anterior horn lateral meniscus tear: mridaisy esparza where is she now waiting for superman
Indications for meniscal repair typically include posttraumatic peripheral (red zone) longitudinal tears located near the joint capsule, ideally in younger patients (less than 40). A previous study by De Smet et al. Resnick D, Goergen TG, Kaye JJ, et al. Lateral meniscus tears of the posterior root are a common concomitant injury to anterior cruciate ligament (ACL) tears [6, 16, 20]. Extension to the anterior cortex of . {"url":"/signup-modal-props.json?lang=us"}, El-Feky M, Flipped meniscus - anterior horn lateral meniscus. MRI has high sensitivity and specificity for detecting meniscus tears in patients without prior knee surgery. It is often explained by fibers of the anterior cruciate ligament and the covering synovium . instance, tears of the lateral aspect of the anterior horn of the Kelly BT, Green DW. The most frequent symptom is pain that usually begins with a minor Thompson WO, Thaete FL, Fu FH, Dye SF. Healed peripheral medial meniscus posterior horn repair and new longitudinal tear in a different location. horns to the meniscal diameter on a sagittal slice that shows a maximum Radiology. A classification system developed by the International Society of Arthroscopy, Knee Surgery, and Orthopedic Sports Medicine [, Longitudinal-vertical tear. 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. The ends of the anterior and posterior horns are firmly attached to the tibia at their roots. Sagittal proton density-weighted image (8A) through the medial meniscus demonstrates signal extending to the tibial surface (arrow). The discoid lateral-meniscus syndrome. Rao PS, Rao SK, Paul R. Clinical, radiologic, and arthroscopic assessment of discoid lateral meniscus. 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. He presented after a few months with symptoms of instability. Grade 3 is a true meniscus tear and an arthroscope is close to 100 percent accurate in diagnosing this tear. meniscus. The MRI revealed a longitudinal tear in the posterior horn of the lateral meniscus. 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 ]. 2006;239(3):805-10. meniscus is partial meniscal excision, leaving a 6- to 7-mm peripheral Tears 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). Knee Surg Sports Traumatol Arthrosc. It splits into two bands at the PCL, named Humphry(anterior to the PCL) and Wrisberg (posterior to the PCL). The reported prevalence is 0.06% to 0.3%.25 Arthroscopy: The Journal of Arthroscopic & Related Surgery. 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. for the ratio of the sum of the width of the anterior and posterior Because this is a relatively new procedure, few studies have been dedicated to MRI evaluation of postoperative root repair. Meniscus tears, indicated by MRI, are classified in three grades. 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. Sometimes T2 signal in a healed tear may look similar to fluid. Figure 8: Medial oblique menisco-meniscal . The congenitally absent meniscus appears to influence the development Twenty-one had ACL tears; all those with an PHLM tear had an ACL tear. 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. By comparison, the complication rate for ACL reconstruction is 9% and PCL reconstruction is 20%.20 Potential complications associated with arthroscopic meniscal surgery include synovitis, arthrofibrosis, chondral damage, meniscal damage, MCL injury, nerve injury (saphenous, tibial, peroneal), vascular injury, deep venous thrombosis and infection.21 Progression of osteoarthritis and stress related bone changes are seen with increased frequency in the postoperative knee, particularly with larger partial meniscectomies. Mucinous degeneration of meniscus can also produce abnormal signal within a meniscus which does not contact an articular surface and should not be mistaken for a tear. the intercondylar notch, most commonly to the mid ACL, and less commonly However, few studies have directly compared the medial and lateral root tears. An intact meniscal repair was confirmed at second look arthroscopy. The medial meniscus is more tightly anchored than the lateral meniscus, allowing for approximately 5mm of anterior-posterior translation. Magnetic resonance imaging (MRI) revealed an elongated free edge of the diffusely enlarged lateral meniscus extending toward the intercondylar region on coronal T1-weighted images (Figure 1A). If missing on MR images, a posterior root tear is present. CT arthrography may be used to evaluate the postoperative meniscus when MRI is contraindicated. On this page: Article: Epidemiology Pathology Radiographic features History and etymology The superior, middle and inferior geniculate arteries are the main vascular supply to the menisci. occur with minor trauma. 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. 2059-2066, Kinsella S.D., and Carey J.L. seen on standard 4- to 5-mm slices.21 The Wrisberg ligament may also be thick and high in patients with a complete discoid lateral meniscus.22 Other criteria used to diagnose lateral discoid meniscus include the following: In the Pathology - a tear that has developed gradually in the meniscus. Kim SJ, Choi CH. Magnetic resonance imaging (MRI) and computed tomography (CT) arthrography are both well suited for evaluation of these lesions though somewhat limited by cost and access for MRI and by invasiveness for CT arthrography . When interpreting MR images of the knee, it is important to assess for any change from the expected shape of the menisci. Youderian A, Chmell S, Stull MA. Illustration of the medial and lateral menisci. And, some tears do not fill with contrast during arthrography. Exam showed a mild effusion and medial joint line tenderness. 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. In this case, we can determine that there is a new tear in a different location. On examination, there was marked medial joint line tenderness and a large effusion. This case is almost identical to the previous case with a different clinical history. Type 1: A complete slab of meniscal tissue with complete tibial coverage. meniscal diameter. reported.4. Examination of the knee showed a mild effusion, 1+ Lachman, positive Pivot shift, and mild tenderness to both medial and lateral joint lines. of the transverse ligament is comparable to the general population.5. However, the tear changes plane of orientation over its course. . 7 Therefore, it is important for the radiologist to be familiar with the appearance of a recurrent tear versus an untorn postoperative meniscus. An intact meniscal repair was confirmed at second look arthroscopy. 4. The anterior horn inserts on the tibia and continues laterally to the anterior horn of the lateral meniscus via the transverse intermeniscal ligament. the menisci of the knees. In the U.S., intraarticular injection of gadolinium-based contrast is off label. Bilateral complete discoid medial menisci combined with anomalous insertion and cyst formation. Meniscal root tears are a form of radial tear that involves the central attachment of the meniscus (12a). ADVERTISEMENT: Supporters see fewer/no ads. 1427-143. The lateral meniscus is one of two fibrocartilaginous menisci of the knee. It is usually seen near the lateral meniscus central attachment site. 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). Figure 7: Meniscofemoral ligament. 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. 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. MR imaging and MR arthrography for diagnosis of recurrent tears in the postoperative meniscus. AJR Am J Roentgenol 2009;193:515-523. Each meniscus has three main parts, the back (posterior horn), middle (body), and front (anterior horn). Bilateral hypoplasia of the medial meniscus has also been Am J Sports Med 2017; 45:884891, Zaffagnini S, Grassi A, Marcheggiani Muccioli GM, et al. patella or Hoffas fat pad, and should be fairly easily differentiated There is a medial and a lateral meniscus. proximal medial tibia was convex and the distal medial femoral condyle Close clinical correlation is advised before recommending surgery based on this finding alone. This case features the following signs of meniscal tear: Case courtesy, Prof. Dr. Khaled Matrawy, Professor of radiology, Alexandria university, Egypt. The anterior and posterior meniscofemoral ligaments (Humphrey and Wrisberg respectively) are commonly present with one or both found in 93-100% of patients. posterior fascicles and meniscotibial ligament are absent and a high Become a Gold Supporter and see no third-party ads. meniscus are not uncommon; they include an anomalous insertion of the When bilateral, they are usually symmetric. What causes abnormal mobility in the medial meniscus? The MRI sign of a radial tear is a linear, vertical cleft of abnormal high signal at the free edge (Fig. An MRI of plaintiff's left knee conducted in May 2018 demonstrated a complex 7 tear of the posterior horn of the lateral meniscus and a suspected horizontal tear of the anterior horn of the lateral meniscus. Weight-bearing knee X-rays showed a 50 % narrowing in the medial compartment. On sagittal proton-density and T2-weighted images, this lesion was demonstrated by sensitive but nonspecific signs, such as the flipped meniscus . Meniscal disorders: Normal, discoid, and cysts. The patient failed conservative management of aspiration and cortisone injection. 3: The Wrisberg variant, where the meniscus may have a normal They found that 76 (8%) of these indicated a tear of the anterior horn of either the medial or lateral meniscus. Comparison of Postoperative Antibiotic Regimens for Complex Appendicitis: Is Two Days as Good as Five Days? Generally, 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. 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. Discoid lateral meniscus and the frequency of meniscal tears. The posterior horn is always larger than the anterior horn. The sagittal proton density-weighted image (13A) demonstrates linear high signal extending to the femoral and tibial surfaces (arrow). Anterior horn of the lateral meniscus: another potential pitfall in MR imaging of the knee. 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. Best assessed on T2 weighted sequences. 22 year-old male with a history of ACL and MCL reconstruction and medial meniscus posterior root repair. Associated anomalies in a discoid medial 300). 2008;191(1):81-5. (middle third), or Type 3 (superior third; intercondylar notch) (Figure variants of the meniscus are relatively uncommon and are frequently Skeletal radiology. Total meniscectomy is rarely performed unless the meniscus is so severely damaged that no salvageable meniscal tissue remains. Create a new print or digital subscription to Applied Radiology. After failing conservative management with NSAIDs, PT, and activity modification, he underwent an MRI. At the time the article was created Yuranga Weerakkody had no recorded disclosures. horn of the lateral meniscus, and oblique tear orientation In the present study, the patients analyzed came from the have been the most difficult for imaging planes to visualize same geographical area . There 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. 1. Lateral meniscal variant with absence of the posterior coronary ligament. MR arthrogram fat-suppressed sagittal T1-weighted image (11C) shows no gadolinium in the repair. 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. On MRI, they exhibit abnormal horizontal linear signal contacting the inferior articular surface near the free edge or less commonly the superior surface. 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). 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. Collagen fibers are arranged for transferring compressive loads into circumferential hoop stresses, secured by radially oriented tie fibers. of the menisci can be summarized as providing: Clark and Ogden studied the natural development of the menisci in the 2002;30(2):189-192. 36 year old male with history of meniscus surgery 7 years ago. Monllau J, Gonzalez G, Puig L, Caceres E. Bilateral hypoplasia 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. AJR Am J Roentgenol 211(3):519527, De Smet AA. While this test will show a tear up to 90% of the time, it does not always. A slightly overweight 44-year-old male sought evaluation for medial knee pain that persisted for months after running on the beach. Radiology. A Arthroscopy revealed a horizontal tear of PHMM, and a partial medial meniscectomy was performed. Sagittal proton density-weighted image (10A) demonstrates increased signal extending to the articular surface consistent with granulation tissue. CT arthrography is a recommended alternative for patients who are not MR eligible. Of the 14 athletes, 8 repairs were performed, 5 patients . The remaining 42 cases were located in the red zone (19 cases) or the red-white zone. separate the cavity. The patient underwent meniscal repair but had recurrent pain prompting repeat MRI 8 months post-operative. Pain is typically medial and activity-related (e.g. 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. Menisci ensure normal function of the A Wrisberg type variant has not been documented in However, clinically significant tears that can mechanically impinge were unlikely to have been missed. There is no universally accepted system for classifying meniscal tear patterns. Anatomic variability and increased signal change in this area are commonly mistaken for tears. tissue only persists at the edges, where differentiation into the Menisci are present in the knees and the Meniscus repair is superior to partial meniscectomy in preventing osteoarthritis and facilitating return to athletic activity.11 However, the period of postoperative immobilization and activity restriction associated with meniscus repair is longer than that associated with partial meniscectomy and requires a compliant, motivated patient to be successful. The example above illustrates marked degenerative changes caused by loss of meniscal function. Tachibana Y, Yamazaki Y, Ninomiya S. Discoid medial meniscus. They are most frequently seen at the posterior horn of the medial meniscus. They divide the meniscus into superior and inferior halves (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. 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. 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. 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. The most common morphology but lacks its posterior attachments; ie, the meniscotibial Unable to process the form. Source: Shepard MF, et al. 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. Proper preoperative sizing of the allograft is critical for surgical success and usually performed with radiographs. This is a well-done study with clinical correlation and adequate follow-up. Fukuta S, Masaki K, Korai F. Prevalence of abnormal findings in magnetic resonance images of asymptomatic knees. of the distal femur and proximal tibia, and in the case report of This scan showed a radial MMT. treatment for stable complete or incomplete types of discoid lateral A tear of the meniscal root means the tear is near where it attaches to the bone, usually far in the back. in this case were attributed to an anterior cruciate ligament tear in 19916. Brody J, Lin H, Hulstyn M, Tung G. Lateral Meniscus Root Tear and Meniscus Extrusion with Anterior Cruciate Ligament Tear. It can be divided into five segments: anterior horn, anterior, middle and posterior segments, and posterior horn. The torn edges are aligned, and stable fixation applied with sutures or bioabsorbable implants at approximately 5 mm intervals. Congenital absence of the meniscus is extremely rare and has been documented in TAR syndrome and in isolated case reports.2,3 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. Magn Reson Imaging Clin N Am 2014;22(4): 517555, White LM, Schweitzer ME, Weishaupt D, Kramer J, Davis A, Marks PH. MRI of the knee is commonly indicated for evaluation of unresolved or recurrent knee pain following meniscal surgery. 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. Repair of posterior root tears are being performed with increased frequency over the past several years. 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. Stay up to date with the latest in Practical Medical Imaging and Management with Applied Radiology. The MFL was not observed in five (19%) of 26 studies of an LMRT. Definite surfacing signal or distortion on only one image represents a possible tear. AJR Am J Roentgenol. MRI plays a critical role in influencing the treatment decision and enables information that would obviate unnecessary surgery including diagnostic arthroscopy. Ross JA,Tough ICK, English TA. does not normally occur.13. A detached posterior root is functionally equivalent to a total meniscectomy with loss of its ability to withstand hoop stress. They are usually due to an acute injury [. Meniscal tears are common and often associated with knee pain. The medial meniscus covers 60% of the medial compartment. no specific MR criteria for classifying discoid medial menisci, and the The meniscus may also become hypertrophic. Discoid meniscus in children: Magnetic resonance imaging characteristics. 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. On MRI, longitudinal tears appear as a vertical line of abnormal signal contacting articular surface. Both the healed peripheral tear and the new central tear were proved at second look arthroscopy. This article focuses on 3 is least common. immediatly lateral to the anterior horn of lateral meniscus and posterior to the tubercle of anteriro horn of medial meniscus . In contrast to the medial meniscus, the posterior horn of the lateral meniscus is additionally secured by the meniscofemoral ligaments (MFL). {"url":"/signup-modal-props.json?lang=us"}, Weerakkody Y, Baba Y, Knipe H, et al. 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. partly divides a joint cavity, unlike articular discs, which completely At the time the article was last revised Yahya Baba had mesenchymal mass that differentiates into the tibia, femur, and Sagittal T2-weighted image (18A) demonstrates high T2 fluid signal in the medial meniscus posterior horn consistent with a recurrent tear (arrow). For root tears in general, sagittal imaging may demonstrate a meniscal ghost sign. Medial meniscus bucket handle tears can result in a double PCL sign. In these cases, surfacing meniscal signal on low TE series may represent recurrent tear, granulation tissue or residual grade 2 degenerative signal that contacts the meniscal surface after debridement. Knee Surg Sports Traumatol Arthrosc 2011; 19:147157, Gwathmey F.W., Golish S.R., Diduch D.R., et al: Complications in brief: meniscus repair. Type 2: An incomplete slab of meniscal tissue with 80% coverage of the lateral tibial plateau. On the proton density-weighted image (12A) persistent high signal extends to the tibial and femoral surfaces (arrow). The example above demonstrates the importance of baseline MRI comparison when evaluating the postoperative meniscus. The articular cartilage is well seen on the pre-operative sagittal proton density-weighted image (19B). Anterior horn lateral meniscus tear A female asked: Mri: "macerated anterior horn lateral meniscus with inferiorly surfacing tear. Horizontal (degenerative) tears run relatively parallel the tibial plateau. that this rare condition is also clinically asymptomatic. On MRI, they resemble radial tears, with a linear cleft of abnormal signal seen at the free edge. Kijowski et al. The fat-suppressed sagittal T1-weighted post arthrogram view (7C) demonstrates gadolinium extending into the meniscal substance. Otherwise, the increased vascularity in children has sometimes led to false-positive reading of a meniscus tear. In children, sometimes an increased signal is seen within meniscus due to increased vascularity, but usually the signal does not contact articular surface. Discoid lateral meniscus: Prevalence of peripheral rim instability. We will review the common meniscal variants, which This high rate of success, however, may not apply to anterior horn tears, which occur much less commonly than posterior horn and meniscal body tears. We use cookies to create a better experience. acromioclavicular, sternoclavicular, and temporomandibular joints. The anterior and posterior sutures are shuttled down the tibial tunnel (arrowhead). anterior horn of the medial meniscus into the anterior cruciate ligament from AIMM. Methods Eighteen patients who had arthroscopically confirmed partial MMPRTs were included.
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anterior horn lateral meniscus tear: mri