Popliteal Area Research Articles

Vascular anatomy of the lateral meniscus with special focus on the joint capsule.

Previous studies have reported that the lateral meniscus (LM) has two regions, the popliteal hiatus area (PH) with a scarce blood supply and the roots with an abundant one. However, the description of its vascular anatomy remains insufficient. We hypothesized that the difference in the width of the meniscus hilum (MH) affects the scarcity and abundance of blood supply to the LM. The MH is a concept proposed by us and is the only site of entrance or exit of blood vessels and nerves associated with the meniscus. The purpose of this study was to provide a structural explanation for the disparity of blood supply to the LM using the concept of MH. Sixteen knees were examined to investigate the blood supply to LM. In most areas, the femoral joint capsule (FJC) and tibial joint capsule (TJC) continued to the cranial and caudal edges of the LM, respectively. In the roots, the FJC and TJC covered the femoral and the outer-femoral surfaces. In contrast, the FJC in the PH did not attach to the cranial edge and only the TJC there did to the caudal edge of the LM. Histochemical examination showed that the blood vessels enter the LM via the MH. In the PH, the MH at the caudal edge was extremely narrow; and in the roots, the MH on the outer-femoral surfaces was wide. The results suggest that the difference in the width of the MH affected the scarcity and abundance of blood supply to the LM.

Arthroscopic surgery for injuries to the popliteal tendon area of the lateral meniscus

To investigate the mid-term effect and complications of arthroscopic popliteal tendon suture in the treatment of lateral meniscus injury. From January 2016 to December 2020, the data of 57 patients with lateral meniscus popliteal tendon injury treated by arthroscopic popliteal tendon suture fixation were retrospectively analyzed, including 35 males and 22 females, aged from 18 to 47 years old with an average of (32.9±7.9) years old. Knee function was evaluated using the International Knee Documentation Committee (IKDC) and Lysholm scores both before the operation and at the final follow-up. Meniscus healing was evaluated according to the postoperative Barrett standard. Wound healing complications, such as vascular injury, nerve injury, and lower extremity venous thrombosis, were recorded. All 57 patients were followed up for 12 to 58 months with an average of (38.1±14.9) months.The incisions of the patients after the operation were all Grade A healing without infection, popliteal tendon injury, blood vessel injury, nerve injury and lower extremity venous thrombosis.The IKDC score increased from (49.7±3.6) points preoperatively to (88.5±4.4) points in the final follow-up (P<0.05). The Lysholm score increased from (48.8±4.9) points preoperatively to (91.9±3.9) points at the final follow-up (P<0.05). At 3, 6 months and 1 year after operation, according to Barrett's criteria, 54 cases were clinically healed, the healing rate was 94.7% (54/57). This study preliminarily confirmed that arthroscopic suture technique can result in clinical stability through suture and fixation of the meniscus in the injured lateral popliteal tendon area. No adverse effects on knee joint function were found in the mid-term follow-up after the operation.

Ultrasound detection of non-atherosclerotic intima-medial abnormalities of lower limbs arteries in amateur endurance runners

BackgroundStructural changes in the lower limb’s arterial wall in amateur endurance runners are a rare incidental finding, represented just by several case reports.AimStudy the incidence of non-atherosclerotic lower limb artery wall changes in defined group of amateur endurance runners and identify relationship with the training parameters and the relevant biochemical markers.MethodsAmateur male athletes engaged in endurance running for more than 5 years were enrolled. Tibial and anterior popliteal arteries on each side were examined by ultrasound with focus on non-atherosclerotic structural wall changes: intima-medial border blurring, presence and character of non-atherosclerotic noduli. Subsequently the descriptive and correlation analysis were performed.ResultsThe study enrolled 20 amateur male endurance runners from Black Swan Triathlon Club Slovakia. The low atherosclerotic risk was represented by normal lipid levels, BMI under 30 kg/m2 and non-smokers in all participants. At least one type of structural artery wall abnormality (noduli or intima-medial border blurring) was present in 19 of 20 participants (95%). The most present was the intima-medial blurring. (80% of participants). The noduli were present in 65% of study group, in almost 40% of these, they were considered as hyperechogenic. All these affections were predominantly in popliteal artery area (65%). The vast majority has bilateral affection. We find a mild correlation between these ultrasound findings and training load represented by annual kilometers and run hours. There was no association between these changes and lipid spectrum or CRP level.ConclusionThe subclinical lower limb artery changes, represented by intima-medial border blurring and non-atherosclerotic noduli were present in almost every amateur endurance runner. Despite the underlying mechanism is not understood, the increased training load seems to be one of the responsible factors.

Comparison of Adaptations in the Gastrocnemius Muscle from an Exercise Program with and without Low-Intensity Blood Flow Restriction Banding in 18 Male Amateur Basketball Players Aged 16-45 Years.

BACKGROUND Basketball is a sport with a global impact and recognized major leagues, and is one of the most studied and analyzed sports for improvement at the level of the high-performance athlete. Increasing the jump height of basketball players is an essential factor for high athletic performance. MATERIAL AND METHODS This study aimed to identify the effect of low-intensity training with flow restriction versus the eccentric exercise protocol on amateur athletes. Eighteen amateur basketball players aged 16-45 years were divided into 2 groups: Group A consisted of 9 participants with low-intensity training with flow restriction (40% intensity) with 200 mmHg occlusion applying flow restriction bands in the popliteal area, while Group B consisted of 9 participants who performed an eccentric exercises protocol on the gastrocnemius. An anthropometric evaluation was applied, which consisted of perception of effort, range of movement (ROM), muscle strength intensity, and the power of the jump measured with a jump platform. RESULTS Notable changes were observed in favor of Group A for the right dorsiflexion, with mean difference (MD)=-2.444 (P=0.018); left dorsiflexion with MD=-2.778 (P=0.027) and left foot perimeter variable with MD=-0.667 (P=0.026) at 95% confidence interval (CI); while the vertical jump was in favor of Group B, with MD=-2.899 (P=0.006). CONCLUSIONS Low-intensity training with flow restriction and eccentric exercise protocol were both effective in improving jumping performance. A significant improvement was shown in the jump height and ROM of the 2 study groups.

Lymphaticovenous anastomosis in rabbits: A novel live experimental animal model for supermicrosurgical training

BackgroundLymphaticovenous anastomosis is widely used in lymphedema management. Although its effectiveness in reducing edema in patients can be clinically observed, evaluating the long-term outcomes of this technique can be complex. This study established an animal model to assess the outcomes of lymphaticovenous anastomosis technique at 15 and 30-days post-surgery using indocyanine green lymphography, Patent Blue V dye injection, and histopathological examination. MethodsAn experimental model was established in the hindlimbs of 10 rabbits using the popliteal vein and afferent lymphatic vessels in the popliteal area. The subjects were divided into two groups: the first group (n = 5) underwent patency assessment at 0 and 15 days, and the second group (n = 5) at 0 and 30-days, resulting in 20 anastomoses. Patency was verified at 0, 15, and 30-days using indocyanine green lymphography and Patent Blue V injection. Histopathological examinations were performed on the collected anastomosis samples. ResultsThe patency rate was 90% (19/20) initially, 60% (6/10) at 15 days post-surgery, and 80% (8/10) at 30-days. The average diameter of lymphatic vessels and veins was 1.0 mm and 0.8 mm, respectively. The median number of collateral veins was 3; the median surgical time was 65.8 min. Histopathology revealed minimal endothelial damage and inflammatory responses due to the surgical sutures, with vascular inflammation and thrombosis in a single case. Local vascular neoformations were observed. ConclusionThis study highlights the reliability and reproducibility of using rabbits as experimental models for training in lymphaticovenous anastomosis technique owing to the accessibility of the surgical site and dimensions of their popliteal vasculature.

Clinical anatomy of the popliteal artery and its implications in total knee arthroplasty: a systematic review and meta-analysis.

The popliteal artery (PA) is a lower extremity arterial vessel, a continuation of the superficial femoral artery. PA may be injured in the majority of total knee arthroplasty (TKA), as well as arthroscopic surgeries which may lead to acute ischemic injury. Our objective was analyzing morphometry of PA in relation to other structures both in flexion and extension of the knee, highlighting discrepancies in the PA's location in varying positions. Literature was reviewed in regards to morphological qualities, prevalence rates, and variants of PA were pooled. Five cadaveric and 14 radiological studies were included, totalling 1473 lower limbs. We found that PA, when nearing bone, was more predictable and fixed as seen in axial plane one and two centimeters distal to joint line at 0 degrees flexion. The distance between PA and posterior tibial cortex was estimated at 3.3 mm with 95% confidence interval (CI) 2.6-4.1 and 7.8 mm (95% CI 5.1-10.5) respectively. Once PA passed over and nearing the joint it had larger discrepancies with distance comparing the knee in 0 vs 90 degree flexion. Due to rise of TKA, arthroscopic surgeries and connected vascular complications PA has been investigated more frequently, and while majority of publications describes relationships between vessels of popliteal area and specific landmarks conducted with knee in extension, our study also implemented data regarding knee flexion thus encompassing the problem in a more dynamic manner. We believe this provides superior data for identification of PA, especially during knee surgery.

Lymphatic Drainage-Promoting Effects by Engraftment of Artificial Lymphatic Vascular Tissue Based on Human Adipose Tissue-Derived Mesenchymal Stromal Cells in Mice

Regenerative medicine using lymphatic vascular engineering is a promising approach for treating lymphedema. However, its development lags behind that of artificial blood vascular tissue for ischemic diseases. In this study, we constructed artificial 3D lymphatic vascular tissue, termed ASCLT, by co-cultivation of ECM-nanofilm-coated human adipose tissue-derived mesenchymal stromal cells (hASCs) and human dermal lymphatic endothelial cells (HDLECs). The effect of hASCs in lymphatic vessel network formation was evaluated by comparison with the tissue based on fibroblasts, termed FbLT. Our results showed that the density of lymphatic vascular network in ASCLT was higher than that in FbLT, demonstrating a promoting effect of hASCs on lymphatic vascular formation. This result was also supported by higher levels of lymphangiogenesis-promoting factors, such as bFGF, HGF, and VEGF-A in ASCLT than in FbLT. To evaluate the therapeutic effects, FbLTs and ASCLTs were subcutaneously transplanted to mouse hindlimb lymphatic drainage interruption models by removal of popliteal and subiliac lymph nodes. Despite the restricted engraftment of lymphatic vessels, ASCLT promoted regeneration of irregular and diverse lymphatic drainage in the skin, as visualized by indocyanine green imaging. Moreover, transplantation of ASCLT to the popliteal lymph node resection area also resulted in lymphatic drainage regeneration. Histological analysis of the generated drainage visualized by FITC-dextran injection revealed that the drainage was localized in the subcutaneous area shallower than the dermal muscle. These findings demonstrate that ASCLT promotes lymphatic drainage in vivo and that hASCs can serve as an autologous source for treatment of secondary lymphedema by tissue engineering.

Mid-term results of combined medical and popliteal artery endarterectomy treatment in Buerger's disease

Aim: Our aim in this article is to present the mid-term results of the best preoperative and postoperative medical treatment and analgesia treatment in patients with advanced Buerger's disease who underwent saphenous patchplasty and saphenous distal bypass after endarterectomy to the popliteal artery or trifurcation area. Material and Methods: Between 2015 and 2023, we operated on 83 patients, diagnosed with Buerger's disease, who were in the chronic stage of the disease, and whose advanced imaging was performed. Preoperative, postoperative, and 1st year control evaluations were determined according to Rutherford, Fontaine classification, and Ankle-Brachial Indexes. Medical treatments of the patients were organized by the vascular surgery team and algology department. After determining the surgical approach strategy according to the imaging of the patients, saphenous patchplasty and anatomical bypass were performed. Results: The mean preoperative ankle-brachial index was 0.305, the mean postoperative ankle-brachial index was 0.644, and the mean 1-year ankle-brachial index was 0.629 in 83 patients included in the study. Statistically significant improvements were observed in the Rutherford and Fontaine classifications. (p-value &lt; 0,001) Amputation was performed in 9.6% of patients within 1 year. Conclusion: Good clinical results and limb salvage can be achieved with a combined medical and surgical treatment approach in advancedstage patients who do not respond despite optimal medical treatment. Provided that patients quit smoking, good determination of the target surgical site, Saphenous patchplasty, and Saphenous distal bypass applied after endarterectomy in suitable patients are supported with good medical and analgesia treatment, the results will improve further.

The Posteromedial-Transseptal Portal for Arthroscopic Suture Hook Repair of Posterior Horn Tears and Popliteomeniscal Fascicles Tears of the Lateral Meniscus

We present a convenient and safe arthroscopic technique for suturing the lateral meniscus. In this technique, the clinician establishes a conventional posteromedial approach in the figure-of-four position of the knee by using the anterolateral and anteromedial observation approaches. Behind the posterior cruciate ligament, an operational approach is formed through the posterior mediastinum of the knee joint. Through this approach, suture hook can be brought to the posterior horn and body of the lateral meniscus, thus simplifying the suture of the lateral meniscus. We have used this technique to finish all-inside suture using suture hooks in a variety of types of lateral meniscal injuries, including longitudinal posterior horn tears, bucket handle meniscus tears, and tears around the popliteal hiatus area. Compared with traditional lateral meniscal all-inside suture technology through anteromedial or anterolateral approaches, this technology can suture more accurately, safely, and conveniently, avoid the involvement of the popliteal tendon suture, and the lower risk of complications such as popliteal vascular and nerve injury occur.

A study on repair method of type Ⅱc injury in lateral meniscus popliteal tendon area of porcine knee

To investigate the repair method of type Ⅱc injury in the lateral meniscus popliteal tendon area based on the porcine knee joint. Eighteen commercially available fresh porcine knee joints were randomly divided into 3 groups ( n=6). After preparing a type Ⅱc injury in the lateral meniscus popliteal tendon area, and the anterior (group A), posterior (group B), or anterior and posterior (group C) of the popliteal hiatus (PH) was sutured by vertical mattress. The tension meter was used to apply gradient tensions of 2, 4, 6, 8, and 10 N along the tibial plateau horizontally, respectively, to pull the midpoint of the lateral meniscus popliteal tendon area. The displacement values before modeling, after modeling, and after suture were recorded. The reduction value of lateral meniscus displacement and reduction rate after suture were calculated and compared between groups. There was no significant difference between groups ( P>0.05) in the displacement values before modeling, after modeling, and after suture under different tensions. There was no significant difference between groups A and C ( P>0.05) in the reduction value of lateral meniscus displacement and reduction rate after suture under different tensions. The reduction value of lateral meniscus displacement and reduction rate after suture in group B were lower than those in groups A and C. The reduction value of lateral meniscus displacement under tension of 2 N and the reduction rates under tensions of 2, 4, and 6 N between groups A and B showed significant differences ( P<0.05). The reduction value of lateral meniscus displacement and the reduction rate under tensions of 2, 4, and 6 N between groups B and C showed significant differences ( P<0.05). Suturing the anterior area of PH is the key to repairing type Ⅱc injury of lateral meniscus popliteal tendon area.

Physiotherapy rehabilitation management on phase IV of post-operative anterior cruciate ligament reconstruction with medial meniscus repair : a case report

Background: Sports injuries are injuries that arise as a result of sporting activities or activities. 60% of sports-related injuries occur in the lower limbs, including the knee's anterior cruciate ligament (ACL). This study aims to evaluate the physiotherapy interventions to improve ROM, balance, and knee function following ACLR with medial meniscus repair phase IV. Case Description: The patient complained of pain and stiffness in the popliteal area. The pain was felt when driving a car and squatting. The injury occurred when playing futsal, and the patient made a zigzag while trying to win the ball. The patient took the wrong footing. Namely, the body turned while the left leg was left behind, and the knee joint suddenly rotated or twisted. Before surgery, the patient had carried out physiotherapy for six meetings. The operation was carried out on 11 May 2022 at the Royal Progress Hospital with three-day hospitalisation. The patient has been doing physiotherapy since the first day after surgery. Currently, the patient has entered week 19 (Phase IV). Conclusion: The physiotherapy rehabilitation process, in this case, focuses on maintaining and increasing the strength of the core muscles and lower extremities, preparing the patient to jog, and training the patient's brain coordination through agility training. Returning to futsal is the ultimate goal of physiotherapy rehabilitation in this case.

Single Needle All-Inside Technique for Lateral Meniscus Repair at Popliteal Hiatus Area: Safe, Effective, and Time-Saving

The lateral meniscus tear at the popliteal hiatus area is a tricky problem in clinical treatment due to the difficulty of preoperative diagnosis, narrow space for operation, lack of capsular attachments, and risk of vascular injuries. This article introduces an arthroscopic single-needle, all-inside technique suitable for repairing longitudinal and horizontal lateral meniscus tears at the popliteus tendon hiatus area. We believe this technique is safe, effective, economical and reproducible.

THE EFFECT OF SHORT DURATION BED REST AND TYPE 2 DIABETES MELLITUS ON ARTERIAL STRUCTURE AND FUNCTION IN OLDER ADULTS

Abstract Type 2 diabetes mellitus (T2DM) and inactivity individually accelerate changes related to vascular aging. These changes increase cardiovascular risk and contribute to morbidity and mortality in the elderly. It is unknown if T2DM and bed rest have an additive, deleterious effect on vascular structure and function in older adults. The objective of this study is to determine the magnitude of the effect of bed rest on vascular structure in older adults with T2DM compared to healthy controls and determine if resistance exercise is protective of this effect. So far, we have recruited T2DM (n=9) and healthy control (n=17) subjects (age: 67.0 ± 6.7 years) to undergo five days of bed rest. During bed rest, subjects were randomized to receive intensive bedside resistance exercise physical therapy or standard of care in-bed passive physical therapy. On bed rest days 1 and 5, popliteal artery diameter, area, blood velocity, and blood flow were measured using Doppler ultrasonography. Our preliminary data show that the T2DM, non-exercise group had significantly greater decreases in popliteal artery diameter (-0.59 mm ± 0.18) than the control, non-exercise group (-0.17 mm ± 0.11). Resistance exercise did not prevent artery size changes in either controls or T2DM. Resistance exercise showed a trend in preventing blood velocity and flow reduction in both T2DM and control groups. These preliminary data suggest that older adults with T2DM had greater structural popliteal artery changes compared to controls. Resistance exercise appears to help maintain blood flow by maintaining/increasing popliteal artery blood velocity, but not size.

A 60 Years Old Woman with Ganglion Cyst of Popliteus Tendon Sinistra

The popliteal ganglion, also known as Baker's cyst, is an abnormal, fluid-filled distension of the gastrocnemius-semimembranosus bursa. These cysts rarely manifest alone and are often associated with intra-articular pathology and inflammatory conditions, such as osteoarthritis, meniscus tears, and rheumatoid arthritis. A 60-year-old woman came to the surgery clinic of Dr. Sayidiman Magetan hospital with complaints of lumps in the left knee crease. The patient noticed a lump in the crease of her left knee for two months. The patient said she did not feel pain in the lump, but the patient sometimes felt stiffness in the lump area when the patient worked in the fields. The localization status on inspection showed a mass in the popliteal area of the knee, which was round and well-defined. On palpation there is no pain, and can be moved mobile. Non-medical management is surgery/extirpation of the tumor mass.

Design Evaluation of FFF-Printed Transtibial Prosthetic Sockets Using Follow-Up and Finite Element Analysis

Background: Participants in Sierra Leone received a Fused Filament Fabrication (FFF)-printed transtibial prosthetic socket. Follow-up was conducted on this group over a period of 21 months. To investigate the failure of some of the FFF-printed transtibial sockets, further strength investigation is desired. Methods: A finite element (FE) analysis provided an extensive overview of the strength of the socket. Using follow-up data and FE analyses, weak spots were identified, and the required optimization/reinforcement of the socket wall was determined. Results: Five sockets with a 4 mm wall thickness were tested by five participants. The strength of the 4 mm prosthetic socket seemed to be sufficient for people with limited activity. The 4 mm sockets used by active participants failed at the patella tendon or popliteal area. One socket with a wall thickness of 6 mm was used by an active user and remained intact after one year of use. An FE analysis of the socket showed high stresses in the patella tendon area. An increased wall thickness of 7 mm leads to a decrease of 26% in the stress corresponding to the observed failure in the patella tendon area, compared to the 4 mm socket. Conclusions: Follow-up in combination with an FE analysis can provide insight into the strength of the transtibial socket. In future designs, both the patella tendon and popliteal area will be reinforced by a thickened trim line of 7 mm. A design with a thickened trimline of 7 mm is expected to be sufficiently strong for active users. Another follow-up study will be performed to confirm this.

Simultaneous retrograde venous and anterograde arterial bullet embolism: a case report

BackgroundBullet embolus is a rare condition following gunshot injuries and represents a clinical challenge regarding both diagnosis and management.Case presentationWe report the case of a 35-year-old Iranian (Middle-Eastern) male patient with a shotgun injury to both buttocks, which traveled to the heart and the popliteal area through the femoral vein and superficial femoral artery, respectively. Surgical intervention was applied for the popliteal pellet, and the patient was discharged without further complications.ConclusionAlthough bullet emboli can be a clinical challenge, with the advent of modern procedures, removal has become safer. X-ray, computed tomography, and transthoracic and/or transesophageal echocardiography may be used as adjuncts to help establish the diagnosis.

Myoepithelial tumor in the popliteal area: A diagnostic dilemma.

Introduction and importanceMyoepithelial tumors are under-recognized neoplasms that could be difficult to identify due to their rarity and limited comprehension. Their diverse morphology, varied cytologic features and heterogenous immunohistochemical characteristics create a significant diagnostic challenge.Case presentationWe report the case of a 72-year-old-male patient who received conservative treatment during one year for a popliteal mass on the right knee that showed synovial hyperplasia (benign findings) at initial open tissue biopsy. New symptoms of popliteal area enlargement and discomfort required a second incisional biopsy to reach the diagnosis of a soft tissue myoepithelial tumor through tissue analysis and immunohistochemical staining.Clinical discussionThe myoepithelial tumors represent a medical dilemma due to their heterogenic features requiring high level of suspicion and adequate immunohistochemical markers for their diagnosis.ConclusionOrthopaedic surgeons should be aware of the atypical presentation of these rare neoplasms to provide an early diagnosis and adequate management.

Dynamics of Sonographic and Morphological Changes in Baker's Cyst Formation

Comparative analysis of sonographic and morphologic assessment in formation of Baker's cyst has been performed. There were 25 patients with gonarthrosis lasted 5.6 + years. In development of Bakers cyst 3 periods were defined. Each period is characterized by structural changes caused by cyst development age and gonarthrosis stage. The period has specific quantitative and qualitative patterns of cyst wall and content. Ultrasound diagnosis of cyst structural development was reliably verified by histologic data. Ultrasound assessment of synovial masses in popliteal area allows to differentiate Bakers cyst with other pathologic processes in deforming knee arthrosis of different genesis. Accurate definition of structural cyst development periods is useful for the detection of indications for cyst extirpation.

High-quantum yield alloy-typed core/shell CdSeZnS/ZnS quantum dots for bio-applications

BackgroundQuantum dots (QDs) have been used as fluorophores in various imaging fields owing to their strong fluorescent intensity, high quantum yield (QY), and narrow emission bandwidth. However, the application of QDs to bio-imaging is limited because the QY of QDs decreases substantially during the surface modification step for bio-application.ResultsIn this study, we fabricated alloy-typed core/shell CdSeZnS/ZnS quantum dots (alloy QDs) that showed higher quantum yield and stability during the surface modification for hydrophilization compared with conventional CdSe/CdS/ZnS multilayer quantum dots (MQDs). The structure of the alloy QDs was confirmed using time-of-flight medium-energy ion scattering spectroscopy. The alloy QDs exhibited strong fluorescence and a high QY of 98.0%. After hydrophilic surface modification, the alloy QDs exhibited a QY of 84.7%, which is 1.5 times higher than that of MQDs. The QY was 77.8% after the alloy QDs were conjugated with folic acid (FA). Alloy QDs and MQDs, after conjugation with FA, were successfully used for targeting human KB cells. The alloy QDs exhibited a stronger fluorescence signal than MQD; these signals were retained in the popliteal lymph node area for 24 h.ConclusionThe alloy QDs maintained a higher QY in hydrophilization for biological applications than MQDs. And also, alloy QDs showed the potential as nanoprobes for highly sensitive bioimaging analysis.Graphical

A spreading roots sign: Characteristic sign of the preliminary stage of medial meniscus posterior root tear on magnetic resonance imaging

BackgroundMedial meniscus posterior root tears (MMPRTs) can result in the development of osteoarthritis or osteonecrosis. Clinical experience suggests that symptoms such as dull pain or discomfort in the popliteal area or the calf area, which are sometimes misdiagnosed as sciatic nerve pain, may precede impending rupture. We found that bone marrow edema emanating from the meniscal root on magnetic resonance imaging (MRI) scans—spreading roots sign—may indicate the preliminary stage of an MMPRT. The purpose of this study was to evaluate the efficacy of the spreading roots sign as an MMPRT-predictor. MethodsIn a retrospective study, we reviewed the chart data and MRI results of patients who had required surgery for an acute MMPRT. We grouped patients by whether or not they had reported the above-mentioned precursory symptoms prior to acute rupture (precursory symptom group/non-precursor group), and when possible, we examined MRI scans to identify with which events the appearance/disappearance of the spreading roots sign coincided. Sex, age, body mass index, bone mineral density, radiological parameters, and MRI parameters were compared between groups. ResultsData from 24 patients (precursory symptom group, n = 17 [70.8 %]; non-precursor group, n = 7 [29.2 %]) were included; data from 5 patients included MRI scans prior to acute rupture. There were no significant differences between precursory symptom and non-precursor groups, except for the ratio of the presence of the spreading roots sign (p = 0.005). The appearance of the spreading roots sign on MRI scans coincided with the onset of precursory symptoms, and its disappearance coincided with acute rupture and the appearance of other MRI signs typical of MMPRT (white meniscus/truncation/meniscal extrusion/giraffe neck signs). ConclusionsOur findings suggest that the spreading roots sign can be used as a unique precursory sign for MMPRT.