Anomalous Thompson WO, Thaete FL, Fu FH, Dye SF. The lateral meniscus is one of two fibrocartilaginous menisci of the knee. Unable to process the form. The main functions Diagnosis of meniscal tears on MRI improves when these guidelines are followed to optimize signal-to-noise ratio: high-field-strength magnets are preferable (1.5 T and stronger); a high-resolution surface coil should be used; the field of view should only encompass the necessary structures and routinely be 16 cm or less; image slices should not be too thick (34 mm); and the matrix size should be at least 256192 or higher [, A normal meniscus is low signal on all sequences. 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). meniscus. Sagittal T2-weighted image (18A) demonstrates high T2 fluid signal in the medial meniscus posterior horn consistent with a recurrent tear (arrow). They divide the meniscus into superior and inferior halves (Fig. The anterior root of the medial meniscus attaches to the anterior midline of the tibial plateau or sometimes the anterior surface of the tibia just below the plateau. O'Donoghue unhappy triad | Radiology Case | Radiopaedia.org MRI Findings: Medial meniscus: Tear of the posterior horn seen to the inferior articular surface continuing into the posterior body and becoming more vertical. In contrast to the medial meniscus, the posterior horn of the lateral meniscus is additionally secured by the meniscofemoral ligaments (MFL). A previous study by De Smet et al. Medial meniscus posterior horn peripheral longitudinal tear treated with repair. What is anterior horn of meniscus? - KnowledgeBurrow.com However, the use of MRI arthrography should be considered for post-operative menisci with equivocal findings on conventional MRI as the presence of high gadolinium-like signal within the meniscus would allow for a definitive diagnosis of re-tear. 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. instance, tears of the lateral aspect of the anterior horn of the Connolly B, Babyn PS, Wright JG, Thorner PS. The self-reported complication rate for partial meniscectomy is 2.8% and meniscus repair is 7.6%. 1991;7(3):297-300. Intact meniscal roots. 70 year-old female with history of medial meniscus posterior horn radial tear. This arises from the posterior horn of the lateral meniscus and attaches to the lateral aspect of the medial femoral condyle. These findings are also frequently associated with genu ISAKOS: 2023 Congress in Boston, USA : Abstract Analysis of Risk The Postoperative Meniscus - Radsource 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. Total meniscectomy is rarely performed unless the meniscus is so severely damaged that no salvageable meniscal tissue remains. Long-term outcome after arthroscopic meniscal repair versus arthroscopic partial meniscectomy for traumatic meniscal tears. Exam showed a mild effusion and medial joint line tenderness. Lateral Meniscus Tear | New Health Advisor The patient failed conservative management of aspiration and cortisone injection. (Figure 1). Magn Reson Imaging Clin N Am 2014;22(4): 517555, White LM, Schweitzer ME, Weishaupt D, Kramer J, Davis A, Marks PH. Radiology. diagnostic dilemma, as the AIMM band will be seen to extend to the The incidence was calculated based on arthroscopic findings, and the potential secondary signs of meniscal ramp tears were evaluated on MRI. Meniscal transplants can fail at the implantation site by avulsion, failure of bone plug incorporation or bone bridge fracture. PRIME PubMed | Posterior horn lateral meniscal tears simulating 800-688-2421. medial meniscus, discoid lateral meniscus, including the Wrisberg St. Louis County's newspaper of politics and culture immediatly lateral to the anterior horn of lateral meniscus and posterior to the tubercle of anteriro horn of medial meniscus . We look forward to having you as a long-term member of the Relias Repair of posterior root tears are being performed with increased frequency over the past several years. Meniscal Tear Patterns - Radsource To assess the prevalence of meniscal extrusion and its . (1A) Proton density-weighted, (1B) T2-weighted, and (1C) fat-suppressed T1-weighted MR arthrographic sagittal images are provided. They are usually due to an acute injury [. anterior horn of the medial meniscus into the anterior cruciate ligament This patient had relief after the initial repair surgery, then had a second injury with recurrent symptoms, which is why the surgeon felt this was a recurrent tear. The sensitivity of mri in detecting meniscal tears is generally good, ranging from 70-98%, with specificity in the same range in many studies. of the distal femur and proximal tibia, and in the case report of One important reason for such discrepancies is a failure to understand the transverse geniculate ligament of the knee (TGL). Fukuta S, Masaki K, Korai F. Prevalence of abnormal findings in magnetic resonance images of asymptomatic knees. 2012;20(10):2098-103. This article focuses on Reporting knee meniscal tears: technical aspects, typical pitfalls and It can be divided into five segments: anterior horn, anterior, middle and posterior segments, and posterior horn. The camera can visualize the meniscus and other structures within the knee. What is a Grade 3 meniscus tear? On the proton density-weighted image (12A) persistent high signal extends to the tibial and femoral surfaces (arrow). The most important clinical concern at the time of MRI imaging is often high-grade articular cartilage loss. The condition is typically asymptomatic and, therefore, is infrequently diagnosed.14 We will review the common meniscal variants, which of a case of discoid medial cartilage, with an embryological note. The lateral meniscus is more circular, and its anterior and posterior horns are nearly equivalent in size in cross section. meniscus | Search | Radiopaedia.org The MFL was not observed in five (19%) of 26 studies of an LMRT. These tears are usually degenerative in nature and usually not associated with a discrete injury [. This mesenchymal After failing conservative management with NSAIDs, PT, and activity modification, he underwent an MRI. varus deformity (Figure 3). On examination, there was marked medial joint line tenderness and a large effusion. Mechanical rasping or trephination of the torn meniscus ends and parameniscal synovium is used to promote bleeding and vascular healing. medial meniscus, and not be confined to the ACL as seen in an ACL tear. Anterior horn lateral meniscus tear | HealthTap Online Doctor menisci develop from this mesenchymal tissue in a site where this tissue 2005; 234:5361. Medial meniscus posterior horn peripheral longitudinal tear (arrow) seen on the sagittal proton density-weighted image (15A) and managed by repair. CT arthrography may be used to evaluate the postoperative meniscus when MRI is contraindicated. Surgical Outcomes Lysholm Score Root tears are associated with a high risk for osteoarthritis. 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. bilaterally absent menisci reported by Tolo et al,3 the 2013;106(1):91-115. pivoting). Lateral meniscus bucket handle tears can produce the double anterior horn sign or double ACL sign. Bucket-handle tear of the lateral meniscus: Flipped meniscus sign The most frequent symptom is pain that usually begins with a minor 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. the menisci of the knees. 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. congenital anomalies affect the lateral meniscus, most commonly a The MRI revealed a vertical flap (oblique) tear of the medial meniscus. least common is complete congenital absence of the menisci. Br Med Bull. These features constitute O'Donoghue unhappy triad. The fat-suppressed sagittal T1-weighted post arthrogram view (7C) demonstrates gadolinium extending into the meniscal substance. 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. They were first described by M J Pagnaniet al. Disadvantages include increased cost, increased patient time, potential for adverse reactions to contrast agent compared to conventional MRI and lack of joint distention. 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. high fibula head and a widened lateral joint space.20 Several 2014; 43:10571064, McCauley TR. Check for errors and try again. Nakajima T, Nabeshima Y, Fujii H, et al. Longitudinal medial meniscus tear managed by repair (arrow). De Smet A. from AIMM. Menisci ensure normal function of the 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). 2008;191(1):81-5. Variations in meniscofemoral ligaments at anatomical study and MR imaging. A slightly overweight 44-year-old male sought evaluation for medial knee pain that persisted for months after running on the beach. 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 (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). both enjoyable and insightful. Controlling Blood Pressure During Pregnancy Could Lower Dementia Risk, Researchers Address HIV Treatment Gap Among Underserved Population, HHS Announces Reorganization of Office for Civil Rights, FDA Adopts Flu-Like Plan for an Annual COVID Vaccine. Most studies have shown increased accuracy for direct and indirect MR arthrography compared to conventional MRI for partial meniscectomies of 25% or more.16. There is no universally accepted system for classifying meniscal tear patterns. Again, this emphasizes the importance of accurate history, prior imaging and operative reports. Note the symmetrical shape of the lateral meniscus (left) with similar size of the anterior and posterior horns. 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 RESULTS. Type 2: An incomplete slab of meniscal tissue with 80% coverage of the lateral tibial plateau. Anterior horn lateral meniscus tear A female asked: Mri: "macerated anterior horn lateral meniscus with inferiorly surfacing tear. The meniscus can separate from the joint capsule or tear through the allograft. What are the findings? Laundre BJ, Collins MS, Bond JR, Dahm DL, Stuart MJ, Mandrekar JN: MRI accuracy for tears of the posterior horn of the lateral meniscus in patients with acute anterior cruciate ligament injury and the clinical relevance of missed tears. The remaining 42 cases were located in the red zone (19 cases) or the red-white zone. For partial meniscectomies involving 25% or more, conventional MRI has lower accuracy. According to one source, they are thought to account for ~10% of all arthroscopic meniscectomies 5. Brody J, Lin H, Hulstyn M, Tung G. Lateral Meniscus Root Tear and Meniscus Extrusion with Anterior Cruciate Ligament Tear. Sagittal proton density-weighted image (9A) demonstrates no high signal abnormality. described in thrombocytopenia absent radius syndrome (TAR syndrome).2,3 Bilateral hypoplasia of the medial meniscus has also been reported.4. 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. Arthroscopy for Medial Meniscus Tears The decision to repair or remove the torn portion is made at the time of surgery. show cupping of the medial tibial plateau, proximal medial tibial physis The lateral . Symptomatic anomalous insertion of the medial meniscus. 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. 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. Tears Coronal extrusion of the lateral meniscus does not increase after during movement, and less commonly joint-line tenderness, reduced FSE T2-weighted images, with a slab-like appearance on coronal images. structure on sagittal images on T1, proton density, and fat-saturated does not normally occur.13. Bilateral complete discoid medial menisci combined with anomalous insertion and cyst formation. The patient subsequently underwent successful partial medial meniscectomy. Media community. 6 months post-operative she had increased pain prompting follow-up MRI. Sagittal PD (. A tear of the ACL should also, in practice, not be a Pinar H, Akseki D, Karaoglan O, et al. This emphasizes the importance of meniscal repair over meniscectomy when possible and the need for meniscal preservation when a partial meniscectomy is necessary. American Board of Orthopaedic Surgery Practice of the Orthopaedic Surgeon: Part-II, certification examination case mix. Imaging characteristics of the in 19916. Radiology. Meniscus tears are either degenerative or acute. partly divides a joint cavity, unlike articular discs, which completely 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. Anterior Horn Meniscal Repair Using an Outside-In Suture Technique
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