Location Of Meniscal Tears Research Articles

Meniscal procedures are not increased with delayed ACL reconstruction and rehabilitation: results from a randomised controlled trial

ObjectiveTo assess whether initial non-operative treatment of anterior cruciate ligament (ACL) ruptures with optional delayed ACL reconstruction leads to more meniscal procedures compared with early ACL reconstruction during the 2-year...

Meniscal tears associated with complete vs partial anterior cruciate ligament injury

Purpose: To investigate the incidence and location of meniscal tears in relation to complete vs partial anterior cruciate ligament (ACL) injury.Subjects and Methods: We collected MRI of 114 patients (114 knees) diagnosed with combined ACL and meniscal injury at a follow up 3 months to 2 years of knee injury at our center in last 3 years. The subjects comprised 68 males and 46 females ranging in age from 20 to 55 years. The patients were divided into two groups: Meniscal tears with Partial ACL injury and Complete ACL injury and the results were compared between this two groups.Results: The incidence of complete ACL injury diagnosed with MRI was 52.63% (60 of 114 knees) and partial ACL injury was 47.36% (54 of 114 knees). Regarding the locations of meniscal tears, in complete ACL injury (60 knees), medial meniscal tear was found in 60% (36 of 60 knees), lateral meniscal tear in 31.66 % (19 of 60 knees), and bilateral meniscal tears in 8.33 % (5 of 60 knees). In Partial ACL injury (54 knees), medial meniscal tear was found in 46.29 % (25 of 54 knees) and lateral meniscal tear in 42.59 % (23 of 54 knees) and bilateral (including medial and lateral) meniscal tears in 11.11 % (6 of 54 knees). Bucket handle tear was observed in 11 knees (medial: 8 knees, lateral: 3 knees) in complete ACL injury, and 4 knees (medial: 3 knees, lateral: 1 knee) in partial ACL injury.Conclusion: Incidence of medial meniscus tear was more than 50% in complete ACL injury. Lateral meniscus tear was more associated with partial ACL injury compared to complete ACL injury.

Effects of medial meniscal slope and medial posterior tibial slope on the locations of meniscal tears: A retrospective observational study.

The aim of this study was to analyze the relationship between medial posterior tibial slope (MPTS) and medial meniscus slope (MMS) with the location of meniscal lesions. We hypothesize that meniscuses with greater MPTS and MMS are more likely to have lesions in posterior horn.A total of 292 patients underwent arthroscopic surgery between January 2014 to September 2019 due to knee osteoarthritis (OA) and meniscal lesions were reviewed. Based upon the location of meniscal tears, patients were categorized as group B (tears in posterior horn) and group A (other sites). MPTS and MMS were measured from magnetic resonance imaging (MRI) slices. Osteoarthritis grade was evaluated in anteroposterior radiographs by the criteria defined by Kellgeren and Lawrence. Demographic data, OA grade, MPTS, and MMS for the 2 groups were compared and analyzed.The group A had 29 (39%) male and 45 (61%) female subjects with a mean age of 57.07 ± 6.79 years. Group B consists of 74 (34%) male and 144 (66%) female subjects with a mean age of 58.90 ± 7.594 years. (P = .067 and P = .458 for age and sex, respectively). In group A, 31 knees (42%) were determined to be Kellgren–Lawrence grade one, 32 knees (43%) grade two, and 11 knees (15%) grade three. In group B, 86 knees (39%) were categorized in grade one, 85 knees (39%) in grade two, and 47 knees (26%) in grade three (P = .085). The mean MPTS was 5.06 ± 2.11 degree for group A and 6.15 ± 2.37 degree for group B (P = .001). The mean MMS for group A was lower than group B (1.38 ± 2.12 degree vs 3.14 ± 2.92 degree; P < .000)This study demonstrated that increased MPTS and MMS may be considered as the risk factors for medial meniscal posterior horn tears.

Demographics and Epidemiology of Discoid Menisci of the Knee: Analysis of a Large Regional Insurance Database.

Background:A discoid meniscus is a morphological variant of normal knee joint meniscus shape and ultrastructure that can lead to traumatic tearing of this tissue and early joint osteoarthritis.Purpose/Hypothesis:The purpose of this study was to determine the prevalence of discoid menisci in a large, ethnically diverse regional cohort and to evaluate possible risk factors. The hypothesis was that there would be no difference in the epidemiological distribution of discoid menisci based on ethnicity or sex.Study Design:Descriptive epidemiology study.Methods:The study population was from a regional, integrated health care system cohort from Kaiser Permanente of Southern California that, as of 2016, included more than 4.5 million patients. Patient demographics included age, sex, and ethnicity within this cohort. Potential risk factors analyzed included age, sex, ethnicity, and body mass index (BMI). Unique characteristics of a discoid meniscus were analyzed, including a symptomatic versus asymptomatic meniscus, location of meniscal tear and type of meniscus, and frequency of meniscal surgical treatment.Results:A total of 223 patients with a confirmed discoid meniscus were identified, yielding an overall prevalence rate of 4.88 per 100,000 patients. Those identifying as Black had the lowest prevalence (2.68/100,000), while Hispanic ethnicity had the highest (6.01/100,000). However, there was no significant difference with regard to ethnicity (P = .283), nor any significant difference between sexes. BMI did not significantly influence the rate of discoid menisci (P = .504). A majority (77.5%) of patients were symptomatic, while 22.5% of patients with discoid menisci were asymptomatic and discovered incidentally. Symptomatic discoid menisci were more likely to be operated on compared with asymptomatic discoid menisci (71% vs 14%, respectively; P = .001; odds ratio, 14.8 [95% CI, 5.8-37.2]). Horizontal and bucket-handle tears were the more common tear types. Of the discoid menisci in this cohort, 55.6% underwent surgery, with 95.2% undergoing reported saucerization.Conclusion:In this very diverse population-based cohort of patients, there did not seem to be a significant predilection of discoid menisci with regard to ethnicity. Neither sex nor BMI significantly influenced the rate of discoid menisci. More than three-quarters of those with a diagnosed discoid meniscus were symptomatic. Of the tears that occurred with discoid menisci, horizontal and bucket-handle tears made up the largest proportion.

Association of meniscal flounce in the knee with the pattern and location of meniscal tear, concomitant ligamentous injury, amount of knee joint effusion, and flexion and rotation angles: a magnetic resonance evaluation.

To determine the association of meniscal flounce with the pattern and location of the meniscal tear, concomitant ligamentous injury, amount of knee joint effusion, and flexion and rotation angles. A total of 283 knees of 280 patients were retrospectively reviewed over a 9-month period. Thirty-one magnetic resonance images of patients with meniscal flounce were compared with those of age- and sex-matched control group (n = 62) without meniscal flounce. The presence of meniscal tear was evaluated and, if present, its location and pattern were recorded. The amount of joint effusion was graded, and the joint angle was measured. The Fisher's exact, Cochran-Armitage trend, and t tests were performed to compare the findings between the two groups. The decision tree analysis was employed to determine the most significant factor of meniscal flounce. Meniscal flounce was present in 11.0% (31/283) of the adult population. Approximately 80.6% of meniscal flounce occurred in the torn medial menisci. The presence of meniscal flounce was significantly associated with tears at the body (p = 0.007), posterior horn (p = 0.001), and meniscocapsular junction (p = 0.002) of the medial meniscus. The decision tree analysis revealed that the posterior horn tear of the medial meniscus was the most significant predictor of meniscal flounce. The most significant factor associated with meniscal flounce is tear at the posterior horn of the medial meniscus, followed by tear at the meniscocapsular junction.

Subchondral insufficiency fracture of the knee: grading, risk factors, and outcome.

To propose an magnetic resonance imaging (MRI) grading system for subchondral insufficiency fracture of the knee (SIFK) to predict outcome and assess risk factors. A total of 50 SIFK patients were retrospectively reviewed utilizing two MRI examinations approximately a year apart and compared them with 51 control subjects. A grading system was introduced that classifies lesions as low- vs high-grade. Lesion location 3D dimensions, extent of bone marrow edema (BME), location of meniscal tears and associated extrusion, degree of chondrosis and among other parameters were stratified according to lesion grade and compared with follow-up examinations. Statistical analyses were performed (Pearson's correlation, binary logistic regression, and Chi-squared analysis). The majority of SIFK lesions were low-grade (LG; 78%) and most of them (70%) were observed in the medial femoral condyle. Predictor variables comparing low-grade and high-grade SIFK lesions included meniscal tear (p = 0.01), degree of extrusion (p < 0.003), chondrosis (p = 0.01), medial chondrosis grade (p = 0.001), medial femoral condyle (p = 0.01), surface collapse (p < 0.0001), marrow edema improvement (p < 0.0001), first MRI anteroposterior dimension (p = 0.001), transverse dimension (p < 0.001), and ellipsoid volume (p = 0.02). Predictor variables found to be significantly different between controls and patients were meniscal tear (p = 0.024), location of the medial meniscal tear (p < 0.0001), degree of extrusion (p < 0.0001), chondrosis (p < 0.0001), joint effusion (p < 0.0001), Baker's cyst (p < 0.0001), knee lock (p = 0.03) and buckle (p = 0.01), and history of trauma (p = 0.01). A SIFK grading system for MRI is introduced. Surrogate markers of high-grade lesions include medial meniscus posterior root tears with associated moderate to severe extrusion, high-grade chondrosis, larger lesion sizes (anteroposterior/transverse), and articular surface collapse. Improvement of BME on follow-up was highly predictive of low-grade disease.

Concomitant meniscal injury in anterior cruciate ligament reconstructiondoes not lead to poorer short-term post-operative outcomes.

The main objective was to compare post-operative outcomes in patients undergoing anterior cruciate ligament (ACL) reconstruction both with and without concomitant meniscus injury at a mean follow-up of 3.5years. The secondary objective was to study the effect of different meniscal injury sites and treatment modalities on post-operative outcomes (PROS). This is a retrospective analysis of a prospectively maintained database of patients undergoing ACL reconstruction at our tertiary institution between 2009 and 2012. Age, sex, graft type, graft fixation modality, location of meniscal tear and treatment (meniscal repair or meniscectomy) were recorded in the database. PROS used included the Tegner activity scale and the Lysholm score. There were no significant differences between patients with or without meniscal injury in terms of age, BMI or preoperative PROS. There was no significant difference in the post-operative outcome scores between patients with or without meniscal injury at a mean follow-up of 3.5years. Regardless of the location of meniscal injury, the post-operative scores improved as compared to preoperative scores. Concomitant meniscal injury in cases of ACL reconstruction is not associated with poorer short-term post-operative PROS (mean follow-up time: 3.5years). These findings may influence management decisions and help in preoperative counselling. IV.

Magnetic resonance imaging in the evaluation of meniscal tear

Abstract Background: Magnetic resonance imaging (MRI) has been recognized as the imaging method for non-invasive evaluation of knee pathology, particular meniscus and ligaments. Objective: Compare the sensitivity, specificity, and accuracy of MRI in the detection of meniscal tears with arthroscopy. Material and methods: Twenty-seven patients who were diagnosed as meniscal tear on arthroscopy with preoperative MRI were included in this study between January 2003 and June 2008. MRI was performed with a 1.5 Tesla Signa Horizon Echospeed MRI for eight patients between January 2003 and June 2005 and a 1.5 Tesla Signa Excited HD MRI for nineteen patients between July 2005 and June 2008. The location of meniscal tear was evaluated by studying three areas: anterior horn, body and posterior horn. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of the anterior horn, body, posterior horn and overall meniscus were calculated. Results: The sensitivity of MRI for detecting meniscal tears at the anterior horn, body, posterior horn, and overall medial meniscus was 42.9%, 87.5%, 94.1%, and 81.3%, respectively. The specificity was 95.0%, 84.2%, 81.8%, and 88.0%, respectively. The accuracy was 81.5%, 85.2%, 89.3%, and 85.4%, respectively. The PPV was 75.0%, 70.0%, 88.9%, and 81.2%, respectively. The NPV was 82.6%, 94.1%, 90.0%, and 88.0%, respectively. The sensitivity of MRI for detecting meniscal tears at the anterior horn, body, posterior horn and overall lateral meniscus was 0%, 100%, 85.7%, and 80.0%, respectively. The specificity was 100%, 100%, 90.5% and 97.2%, respectively. The accuracy was 96.0%, 100%, 90.5%, and 97.2%, respectively. The PPV was 100%, 75% and 80%, respectively. The NPV was 96.3%, 100%, 95.0%, and 97.2%, respectively. Conclusion: MRI is a helpful technique to detect meniscal tear with different sensitivity and accuracy on the meniscal location.

PET/MRI depicts the exact location of meniscal tear associated with synovitis

PET/MRI depicts the exact location of meniscal tear associated with synovitis

MR imaging of meniscal cysts: evaluation of location and extension using a three-layer approach

Purpose: To analyze the extension of medial and lateral meniscal cysts relative to the capuloligamentous planes of the knee. Materials and methods: The MR images of 32 patients with meniscal cysts were reviewed. The location and extension of the meniscal cysts with reference to the capsule and ligaments were recorded. Results: Most medial meniscal cysts were located posteromedially. Posteromedial meniscal cysts usually penetrated the capsule and were located between layer I and the fused layers II+III. From this site some extended anteriorly and then became located superficial to the superficial MCL. The location of lateral meniscal cysts was more varied. Anteriorly the cysts were located deep to the iliotibial band, whereas posterolateral cysts were located deep to the lateral collateral ligament. Conclusion: Although the site of capsular penetration of meniscal cysts is determined by the location of meniscal tears, the possible pathways of extension appear to be determined by the capsuloligamentous planes of the knee.

MR imaging of meniscal cysts: incidence, location, and clinical significance.

The purpose of this study was to determine the incidence of medial versus lateral meniscal cysts as seen on MR imaging. A total of 2572 knee MR imaging reports were retrospectively reviewed for the presence of meniscal tears and cysts. Two musculoskeletal radiologists reviewed all images with reported cysts. The type and location of meniscal tear and the presence and location of meniscal cysts were recorded. A total of 1402 meniscal tears were reported in 2572 MR examinations (922 [66%] of 1402 in the medial compartment; 480 [34%] of 1402 in the lateral compartment). Meniscal cysts were present in 109 (4%) of 2572 knees. Of the 109 cysts, 72 (66%) were in the medial compartment, and 37 (34%) were in the lateral compartment. Meniscal cysts were found in association with 72 (7.8%) of the 922 medial meniscal tears and 37 (7.7%) of the 480 lateral meniscal tears. Meniscal cysts showed direct contact with an adjacent meniscal tear in 107 (98%) of 109 cases, with the tear showing a horizontal component in 96 (90%) of 107 cases. Meniscal cysts occur almost twice as often in the medial compartment as in the lateral compartment. Medial and lateral tears occur with the same frequency. These findings, when viewed in the context of the historical literature on meniscal cysts, suggest that MR imaging detects a greater number of medial meniscal cysts than physical examination or arthroscopy, and that MR imaging can have an important impact on surgical treatment of patients.