Cleavage Tears Research Articles

Complex and horizontal cleavage meniscal tears: association with significant cartilage damage (SS-25)

Complex and horizontal cleavage meniscal tears: association with significant cartilage damage (SS-25)

Radial tears associated with cleavage tears of the medial meniscus in athletes

Purpose: To evaluate the significance of a small radial tear in the root of the posterior horn of the medial meniscus in an otherwise normal-looking meniscus in individuals who play vigorous sports. Type of Study: Retrospective review. Methods: Arthroscopy was performed in 1,270 patients; 11 patients (0.86%) had a small radial tear in the root of the medial meniscus. Trimming of the tear revealed a large horizontal cleavage tear of the posterior horn and body of the meniscus. The average age of the affected patients was 29.6 years (range, 21 to 45 years), and all were active in sports. Magnetic resonance imaging was of dubious diagnostic value. Three patients had undergone previous arthroscopy at which time the small radial root tear had been noted but was not thought to warrant treatment. Results: All 11 patients returned to their former levels of activity after adequate surgery. Conclusions: When a radial root tear in the medial meniscus is found in an athletic patient, the edges of the tear should be trimmed, the root of the medial meniscus examined, and any additional torn cartilage resected.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 3 (March), 2002: pp 254–256

Bilateral discoid medial menisci

This article adds 2 more cases of bilateral discoid medial menisci to the previously reported 9 cases. The radiographs of the first case revealed bilateral cupping of the medial tibial plateaus and a small lytic lesion of the left distal medial femoral metaphysis. Beside the posteriorly unstable incomplete type discoid medial meniscus, the left knee had several associated arthroscopic findings: depression of the medial tibial plateau with exposed subchondral bone, anomalous insertion of the anterior horn of the discoid meniscus to the anterior cruciate ligament, a pathological medial plica, and longitudinal deep fissures in the trochlea. The second case was a complete type with peripheral horizontal cleavage tears. Following arthroscopic surgery, magnetic resonance imaging (MRI) scans of the contralateral knees were obtained in both cases to search for bilaterality. MRI revealed discoid medial menisci in the unoperated knees as well. The short-term results of arthroscopic meniscectomy may not be as satisfactory as those reported for normal menisci.

Imaging in sportsmedicine—knee

Since the last decade, the introduction of Magnetic Resonance Imaging has provided a powerful new tool for the clinician to diagnose sports-related knee injuries. The main objective of this paper is to familiarise the relevant specialists with the proven clinical indications and semiology of MRI of the knee. At the present time, the knee joint is the area in which the advantages of MRI are most spectacularly apparent. The MR appearances of meniscal tears in particular, are first discussed in detail, referring to recent literature and personal experience based on more than then thousands MR examinations of traumatic knees. Also the mechanisms of injuries and the most commonly involved sports are described. The precise types of meniscal lesions, as visualised at arthroscopy, are abundantly illustrated on MR images: e.g., bucket-handle, radial and horizontal cleavage tears, meniscocapsular separations, discoid menisci and meniscal cysts. We discuss the numerous pitfalls due to neighbouring anatomical structures as well as non clinically or surgically significant intrameniscal hypersignals in athletes. Towards other imaging techniques, MRI is particularly suited for the diagnosis of ligamentous injuries, especially the cruciate ligaments. We develop the currently used direct and indirect signs of rupture, the diagnostic difficulties related to the age of trauma and the detection of associated lesions. Sport-induced tendinous and bursal pathology is another interesting indication of MRI, not only lesions of the more superficial extensor tendons but also the pes anserinus or hamstring tendons. We finally treat the recent developements of MRI in assessement of cartilage, subchondral and medullary bone disorders of traumatic or microtraumatic origin.

Concomitant meniscal and articular cartilage lesions in the femorotibial joint.

The frequency of concomitant meniscal and articular cartilage lesions in the femorotibial joint was analyzed in a retrospective study of 1740 knee joints examined arthroscopically with the objective of determining possible correlations between the two knee joint abnormalities. Articular cartilage lesions were found in 81.4% (N = 1416) of femorotibial joints examined and meniscal derangements were noted in 72.8% (N = 1268). In the medial compartment, concomitance was noted in 76.3% (821 of 1076) on the femoral condyles and in 48.6% (523 of 1076) on the tibial plateau. In the lateral compartment, 43.1% (212 of 492) of the knees with deranged menisci had femoral and 55.1% (271 of 492) had tibial articular lesions. Medial meniscal lesions were more frequently associated with femoral and tibial chondral degeneration than lateral meniscal derangements (P < 0.001). Longitudinal, bucket-handle, and complex tears of the medial meniscus were significantly more often associated with articular cartilage damage than horizontal cleavage, flap, or radial tears. Degeneration of the meniscus was highly correlated with chondral destruction in both compartments. No cause-and-effect relationship could be established, but practical implications of these findings are discussed.

MRI appearance of meniscal cysts

The purpose of this study was to review the MRI criteria for the distinction of meniscal cysts from other cystic lesions in the knee so that appropriate treatment may be planned. A retrospective review of 62 knee MRI scans possibly showing meniscal cysts was performed. The type of meniscal tear, the appearance of the connection between the cyst and the meniscal tear, and the location, size, morphology, and signal characteristics of the meniscal cysts were recorded. Other types of fluid collections that had been mistaken for meniscal cysts were described. Sixty-two patients were studied, ages 16-79 years, 61% male, 39% female. Most of the meniscal cysts (91%) occurred immediately adjacent to the meniscal tear (98% horizontal cleavage tears, 49% anterolateral), with the tear leading directly into the cysts. In two cases, the cyst had dissected into the soft tissues distant from the meniscus and a connecting stalk was visualized. Fluid collections in normal bursae and recesses that had been mistaken for meniscal cysts had no direct connection to a meniscal tear. MRI can be used to distinguish meniscal cysts from other fluid collections that may mimic meniscal cysts. Pitfalls can be avoided by familiarity with the normal bursal and capsular anatomy, and by the application of specific diagnostic criteria.

Bilateral discoid medial menisci with extensive intrasubstance cleavage tears: MRI and arthroscopic correlation

Although rare, the discoid meniscus can become problematic in active individuals. The arthroscopist is then presented with a challenging treatment problem. Through the current techniques of arthroscopy and MRI, the diagnostic and treatment difficulties are lessened; however, our understanding of the discoid meniscus is incomplete. Currently, the need exists for correlation between arthroscopy and MRI. We present a case of bilateral complete discoid medial menisci with symptomatic extensive intrasubstance horizontal cleavage tears. Both arthroscopy and MRI views of the lesions, pre- and postoperative, are presented. A review and discussion of the literature is included.

The Landscape of Meniscal Injuries

This article analyzes meniscal injuries seen in 10,117 knee arthroscopies. The information was compiled by a centralized data base at Surgical Data Management. The study suggests two patterns of meniscal injuries, degenerative and traumatic. Injuries to the menisci occurring with an associated anterior cruciate injury, radial tears, and tears within 3 mm of the meniscosynovial junction are associated with a younger and more active patient who is more likely to sustain a traumatic or sports-related injury. Tears described as complex, horizontal cleavage, and flap tears are associated with an older age group and follow a more degenerative pattern.

M.R. Imaging of the Knee: A Prospective Trial Using a Low Field Strength Magnet

A double blind prospective study involving fifty patients was performed to assess the diagnostic accuracy of knee MR Imaging using a 0.3 Tesla low field strength scanner. The study compared MR Imaging with arthroscopy. The overall accuracy found for the detection of meniscal tears was 92% and cruciate ligament tears 95%. These results compare favourably with other diagnostic modalities including knee arthroscopy. MR Imaging is good at showing meniscal lesions, especially cleavage tears, though some bucket-handle tears produced no MR abnormality. MR Imaging is very accurate at demonstrating complete cruciate ligament tears. Partial cruciate ligament tears often produced no positive MR findings and in no patients could any features be found to indicate ligamentous laxity.

Isolated lateral meniscectomy. A study of twenty-six patients with isolated tears.

To better define the role that the lateral meniscus plays in stabilizing the knee, a study was made of twenty-six patients who had an uncomplicated lateral meniscectomy between 1972 and 1977. Patients with any degree of ligament instability, cruciate or collateral, prior to lateral meniscectomy were eliminated from the study. Also eliminated were any patients with roentgenographic evidence of degenerative arthrits, osteochondritis dissecans, or loose bodies. Only patients whose operative reports stated that the articular cartilage of the lateral compartment was either grossly normal or showed Grade-1 chondromalacia (less than one centimeter in diameter and only softening of the cartilage) at the time of surgery were included in the review. The meniscal lesions included bucket-handle tears, horizontal cleavage tears, and multiple linear defects. No grossly cystic menisci were included in the study. Two menisci demonstrated cystic degenerative changes on histological section. In sixteen patients some degree of ligament instability developed. The longer the interval between injury to the meniscus and its excision, the less satisfactory the result. Only fifteen (54 per cent) of the patients reported satisfactory results, and twenty lost some motion of the knee. We concluded that stability of the knee joint is a multifactorial problem, in which the lateral meniscus certainly plays an important part.

Horizontal (cleavage) tears of the knee-joint menisci in the elderly.

ABSTRACT:At autopsy, extensive knee arthrotomies were performed on 11 Scottish males (average age 77) and 11 females (average age 75) who had died from various medical disorders and had no history of complaints referable to the knees. The aim was to study the incidence of horizontal (cleavage) tears of the menisci in the general population. In the males, there was a high incidence of cleavage tears of the medial meniscus (in 14 of 22 knees) whereas the lateral menisci were usually normal (in 21 of 22 knees). In the females, there was a low incidence of both medial (in 6 of 22 knees) and lateral meniscal tears (in 2 of 22 knees). Cleavage tears of the medial meniscus in geriatric males may be part of the aging process, and this should be kept in mind if surgery is contemplated for reasons other than severe symptoms.