In the second herrlin study, a prospective randomized study involving 96 middleaged patients with an mriverified medial meniscal tear and radiographic oa, the authors concluded that arthroscopic surgery followed by exercise therapy was not superior to the same exercise therapy alone. Parameniscal cyst formation in the knee is associated with meniscal tear size. Managing atraumatic meniscal tears in middleaged patients. Arthroscopic knee surgery is the gold standard in the diagnosis and. Clinical outcomes of insideout meniscal repair according to. The meniscal roots are very important to overall joint health. Normally when you image the posterior cruciate ligament on sagittal images you should see a considerable portion of the posterior horn of the meniscus on that image or the image adjacent to it. We investigated if presence of a meniscal tear at knee arthroscopy in adults is associated with presence of preoperative selfreported mechanical knee symptoms. It is well established that meniscal damage predisposes the adjacent articular cartilage to increased axial and sheer stress, resulting in early degenerative osteoarthritis. The prevalence of a meniscal tear or of meniscal destruction in the right knee as detected on mri ranged from 19% 95% confidence interval ci, 15 to 24 among women 50 to 59 years of age to 56% 95% ci, 46 to 66 among men 70 to 90 years of age. There has been an increasing awareness of the importance of the meniscus in maintaining the health and function of the knee.
Conventional spinecho versus fast spinecho imaging for detection of meniscal tear in 29yearold man. An mri will specifically look for problems that can be addressed with surgery. Meniscal tears and postoperative cartilage imaging. Rehabilitation exercises a meniscus tear is a common knee joint injury. Tibial spine avulsion fracture the medial meniscus may be entrapped beneath the. A, sagittal conventional spinecho proton densityweighted mr image trte, 2,00020 with fat suppression obtained through medial meniscus shows oblique tear of posterior horn. A longitudinal meniscal tear site demonstrating some fragmentation inferiorly lower left.
A meniscal buckethandle tear is a tear with an attached fragment displaced from the meniscus of the knee joint. Most tears do not heal spontaneously and are treated arthroscopically by meniscus repair if torn in a clear, clean pattern or partial meniscectomy. Magnetic resonance imaging mri is the most accurate imaging technique in the diagnosis of meniscal lesions and represents a standard tool in. Mr imagingbased diagnosis and classification of meniscal tears. A, coronal a and sagittal b reformatted images with bone kernel from ct arthrography. A meniscal root tear is a radial tear located at the meniscal root. These problems include a loose piece of cartilage floating in the knee loose body, a full thickness cartilage defect in a younger patient, a meniscal tear, or a significant ligament injury. Clinical outcomes of insideout meniscal repair according. Send directly for surgical consult for meniscal tear. Magnetic resonance imaging is modality of choice for the noninvasive evaluation of meniscal. Mri is a highly accurate imaging method for diagnosing meniscal tears. We report increased sensitivity for detecting buckethandle tears with the use of coronal short tau inversion recovery stir images.
To achieve the best patient outcome a surgeon must be able to diagnose a meniscal injury by mri as well as identify the injury at time of arthroscopy. These symptoms occur both with internal derangements of the knee e. Meniscal extrusion transverse length ratios on mri and. Meniscal tears are mainly either traumatic or degenerative. The success of meniscus repair depends on tear pattern recognition and location for the capacity to heal. An mri may be used to assist in making the diagnosis. Low sensitivity of mri for detection of buckethandle tears 64% as compared with arthroscopy has been reported previously. Medial meniscal root tears and meniscal extrusion transverse length ratios on mri 1,2hj park,md, 2sskim,md, 1sy lee, md, 1yj choi, md, 1ec chung,md, 1mh rho, md and 1hj kwag, md 1department of radiology, sungkyunkwan university school of medicine, kangbuk samsung hospital, seoul, republic of korea, and 2department of radiology, kangwon national university school of. In the second herrlin study, a prospective randomized study involving 96 middleaged patients with an mri verified medial meniscal tear and radiographic oa, the authors concluded that arthroscopic surgery followed by exercise therapy was not superior to the same exercise therapy alone. Mri is 90% accurate in terms of diagnosis of meniscal tears, however arthroscopy is the gold standard for diagnosis. There are three basic mr characteristicscriteria of meniscal tears 5. B, axial t2weighted mr image shows the typical high signal of the. Incidental meniscal findings on knee mri in middleaged and. Clinical meniscal tear was positive in 41 82% patient while mri meniscal tear positive was present in 44 88%.
This article presents a program for rehabilitation after meniscal injuries, meniscectomy, and meniscal repair based on current knowledge of knee. When people talk about torn cartilage in the knee, they are usually referring to a torn meniscus. The lateral meniscus covers 84% of the lateral tibial plateau. How well the knee will heal and whether surgery will be needed depends in large part on the type of tear see figure in appendix and how bad the tear is. Surgical treatment of meniscus tears of the knee greg i. Mri and arthroscopic evaluation of meniscal injuries. 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. Any information contained in this pdf file is automatically generated from digital material. Accurate and timely diagnosis of a meniscal tear is critical for re. Nov 21, 2016 1 the double pcl sign, the bucket handle tear of the medial meniscus, it is seen on the sagittal mri, when a torn meniscal fragment is flipped and displaced into the notch, its a 100% specific. Injected iodinated contrast agent outlines displaced recurrent bucket handle tear of medial meniscus arrow, a and b. Clinical examination, when combined with mri, provides the most accurate noninvasive source of information currently available for pathological findings in the menisci and the acl. This tear required multiple superior and inferior vertical divergent sutures to achieve an anatomic reduction upper right and left. To achieve the best patient outcome a surgeon must be able to diagnose a.
The meniscus is the soft fibrous shock absorber in the knee. Nakamoto, md facp section of orthopedics and sports medicine virginia mason medical center. Rehabilitation guidelines for meniscal repair of root and. Background mechanical knee symptoms are often considered important in the decision to perform knee arthroscopy on the suspicion of a meniscal tear. Association of mri findings and expert diagnosis of. Anatomic variants and pitfalls that can mimic a tear include discoid meniscus, meniscal flounce, a meniscal ossicle, and chondrocalcinosis. Meniscus tears are either vertical, which are generally associated with traumatic injury, horizontal, which are associated with degenerative injury, or combinations. Incidental meniscal findings on knee mri in middleaged. To avoid errors in diagnosing meniscal tears, those interpreting mr examinations of the knee need to be aware of the attachments of the menisci and the normal variations in meniscal anatomy that may resemble a meniscal tear. Patients treated with arthroscopic surgery for a torn meniscus may have new pain, clicking, locking, or swelling develop in the treated knee.
Because of this tear distribution, i am cautious in diagnosing a medial meniscal tear that does not involve the posterior horn. They often tend to be radial tears extending into the meniscal root. Mri versus ultrasound in diagnosis of meniscal tear in. Meniscal tear patterns in acl disruption radsource. Reprinted with permission from noyes fr, barberwestin sd. Meniscal tear and extrusion are strongly associated with. Methods we used data from knee arthroscopy cohort southern denmark kacs. The physician treating an athlete with a known or suspected meniscal tear needs to understand the structure and function of the meniscus and the factors involved in treating an athlete with nonoperative versus operative treatment. Often times these tears can be diagnosed by taking a thorough history and completing a physical examination. Unfortunately, multiple studies indicate that mri has the lowest sensitivity for identifying meniscal tears in the posterior horn of the lateral meniscus, which has been attributed to various factors including pulsation artifact from the popliteal artery, volume averaging and magic angle associated with the contour of the tibial eminence and.
The information obtained from the mri helps determine the need for surgical intervention. According to one source, they are thought to account for 10% of all arthroscopic meniscectomies 5. It has been reported that a posterior horn medial meniscus root tear is equivalent to a subtotal medial meniscectomy,1,2. Meniscal tear symptoms, diagnosis and treatment bmj. Mri scan considered most accurate and noninvasive method of diagnosis. Racgp meniscal tear presentation, diagnosis and management. Knee technique guide meniscal root repair using a two.
To quantitate the cartilage volume changes in knee osteoarthritis using magnetic resonance imaging mri, and determine whether meniscal alteration predicts cartilage volume loss over time. Population based magnetic resonance imaging mri studies report a 35% prevalence of degenerative meniscal tears in people over 50 years,3 and a 24% prevalence in those with no radiographic evidence of osteoarthritis. Meniscal cartilage curves like the letter c at the inside and outside of each knee. This may be clinically indistinguishable from a meniscal tear. Management of degenerative meniscal tears and the role of. Isakos classification of meniscal tearsillustration on 2d and 3d. Pdf magnetic resonance imaging in the evaluation of meniscal tear. All patients demonstrated significant improvements with insideout meniscal repair from preoperatively to postoperatively, regardless of the meniscal tear location.
Schematic demonstrating the maximal transverse length of the medial meniscus. When a meniscal tear is identified, accurate description and classification of the tear pattern can guide the referring clinician in patient education and surgical planning. Meniscal extrusion is measured by the distance from the perpendicular line to the edge of the tibial plateau and the outer edge of the meniscus at the point of the midportion of its maximal thickness. Magnetic resonance imaging versus arthroscopy in the.
Meniscal tears can be assessed arthroscopically for stability and vascularity. No contrast reference sheet headneck body part reason for exam procedure to precert cpt. Reliability of two clinical meniscal tests and magnetic resonance imaging. A combination of historical features and examination findings will help alert physicians to the possibility of meniscal tear more than the results of any one test. For example, longitudinal tears are often amenable to repair, whereas. When injured, magnetic resonance imaging mri has become the gold standard to diagnose meniscal tears. A meniscal tear is the most common soft tissue injury affecting the knee. Pdf mri of meniscal buckethandle tears gary hinson.
Medial meniscal root tears and meniscal extrusion transverse. A, coronal t1weighted mr image of the knee shows a heterogeneous mass curved arrow along the posteromedial aspect of the knee, in contiguity with the posterior horn of the medial meniscus. Ligament tear meniscal tear muscletendon tear mri joint without contrast upper extremity lower extremity 73221 73721 extremity, joint. It is a noninvasive test that can visualize the inner structures of the knee, including the cartilage and ligaments, the surface of the bones, and the muscles and tendons that surround the knee joint. Pdf parameniscal cyst formation in the knee is associated.
On mri, a tear presents as an abnormal intrameniscal signal on t2weighted or proton density mr images that unambiguously contacts the meniscal surface. Mr imagingbased diagnosis and classification of meniscal. Work with your doctor to plan a rehabilitation rehab program that helps you regain as much. With a sensitivity of 95% and a specificity of 81% for medial meniscal tears and sensitivity of 85% and a specificity of 93% for lateral meniscal tears 2,5, mri is the modality of choice when a meniscal tear is suspected, with sagittal images being the most sensitive 5. The medial meniscus is semicircular in shape and the lateral meniscus is almost a. The relation between knee meniscal structural damage and cartilage degradation is plausible but not yet clearly proven. Comparison of fast spinecho versus conventional spinecho. These signs are mri findings that can accompany meniscal tears. Most tears do not heal spontaneously and are treated arthroscopically by meniscus repair if torn in a clear, clean pattern or partial meniscectomy if torn in a complex or. Meniscus tears are among the most common knee injuries. Magnetic resonance imaging mri is the test of choice to confirm the diagnosis of a torn meniscus. If an athlete suffers a meniscal root tear, the three options for treatment. Any information contained in this pdf file is automatically generated from digital. The final diagnosis of the 62 meniscal lesions according to mri examination was meniscal degeneration in 44 71% lesions, and meniscal tear in 18 29% lesions table 3.
Athletes, particularly those who play contact sports, are at risk for meniscus tears. There have been multiple studies that have demonstrated the clinical success of meniscal repair. Meniscal tear one of the most commonly injured parts of the knee, the meniscus is a wedgelike rubbery cushion where the major. Mri should further improve the diagnosis of meniscal tears. Currently magnetic resonance mr is the modality of choice for assessing the meniscus with reported accuracies, sensitivities, and specificities ranging between 85% to 95% in detecting meniscal tears. Apr 24, 2020 the clinical diagnosis of meniscal tear is not easy. Ct arthrography was performed rather than mri because of claustrophobia. Compare the sensitivity, specificity, and accuracy of mri in the detection of meniscal tears with arthroscopy. We examined the association between presence of meniscal tear on mri and the surgeons confidence that the knee pain was due to meniscal tear using a.
Even partial meniscectomy may lead to osteoarthritis. The prevalence of asymptomatic tears, which typically are horizontal tears, increases with age 1,2. Most tears do not heal spontaneously and are treated arthroscopically by meniscus repair if torn in a clear, clean pattern or partial meniscectomy if torn in a complex or degenerative pattern. Meniscal tear one of the most commonly injured parts of the knee, the meniscus is a wedgelike rubbery cushion where the major bones of your leg connect.
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