 1 cm from the meniscal attachment or a bony rootavulsion. The incidence was calculated based on arthroscopic findings, and the potential secondary signs of meniscal ramp tears were evaluated on MRI. By continuing to use our site, you consent to the use of cookies outlined in our Privacy Policy. The patient had a recent new injury with increased pain. hypermobility. to tear. 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. There is no telling how much this error rate will change for radiologists less experienced with MRI. Weight-bearing knee X-rays showed a 50 % narrowing in the medial compartment. The example above demonstrates the importance of baseline MRI comparison when evaluating the postoperative meniscus. Radial Tear of the Medial Meniscal Root: Reliability and Accuracy of MRI for Diagnosis. Create a new print or digital subscription to Applied Radiology. of the menisci can be summarized as providing: Clark and Ogden studied the natural development of the menisci in the Papalia R, Vasta S, Franceschi F, D'Adamio S, Maffulli N, Denaro V. Meniscal Root Tears: From Basic Science to Ultimate Surgery. The anterior and posterior meniscofemoral ligaments (Humphrey and Wrisberg respectively) are commonly present with one or both found in 93-100% of patients. . Sagittal proton density-weighted image (10A) demonstrates increased signal extending to the articular surface consistent with granulation tissue. 2006; 187:W565568. The anterior horn inserts on the tibia and continues laterally to the anterior horn of the lateral meniscus via the transverse intermeniscal ligament. In cases like this, MR arthrography is quite helpful. According to one source, they are thought to account for ~10% of all arthroscopic meniscectomies 5. They are usually due to an acute injury [. 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. 2006; 88:660667, Boutin RD, Fritz RC, Marder RA. The lateral meniscus is more circular with a shorter radius, covering 70% of the articular surface with the anterior and posterior horns approximately the same size. of the transverse ligament is comparable to the general population.5. Lateral meniscus posterior horn peripheral longitudinal tear managed by repair. Most studies have shown increased accuracy for direct and indirect MR arthrography compared to conventional MRI for partial meniscectomies of 25% or more.16. menisci develop from this mesenchymal tissue in a site where this tissue Clark CR, Ogden JA. 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. Presentation - Middle-older aged individuals, non-traumatic, progressive onset of pain. snapping knee due to hypermobility. 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. This emphasizes the importance of baseline MRI comparison for evaluation of the postoperative meniscus.3. Posteroinferior displacement of the meniscal tissue (arrowheads) is also diagnostic of recurrent tear. Longitudinal lateral meniscus tear status post repair (arrow). It splits into two bands at the PCL, named Humphry(anterior to the PCL) and Wrisberg (posterior to the PCL). Fukuta S, Masaki K, Korai F. Prevalence of abnormal findings in magnetic resonance images of asymptomatic knees.
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