Figure 4b Anatomic variants. Each meniscus can be subdivided into the anterior horn, body, posterior horn, and roots (Fig 1b). Typically this type of tear involves the majority of the meniscus. 2, 20 April 2017 | Acta Radiologica, Vol. A radial tear runs perpendicular to both the tibial plateau and the long axis of the meniscus and transects the longitudinal collagen bundles as it extends from the free edge toward the periphery (Fig 9, Movie 2). Parameniscal cysts are distinguished from bursae and ganglion cysts by their intimate association with the meniscus, either through direct contact or via a fluid track. Discoid meniscus represents an enlarged meniscus with further central extension onto the tibial articular surface. (b) Image from arthroscopic video shows a typical horizontal tear that extends into the free edge. (a) Sagittal PD-weighted MR image shows the absent bow-tie sign, with nonvisualization of the meniscal body (arrows). Figure 11c MR imaging signs of a radial tear. A prospective and blinded investigation of magnetic resonance imaging of the knee: abnormal findings in asymptomatic subjects, Myriam Hunink MG. 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It connects and stabilizes the anterior horns of the menisci (21). It is postulated that the hydrogen nuclei within a tear are bound to macromolecules rather than being free, which gives them a shorter T2 relaxation time (14,15). Once again, correlation with radiographs will aid in reducing the number of false-positive diagnoses. This type of tear should not extend to the free edge. The transverse or [anterior] meniscomeniscal ligament is a ligament in the knee joint that connects the anterior convex margin of the lateral meniscus to the anterior end of the medial meniscus. 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). Figure 11b MR imaging signs of a radial tear. With application of the “two-slice-touch” rule, MR imaging has high accuracy for preoperative detection of meniscal tears.   Anterior horn tears are less common and located in the front of the meniscus. To date, comparisons between 2D and 3D FSE techniques show relatively equivalent tear detection accuracy (10–12), with the exception of significantly lower sensitivity for detection of LM tears, particularly those involving the root, when 3D FSE imaging is used (13). 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. 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. (a) Three-dimensional model (left) and cross-sectional diagram (right) show a radial tear (black arrows) that involves the free edge and is perpendicular to the long axis of the meniscus. 4, 26 September 2017 | Skeletal Radiology, Vol. (a) Coronal fat-suppressed PD-weighted MR image through the body of the menisci shows a discoid LM (arrow) that measures 19 mm (normally <15 mm). 1, © 2021 Radiological Society of North America. 1, Journal of Family Medicine and Primary Care, Vol. (b) Sagittal T2-weighted MR image shows a tear of the posterior horn (arrow) and an associated multiloculated parameniscal cyst (arrowhead). (a, b) Coronal PD-weighted (a) and axial fluid-sensitive reconstructed (b) MR images show a complete posterior root tear (arrow). Meniscal tears can be treated with conservative therapy, surgical repair, or partial or complete meniscectomy. When present, it can simulate a centrally displaced meniscal fragment. The medial meniscus tear on MRI shows up as black. (a) Sagittal PD-weighted MR images show the typical bow-tie configuration of the meniscal body (left) and the opposing triangles of the horns (center and right). Therefore, diagnosis of a tear relies more heavily on morphologic distortion than on abnormal signal intensity. (b) Arthroscopic image from Movie 6 shows free-edge surface irregularity. (b) Arthroscopic image from Movie 1 shows a longitudinal tear parallel to the free edge. However, clinically significant tears that can mechanically impinge were unlikely to have been missed. 26, No. 5, No. A narrative review with focus on relevance for osteoarthritis research, Post-operative deformation and extrusion of the discoid lateral meniscus following a partial meniscectomy with repair, Posterior Root Meniscal Tears: Preoperative, Intraoperative, and Postoperative Imaging for Transtibial Pullout Repair, Use of intravoxel incoherent motion diffusion-weighted imaging in identifying the vascular and avascular zones of human meniscus, T2 black lesions on routine knee MRI: differential considerations, Reporting knee meniscal tears: technical aspects, typical pitfalls and how to avoid them, Risk Factors of False-Negative Magnetic Resonance Imaging Diagnosis for Meniscal Tear Associated With Anterior Cruciate Ligament Tear, Arthroscopic Meniscectomy for Medial Meniscus Horizontal Cleavage Tears in Patients under Age 45, A Current Review of the Meniscus Imaging: Proposition of a Useful Tool for Its Radiologic Analysis, ISAKOS classification of meniscal tears—illustration on 2D and 3D isotropic spin echo MR imaging, Imaging of Athletic Injuries of Knee Ligaments and Menisci: Sports Imaging Series, Fully Automated Diagnosis of Anterior Cruciate Ligament Tears on Knee MR Images by Using Deep Learning, Deep Learning for Hierarchical Severity Staging of Anterior Cruciate Ligament Injuries from MRI, Five-Minute Five-Sequence Knee MRI Using Combined Simultaneous Multislice and Parallel Imaging Acceleration: Comparison with 10-Minute Parallel Imaging Knee MRI, Commonly Missed Meniscal Tears and Displaced Flaps and Fragments on MRI: A Simple Guide, Coronal Oblique MRI for Optimal Assessment of the Anterior Cruciate Ligament: Not Everything that Matters is the ACL, MRI Evaluation of Anatomic Variations of Menisci and Perimeniscal Ligaments Anatomy and Potential Related Pitfalls. Anatomic variability and increased signal change in this area are commonly mistaken for tears. 5, Operative Techniques in Sports Medicine, Vol. Similarly, Kaplan et al (77) found that 64% of bone bruises of the posterior medial tibial plateau have an associated tear of the MM posterior horn. There is a close association between meniscal extrusion and root tears. Both horns are triangular in shape and have very sharp points. More recently, three-dimensional (3D) sequences with isotropic resolution have been developed that provide thinner sections and reduce partial volume averaging. 85, No. Prevention of Venous Thromboembolism in the Medical Patient: Fact vs. Fiction. (a) Diagram shows a longitudinal tear (white arrow), with central displacement (red arrows) of the inner segment or “handle.” (b) Axial fluid-sensitive reconstructed MR image shows a rare bucket-handle tear that involves only about one-third of the meniscus (arrow). Note the “kissing” bone contusions from an ACL tear. The menisci function to absorb shock, distribute axial load, assist in joint lubrication, and facilitate nutrient distribution (17). High-spatial-resolution imaging of the meniscus can be performed using fast spin-echo and three-dimensional MR imaging sequences. (a) Sagittal PD-weighted MR image shows the absent bow-tie sign, with nonvisualization of the meniscal body (arrows). Tears are more common in the posterior horn of the menisci, particularly favoring the more constrained MM. Recently, studies have reported that a far lateral insertion of the MFL onto the posterior horn of the LM (seen on four or more 3-mm-thick images with a 0.5-mm inter-section gap) should be considered a probable peripheral longitudinal tear (24). 1, Acta Médica Grupo Ángeles, Vol. Complete root tears have a high association with meniscal extrusion, particularly when the tear occurs in the MM (58,59). On coronal images, the menisci appear either triangular or wedge-shaped, depending on whether the imaging plane is through the body or horn, respectively. Figure 20a Indirect signs of meniscal tear. (b) Three-dimensional model shows the meniscus subdivided into thirds (the anterior horn [AH], body [B], and posterior horn [PH]) and attached to the tibia via the anterior and posterior root ligaments. They tend to predominate at the: posterior horn of the medial meniscus junction of the anterior horn and body of the lateral meniscus Typically this type of tear involves the majority of the meniscus. (d) Sagittal PD-weighted MR image shows the double anterior horn sign, with a meniscal fragment (white arrow) posterior to and displacing the native anterior horn (black arrow) and a markedly diminutive posterior horn (arrowhead). Medial meniscus. What these researchers examined was the phenomena of pseudotear, the appearance of a meniscus tear that is not there. In our experience, improved in-plane resolution and thinner sections have resulted in MR imaging depiction of areas of meniscal fraying, which can involve the free edge of the body, the posterior horn, or the posterior root ligaments. False-positive errors include mistaking normal anatomic structures and variants for a meniscal tear. These tears often occur in younger patients after significant knee trauma (55) and have a propensity to involve the peripheral third of the meniscus and posterior horns (15).
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