A tear of the lateral meniscus can occur from a sudden injury, or from chronic wear and overload. 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 70 year-old female with history of medial meniscus posterior horn radial tear. separate the cavity. Also, the inferior patella plica inserts on the Both ligaments attach distally to the posterior horn of the lateral meniscus and contribute to posterior drawer stability . discoid lateral meniscus is a relatively uncommon developmental variant Surgical Outcomes Lysholm Score 1). The examiner can test the entire posterior horn up to the middle segment of the meniscus using the IR of the tibia followed by an extension. ISAKOS: 2023 Congress in Boston, USA : Abstract Analysis of Risk Definite surfacing signal or distortion on only one image represents a possible tear. appearance.12 It is now believed that the knee develops from a Disadvantages include patient discomfort, increased cost, physician time needed for the procedure and radiation exposure during fluoroscopy. 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). Become a Gold Supporter and see no third-party ads. Kijowski et al. in 19916. For DSR inquiries or complaints, please reach out to Wes Vaux, Data Privacy Officer, As a result, the accuracy rate of diagnosis by MRI is 83.3%. Discoid lateral meniscus: importance, diagnosis, and treatment Financial Disclosure: None of the authors or planners for this educational activity have relevant financial relationships to disclose with ineligible companies whose primary business is producing, marketing, selling, reselling, or distributing healthcare products used by or on patients. of the anterior horn of the medial meniscus, an inferior patella plica, The Wrisberg variant may present with a The sensitivity of mri in detecting meniscal tears is generally good, ranging from 70-98%, with specificity in the same range in many studies. meniscus. Results: Arthroscopic examination of the anterior horn of the lateral meniscus in all 22 patients was normal. According to these authors, increased signal to the surface on only one slice should be interpreted as a possible tear. Cases of only one abnormal slice correlated to tears at arthroscopy 55 % of the time for the medial meniscus and 30 % for the lateral [, Accuracy of diagnosing meniscus tear with these criteria has been good. frequently. the intercondylar notch, most commonly to the mid ACL, and less commonly Examination showed lateral joint line tenderness and a positive McMurray sign. to the base of the ACL or the intercondylar notch. Anterior Horn Meniscal Tears — Fact or Fiction - Relias Media Stein T, Mehling AP, Welsch F, von EisenhartRothe R, Jger A. Bilateral hypoplasia of the medial meniscus has also been A classification system developed by the International Society of Arthroscopy, Knee Surgery, and Orthopedic Sports Medicine [, Longitudinal-vertical tear. They divide the meniscus into superior and inferior halves (Fig. However, recognizing these variants is important, as they can Intact meniscal roots. 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. One of the most frequent indications for arthroscopic knee surgery is a meniscal tear.1 It is estimated that 1 million meniscus surgeries are performed in the U.S. annually with 4 billion dollars in associated direct medical expenditures.2 Meniscal surgeries include partial meniscectomy, meniscal repair and meniscal replacement. Knee Surg Sports Traumatol Arthrosc 2011; 19:147157, Gwathmey F.W., Golish S.R., Diduch D.R., et al: Complications in brief: meniscus repair. The anterior and posterior sutures are shuttled down the tibial tunnel (arrowhead). Pullout fixation of posterior medial meniscus root tears: correlation between meniscus extrusion and midterm clinical results. Atypically thick and high location The MRI revealed a longitudinal tear in the posterior horn of the lateral meniscus. According to one source, they are thought to account for ~10% of all arthroscopic meniscectomies 5. Papalia R, Vasta S, Franceschi F, D'Adamio S, Maffulli N, Denaro V. Meniscal Root Tears: From Basic Science to Ultimate Surgery. As DLM is a congenital anomaly, the ultrastructural features and morphology differ from those of the normal meniscus, potentially leading to meniscal tears. Increased signal intensity at the anterior horn of the lateral meniscus was seen on the images of seven of the 11 MR studies of the volunteers. Arthroscopy for Medial Meniscus Tears The decision to repair or remove the torn portion is made at the time of surgery. 2005; 234:5361. What is a Lateral Meniscus Tear? OITE 7 Flashcards | Chegg.com Anterior horn lateral meniscus tear A female asked: Mri: "macerated anterior horn lateral meniscus with inferiorly surfacing tear. Incidence and Detection of Meniscal Ramp Lesions on Magnetic Resonance (Tr. The Journal of bone and joint surgery American volume. Sometimes T2 signal in a healed tear may look similar to fluid. Bilateral discoid medial menisci: Case report. Clin Orthop Relat Res 2013; 471: pp. Pagnani M, Cooper D, Warren R. Extrusion of the Medial Meniscus. The patient failed conservative management of aspiration and cortisone injection. The anterior root of the lateral meniscus attaches to the tibia, just lateral to the midline and posterior to fibers of the anterior cruciate ligament (ACL). 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. 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? 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. Media community. 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. It is located in the lateral portion of the knee interior of the knee joint. Pain is typically medial and activity-related (e.g. There are There was no history of a specific knee injury. The posterior horn is always larger than the anterior horn. Sagittal T2-weighted image (10B) reveals no fluid at the repair site. {"url":"/signup-modal-props.json?lang=us"}, Weerakkody Y, Baba Y, Knipe H, et al. (PDF) Sensitivity and Specificity of MRI in Diagnosing Concomitant Conventional MRI imaging of the postop meniscus offers a noninvasive evaluation of the knee, but postoperative changes can mimic a recurrent or residual meniscus tear. may simulate a peripheral tear (Figure 6).23 The only proximal medial tibia was convex and the distal medial femoral condyle published a case series of anterior horn tears of the lateral meniscus in 14 soccer players (mean age 20.2 years). Am J Sports Med 2016; 44:625632, De Smet AA, Horak DM, Davis KW, Choi JJ. Fat suppressed sagittal T1-weighted MR arthrogram (5C) demonstrates gadolinium within the tear (arrow). (as previously described), meniscal cyst,26 discoid lateral meniscus in the same knee (Figure 9),25 and pathologic medial patella plica.27. AJR Am J Roentgenol 211(3):519527, De Smet AA. This mesenchymal The reported prevalence is 0.06% to 0.3%.25 ADVERTISEMENT: Supporters see fewer/no ads. 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 Among these 26 studies of an LMRT . 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. 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. A Wrisberg type variant has not been documented in 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. Congenital absence of the meniscus is extremely rare and has been documented in TAR syndrome and in isolated case reports.2,3 In 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. Thirty-one of these patients underwent subsequent arthroscopic evaluation to allow clinical correlation. Exam showed a mild effusion and medial joint line tenderness. 3: The Wrisberg variant, where the meniscus may have a normal An abnormal shape may indicate a meniscal tear or a partial meniscectomy. Case 9: posterior root of medial meniscus, View Yuranga Weerakkody's current disclosures, see full revision history and disclosures, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, Ahlback classification system in assessing osteoarthritis of the knee joint, Kellgren and Lawrence system for classification of osteoarthritis, anterior cruciate ligament mucoid degeneration, MRI grading system for meniscal signal intensity, shortening or absence of the root on sagittal images, vertical fluid cleft on coronal fluid-sensitive (T2) images. . He presented after a few months with symptoms of instability. However, few studies have directly compared the medial and lateral root tears. The torn edges are aligned, and stable fixation applied with sutures or bioabsorbable implants at approximately 5 mm intervals.
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