Intra-meniscal degeneration can be detected at MRI examination (Hamada, 1994). The reports of additional anatomic variations complicate the original etiology theories and support the concept that discoid lateral meniscus may be due to multiple etiologies. Discoid meniscus in children: Magnetic resonance imaging characteristics. The most prominent distinguishing features of discoid lateral meniscus on plain radiographs include widening of the lateral joint space and a high fibular head.12,14,15 Additionally, marginal osteophytes and cupping or flattening of the lateral tibial plateau may be revealed.15 MRI has been shown to be effective in the diagnosis of discoid lateral meniscus. Meniscal disorders: Normal, discoid, and cysts. The MRI can show the abnormal shape of the discoid meniscus, as well as tears within the meniscus. A focal ossification of the posterior horn of medial meniscus. 199 (3): 481-99. An MRI may be ordered to show the discoid meniscus or any tears within it. Discoid menisci of the knee are not uncommon, and the criteria for arthrographic diagnosis and the clinical symptoms are well known. [7, 8] The discoid lateral-meniscus syndrome. AJR Am J Roentgenol. Magnetic resonance imaging (MRI) is widely used to diagnose musculoskeletal pathologies affecting the knee since it gives a clear picture of soft-tissue structures. If this is unsuccessful, then partial or total resection may be carried out. by So Yeon Lee et al AJR 2008; 191:81-85. Included are 125 knees with meniscal disorders after arthroscopic surgery, divided according to preoperative MRI and symptoms into group A (torn DLM with mechanical … The lesion follows bone MRI signals (a; sagittal PD fat sat and b; T1 shown in this case) and this helps distinguish between a meniscal tear. Kaplan P. Musculoskeletal MRI. Kim JG, Han SW, Lee DH. Discoid lateral meniscus is a common abnormal meniscal variant in children. They are incidentally found in 3-5% of knee MRI examinations. Discoid menisci are congenital, frequently bilateral (up to 50%) and have been reported in twins, although no genetic locus has been identified 2. Davies AM, Cassar-Pullicino VN. Other symptoms include clicking, snapping, clunking, and locking during movement, as well as joint-line tenderness, reduced mobility, and “giving-way.”6,8,9 A high percentage of cases present with an associated meniscal tear and peripheral rim instability.4,9,10 Although discoid lateral meniscus is commonly bilateral, symptoms tend to occur on one side.8, Discoid lateral meniscus is traditionally classified as one of 3 types based on those described by Watanabe et al.11 The complete type refers to complete meniscal coverage of the tibial plateau, while the incomplete type covers <80% of the tibial plateau. Discoid meniscus represents an enlarged meniscus with further central extension onto the tibial articular surface. Although frequently asymptomatic, discoid menisci are prone to cystic degeneration with subsequent tear. 20 (1): 59-64. Arthroscopy. tears. discoid meniscus is larger than usual. Figure 9: Meniscal ossicle. On coronal imaging, meniscal body width of 15 mm or more is typically considered diagnostic of discoid morphology. Alternatively, a ratio of the minimal meniscal width to the maximal tibial width of more than 20% may be used 7,8. There is a higher prevalence in Asians without any gender predilection 7. PEARLS A meniscal tear can be Clinical presentation may, therefore, be either incidental or with pain, locking or a 'clunk'. Magnetic resonance imaging (MRI) scan. The intrameniscal signal in the anterior horn was compatible with mucinous degeneration. Magnetic resonance imaging (MRI) is the modality of choice for evaluating a discoid meniscus before surgery. MRI is the modality of choice to evaluate a discoid meniscus before surgery. The widened and thickened discoid meniscus may be demonstrated on routine radiography of the knee. The tear pattern was categorized into six types based on arthroscopic findings: horizontal, longitudinal, radial, combined radial, degenerative, and complex tear. A complete discoid meniscus is easily recognized on MR images because it has parallel superior and inferior surfaces and extends into or near the notch with a disk configuration. 5 However, the snapping phenomenon is not easily detected using routine MRI. Springer Verlag. Any of the following factors have been shown to be specific for diagnosis: 1) 14- to 15-mm minimum transverse width of the lateral meniscus on a central coronal image. The most commonly practiced treatment for stable, complete, or incomplete types of discoid lateral meniscus is partial meniscal excision. Snapping and pain … Appl Radiol. Discoid Meniscus. Discoid lateral meniscus is a congenital condition that is estimated to occur in 4% to 5% of the population1-4 but has been shown to be as high as 13% in Asian populations.5 It is the most common abnormal meniscal variant in children.6 The condition is typically asymptomatic and, therefore, is infrequently diagnosed.7 The most frequent symptom is pain that usually begins with a minor trauma. Discoid menisci are those that have a body that is too wide, usually affecting the lateral meniscus. On this image, it is not possible to tell if the tear has healed. The discoid lateral meniscus was first described by Young in 1889, and the prevalence of discoid meniscus has been reported to range from 0.4% to 20% among patients undergoing arthroscopy. Classification is based on the degree of peripheral attachments to the tibial plateau, and the shape of the meniscus itself: Radiographs may well suggest the diagnosis with the widening of the lateral joint space and cupping of the lateral tibial plateau, which is normally flat or even slightly convex. Bancroft LW, Bridges MD. failure of apoptosis in utero. A radiographic study of 21 cases. Discoid meniscus on coronal proton-density weighted MRI The transverse diameter of a normal meniscus is approximately 10 to 11 mm; therefore a normal meniscus body will be visible on only 2 slices of a MR with 4-5-mm sagittal slices. A cutoff value of 0.32 using the ratio of the shortest width of the lateral meniscus and the longest width of the tibia are probably useful to help distinguish between complete DLM and incomplete DLM. 3. Davidson D, Letts M, Glasgow R. Discoid meniscus in children: Treatment and outcome. Klingele KE, Kocher MS, Hresko MT, et al. Alternatively, a discoid lateral meniscus shows more than two meniscal body segments on consecutive … Discoid lateral meniscus: Diagnosis and results of arthroscopic treatment. For these reasons, a description of the histology of discoid lateral meniscus in children and adolescents is warrant. 2006;187 (2): 384-7. Neuschwander DC, Drez D Jr, Finney TP. Rohren EM, Kosarek FJ, Helms CA. MR imaging-based diagnosis and classification of meniscal tears. The structure on the medial side is again a vacuum phenomenon. She had to undergo a second knee arthroscopy to remove more of the meniscus and remaining scar tissue. The discoid lateral-meniscus syndrome. American journal of roentgenology. Discoid menisci are those that have a body that is too wide, usually affecting the lateral meniscus. Singh K, Helms CA, Jacobs MT et-al. The MRI diagnosis of discoid meniscus in children is based on adult’s studies [ 9, 10, 11 ]; there is little data in the literature regarding the quantitative MR diagnostic criteria for discoid meniscus in children [ 12, 13, 14 ]. CONCLUSIONS: Menisci increase in all dimensions in correlation with age; except in the coronal meniscal width, which is a useful dimension to diagnose discoid meniscus on MRI, based on this, it would seem that the currently published size criteria, … It affects 4% to 5% of the patient population, 6-9 with a much higher incidence, up to 13%, in the Asian patient population. Kim SJ, Moon SH, Shin SJ. Araki Y, Yamamoto H, Nakamura H, Tsukaguchi I. MR diagnosis of discoid lateral menisci of the knee. 7. Imaging of the Knee, Techniques and Applications. Discoid menisci have decreased collagen fibers and loss of normal collagen orientation, which predisposes them to intrameniscal mucoid degeneration 7. Abnormal development of the meniscus leads to a hypertrophic and discoid shaped meniscus. The presence of discoid meniscus on MRI was determined by coronal and sagittal measurements, considering the tear pattern of lateral meniscus. Discoid lateral meniscus: Prevalence of peripheral rim instability. 4. On sagittal imaging, the body of the lateral meniscus is normally only seen on two adjacent slices. As shown in a previous study, symptomatic discoid lateral meniscus has tear or degeneration, though no visible tear is observable at arthroscopy. {"url":"/signup-modal-props.json?lang=us\u0026email="}, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":1226,"mcqUrl":"https://radiopaedia.org/articles/discoid-meniscus/questions/1192?lang=us"}. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Dickhaut SC, DeLee JC. Ideally, the meniscus is preserved with conservative management. also referred to as "popping knee syndrome". Samoto N, Kozuma M, Tokuhisa T, Kobayashi K. Diagnosis of discoid lateral meniscus of the knee on MR imaging. Nguyen JC, De Smet AA, Graf BK, Rosas HG. 6. W B Saunders Co. (2001) ISBN:0721690270. This study was undertaken to elucidate the clinical significance of widening of the popliteal hiatus on magnetic resonance imaging (MRI) after a torn discoid lateral meniscus (DLM). The authors describe 29 discoid menisci imaged by means of MR. After a new injury, the PD-images show high signal unequivocally reaching the surface of the meniscus (seen on the original films, but not clearly seen on the compressed image on the left). The MRI can show the abnormal shape of the discoid meniscus, as well as tears within the meniscus. Nawata K, Teshima R, Ohno M, et al. Evaluation of a discoid meniscus is prompted by pain or mechanical symptoms, although this can also be an incidental finding on X-ray or MRI in the setting of acute trauma . This study can create detailed images of the soft tissues of the knee joint and is the best imaging test for discoid meniscus. 28 (4): 255-262. 2000;16:511-516. This report is to investigate the abnormal meniscus displacement using additional MRI analyses with the knee in deep flexion or full extension for a complete discoid meniscus… 10 It is the most common meniscal variant in children. Check for errors and try again. A detailed history and physical examination, when combined with an MRI of the knee, can predictably diagnose a discoid meniscus. Kocher MS, Klingele K, Rassman SO. Reliability and Accuracy of MRI for Diagnosis. A discoid meniscus is usually present if the meniscal body is seen on three or more standard sagittal slices - the opposite of the absent bow tie sign. In this case, our patient underwent surgical excision, leaving a 6- to 7-mm peripheral rim circumferentially, anteriorly, and posteriorly. Summary:  A 58-year-old man presented with a 6-month... Summary:  Rest-stress perfusion and viability cardiac... Summary A 16-year-old woman presented with progressive dyspnea... Summary:  Over 79% of respondents reported they would... Discoid lateral meniscus. 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). Radiographic knee dimensions in discoid lateral meniscus: Comparison with normal control. Discoid lateral meniscus and the frequency of meniscal tears. (2014) Radiographics : a review publication of the Radiological Society of North America, Inc. 34 (4): 981-99. Correlation between type of discoid lateral menisci and tear pattern. Intraoperative finding and the postoperative MRI of Case2 Under arthroscopy, the discoid meniscus (black arrows) moved from a reposition at flexion of the knee (A) to a … Surgical treatment for sports injuries at Johns Hopkins All Children’s is provided by the surgeons at COSSA. Plain radiographs may be normal, however, there are well documented radiologic features that may be present in patients with a discoid meniscus [2] . (2003) ISBN:3540002502. The Wrisberg ligament type refers to a more normal morphology, except for a thick posterior horn and a lack of posterolateral meniscotibial attachment, and has a thick posterior tibial attachment.2,3,6 Newer classifications based on shape, stability, tear pattern, and symptoms have been proposed because classification and surgical outcomes have been associated with meniscal tear patterns and lateral compartment changes.12,13. Dickhaut SC, DeLee JC. present in 3-5% of population. Rao PS, Rao SK, Paul R. Clinical, radiologic, and arthroscopic assessment of discoid lateral meniscus. Bin SI, Kim JC, Kim JM, et al. MRI Normal Variants and Pitfalls. Discoid meniscus is fairley common in children on clinical examination to come with snapping sounds of the knees.Clinical examination shows a senstivity of 88 % v/s an MRI sensitivity of only 38 % in various series. Lateral discoid meniscus is far more common than medial discoid meniscus, with the latter being rare. Discoid lateral meniscus: Clinical manifestations and arthroscopic treatment. usual diagnosis of a discoid lateral meniscus is found on an MRI scan. 8. Fukuta S, Masaki K, Korai F. Prevalence of abnormal findings in magnetic resonance images of asymptomatic knees. The hypointense structure on the lateral side is a discoid meniscus (blue arrow). How I diagnose meniscal tears on knee MRI. Diagnosis and Treatment of Discoid Meniscus. Samoto N, Kozuma M, Tokuhisa T, Kobayashi K. Diagnosis of discoid lateral meniscus of the knee on MR imaging. The diagnosis of discoid lateral meniscus is easily rendered on MRI. MRI appearance of Wrisberg variant of discoid lateral meniscus. etiology. The discoid meniscus is a morphologic abnormality of the knee occurring almost exclusively on the lateral side. Invasive surgical treatment for discoid lateral meniscus is effective for symptomatic relief but is recommended only if the symptoms of the condition become significantly problematic. The etiology of discoid lateral meniscus is still debatable, although opinions in the literature tend toward a congenital origin. Discoid meniscus is an uncommon congenital anomaly, and it is rarely seen in the medial compartment of the knee. Normally, the meniscus measures 5 to 13 mm; 2) 20% for the ratio of the meniscus to the tibia; and 3) 75% for the ratio of the sum of the width of the anterior and posterior horns to the meniscal diameter on a sagittal slice that shows a maximum meniscal diameter. The MRI findings of the Wrisberg variant encompass those of a discoid lateral meniscus, which include a specific measurement of the left-to-right width of the meniscus at the center of the body greater than 15 mm on a coronal slice (reference average, 12.8 mm) [3, 4]. (2012) AJR. De Smet AA. (2008) ISBN:0781783143. 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. The most accurate criteria for the diagnosis of discoid meniscus on MRI are a ratio of the minimal meniscal width to maximal tibial width (on the coronal slice) of more than ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Connolly B, Babyn PS, Wright JG, Thorner PS. 5. MR Imaging of Meniscal Cysts: Incidence, Location, and Clinical Significance. The diagnosis of discoid lateral meniscus is easily rendered on MRI. location. Reson. Following four quantitative parameters were measured. Additionally, the new ratio using the width of the medial meniscus is also useful to improve distinguishing between the types of DLM. An incomplete discoid meniscus has a trapezoidal appearance and may involve only one horn of the meniscus or may extend only partly onto the articular surface of the tibia. By Ari Youderian, MD, Margaret A. Stull, MD, and Samuel Chmell, MD, University of Illinois at Chicago, Chicago, IL, Cardiac MRI perfusion and viability imaging: Clinical value in cardiac care, Patient imaging portals boost patient satisfaction. Kelly BT, Green DW. Asik M, Sen C, Taser OF, et al. 2. 1. Lateral meniscal variant with absence of the posterior coronary ligament. Post-operative Meniscus 3 This patient also had a suture repair for meniscal tear. Discussion. Epidemiology. J. Magn. Postsurgically, the patient continued to have pain and decreased extension of the knee. The discoid meniscus was typically classified as type I (complete), type II (incomplete), or type III (Wrisberg variant).
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