Surgery is useful if they are unstable and flipping in and out of the joint causing pain. 7.13 . 2,3,4 However, it is important that these tears be diagnosed as several complications of meniscal root tear have been described, including meniscal extrusion, 1,5 secondary osteoarthritis, 3,4,5 and subchondral insufficiency fracture. (c, d) Taken at 40-day follow-up. Also, the lateral meniscus should be carefully evaluated when there is an ACL tear even though meniscal extrusion is rare in a lateral meniscus root tear. More on meniscal root tears. Tears of the meniscal root, or root ligament attachment, are typically radial-type tears that can involve both the posterior or anterior roots. The role of the meniscal root is paramount; it prevents the meniscus from being extruded and allows the meniscus to generate hoop stress. A normal, healthy meniscus should look like a dark black triangle; however, as this figure shows the meniscus is much lighter or “ghosted” representing the root tear. Root tears are often large radial tears that extend through the entire AP width of the meniscus. Usually, root tears occur at the meniscal attachment in the back of your knee – the posterior root. Images of 29 age- and gender-matched individuals with two MRIs of the same knee were reviewed as a control group. Matheny, 2015 #34. A recent MRI study also demonstrated that posterior lateral meniscal root tears often have intact meniscofemoral ligaments that prevent meniscal radial displacement . There is also minimal extrusion of the meniscus (image 1/6). View Record in Scopus Google Scholar. Magnetic resonance imaging (MRI) is the imaging modality of choice to diagnose meniscal root tears and concomitant pathologies (32, 35, 49–51). Methods: From January 2007 to December 2008, 387 consecutive cases of medial meniscal tears were treated arthroscopically. Therefore, the meniscal extrusion on MRI should be used as an additional clue for diagnosing a meniscal root tear, especially in the case of a medial meniscus root tear. They are most frequently seen at the posterior horn of the medial meniscus. 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. A woman in her 50s. If this is not the case it is an absent or empty meniscus-sign, indicating a radial tear. (a, b) Taken at the time of initial presentation. It is important to recognize these as the incidence of secondary osteoarthritis is high. Images: Krych AJ. The most common criterion for diagnosing meniscus tear on MRI is an increased signal extending in a line or band to the articular surface. In the case on the left there is a complete radial tear separating the posterior horn from its root (red arrows). Chung KS, Noh JM, Ha JK, Ra HJ, Park SB, Kim HK, et al. Meniscal Root Tear. The pre- and post-tear MR images were evaluated for marrow signal changes deep to the root anchor, meniscal root signal intensity, medial compartment articular cartilage thinning, and meniscal body extrusion. J Comput Assist Tomogr, 32 (2008), pp. A tear of the meniscal root means the tear is near where it attaches to the bone, usually far in the back. Treatment for a torn meniscus often begins conservatively, depending on the type, size and location of your tear. Avulsions or tears of the meniscal root are relatively uncommon, occurring in 2.2% – 9.8% of patients undergoing MRI of the knee. Root tears have received increased recognition in recent years, partially because of their previous underdiagnosis at both MR imaging and arthroscopy. A meniscal root tear is a radial tear located at the meniscal root. The MRI findings of meniscal root tear of the medial meniscus: emphasis on coronal, sagittal and axial images. Meniscal root tears are a form of radial tear that involves the central attachment of the meniscus (12a). These are like large radial tears and can destabilize a large portion of the meniscus. Most patients with meniscal root tears will ultimately need surgical fixation of the root. In many cases, a meniscal root tear is not prominent on a single MRI image as the structures follow oblique courses. Radial tear of the meniscal root is particularly difficult to diagnose. Should be normal in young patients with an acute meniscal injury; Meniscal calcifications may be seen in crystalline arthropathy (ex. Thirty arthroscopically diagnosed patients who had undergone preoperative knee MRI were included in this study. This displacement occurs due to tears … Wilson, 2018 #25. The posterior root attachment of the medial meniscus is readily identifiable on MRI. Significant meniscal root pathology may cause functional incompetence of the meniscus, with consequent early onset cartilage degeneration and osteoarthritis. 452-457. Radial tear which progressed to a flap tear. Imaging: Radiographs . often result in significant knee joint disorders. MRI findings that were predictors of arthroscopically-diagnosed root tear (p<.05) were lateral meniscus root tear in any segment (OR=16.8, 95% CI 5.6-50.1), degeneration in any segment (OR=3.9, 95% CI 1.6-9.6), coronal cleft (OR=5.7, 95% CI 2.0-16.7), sagittal ghost (OR=4.8, 95%CI 1.2-19.1), and axial radial defect signs (OR=7.1, 95%CI 2.4-20.5). 7.13). MRI is used to look more closely at the meniscus and determine if it is something that needs surgical treatment, although not all meniscus root tears show up on MRI. • Anatomic repair of the meniscal root should be attempted whenever possible in order to prevent further meniscus and cartilage damage and allow return to usual activities.1 1. Meniscal root tears are often associated with extrusion of the meniscus beyond the margin of the tibial plateau. Because the meniscal root is the anchor point for the meniscus, a complete tear of the meniscal root will result in shifting or displacement of the horn and/or body; on imaging one may see the meniscal body displaced into the femorotibial gutter. Root tears can be complete avulsions of the meniscus from the bone – the root pulls off the bone ( see picture ). • The finding of meniscal extrusion on MRI has been shown to be highly associated with the presence of a meniscal root tear. In meniscal root tears (MRTs), the disruption of collagen fibers that provide hoop strength results in extrusion of the menisci, altering their biomechanical properties. Pache, 2018 #20. MRI is the technique of choice for assessing the meniscal … Fig. If radial tear progresses, a portion on the side of free border becomes detached from the meniscal body and creates a flap (Fig. Tears associated with arthritis often improve over time with treatment of the arthritis, so surgery usually isn't indicated. Knee Surg Sports Traumatol Arthrosc. Avulsions or tears of the meniscal root are uncommon, occurring in 2.2-9.8% of patients undergoing MRI of the knee. In this series of how to read a MRI of a meniscal root tear, this patient was very active and felt a pop in the back of the knee when squating down and a few weeks later was unable to bare weight. Medial meniscal extrusion (MME) is a significant medial displacement of the medial meniscus with respect to the central margin of the medial tibial plateau and is closely associated with medial meniscal root tears (MMR) . DeHaven, 1980 #7. Purpose: The purpose of this study was to evaluate the relation between meniscal extrusion on magnetic resonance imaging (MRI) and tearing of the posterior root of the medial meniscus, as well as to understand the relation between meniscal extrusion and chondral lesions. On the sagittal view, as seen in Figure C, there is a “ghost sign” which is indicative of meniscal root tear. A different approach to reading MRI is recommended when diagnosing … Choi SH, Bae S, Ji SK, Chang MJ. The purpose of this study was to evaluate the accuracy of the characteristic magnetic resonance imaging (MRI) findings of medial meniscal root tear in the coronal, sagittal and axial planes. MRI has been shown to have 98% accuracy for medial meniscal tears and 90% for lateral meniscal tears. They can also exist as partial or full tears through the tissue of the meniscus adjacent to the bone. Radial displacement of the meniscus has been defined as displacement of the meniscus with respect to the outer margin of the tibial plateau and is considered pathological when exceeding 3 mm. Treatment Initial treatment . a palpable pop / click + pain is a positive test and can correlate with a medial meniscus tear. Meniscal Root Tear Meniscal root tears can be seen on coronal, axial and sagittal MRI views. Magnetic resonance imaging findings of surgically proven medial meniscus root tear: tear configuration and associated knee abnormalities. R. Allaire, M. Muriuki, L. Gilbertson, C.D. In some individuals the meniscal root may degenerate and tear as a consequence of primary … Types of root tears Arthroscopic view of a traumatic posterior horn medial meniscus root tear avulsion is shown. More than 3 mm meniscus extrusion is often associated with tears involving the meniscal root (6). Biomechanical consequences of a tear of the posterior root of the medial meniscus. Unless specifically reviewed, injuries involving this structure may be overlooked. Meniscal root tears, less common than meniscal body tears and frequently unrecognized, are a subset of meniscal injuries that. The first sequence of MRI scans in a coronal scan. MRI readily shows the normal, intact posterior medial meniscal root ().If an MRT is identified,8, 9, 10, 12, 25 one must determine whether there is associated medial compartment degenerative cartilage wear, to identify the subset of patients who might benefit from root repair (Fig 2B). Another finding is the abnormal size or shape of the meniscus, which would indicate damaged surfaces [12, 16, 17].Studies by Kaplan and colleagues [] and De Smet and coworkers [] showed that the abnormal signal must unequivocally contact the surface of … The meniscal roots are ligament-like structures that serve to anchor the fibrocartilaginous menisci onto the tibial intercondylar fossa or intercondylar eminence [1, 2]. The prevalence of a complete meniscal root tear at arthroscopy is reported as 9.1% . Similar to total meniscectomy. Harner. Although a variety of arthroscopic classification systems for meniscal root tears have been developed, they are rarely used in clinical practise [34, 41, 42]. MRI; Ultrasound; X-ray; Show more related information. Treatment of torn Meniscus Non-Operative treatment: Indications: An incomplete meniscal tear or a small (5 mm) stable peripheral tear with no other pathological condition, such as a torn anterior cruciate ligament. Meniscal root tears are an increasingly recognized injury leading to notable functional limitations, potential rapid cartilage deterioration of the affected compartment, and subsequent risk of total knee arthroplasty if left untreated. Clinical diagnosis is difficult, but magnetic resonance imaging usually allows to identify the lesion. There are two types of meniscal root tears. The meniscal root anchors the meniscus and prevents its being extruded. They were compared to 30 age-matched patients with medial meniscus tears without root tears. indications. CPPD) MRI . Complete root tears have a high association with meniscal extrusion, particularly when the tear occurs in the MM (58,59). 2012;20(10):2098-103. 6 This enables the meniscus to generate hoop stress which transfers load from the femur to the tibia without damage to underlying cartilage. 18. Keywords: medial meniscus tear, MRI, posterior root ligament. Meniscal root tear. Tears associated with ligamentous instabilities can be treated …
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