Tear Location Research Articles

Management of Acute Type A Aortic Dissection.

Management of Acute Type A Aortic Dissection.

Preoperative MRI Underestimates ACL Stump Length and Misclassifies Tear Location in 49% of Cases

Preoperative MRI Underestimates ACL Stump Length and Misclassifies Tear Location in 49% of Cases

MRI and US in Hamstring Sports Injury Assessment: Anatomy, Imaging Findings, and Mechanisms of Injury.

Most muscle tears occur in the lower extremities, especially in the hamstrings. The hamstring muscle complex consists of the semimembranosus (SM), semitendinosus (ST), and biceps femoris (BF) muscles. They originate from the ischial tuberosity, and while the BF inserts into the head of the fibula, the ST and SM muscles attach to the medial aspect of the tibia. The hamstrings are primarily hip extensors and knee flexors. Tears mostly occur during sport practice, particularly during forceful stretching or high-speed running, and typical sites are grouped and classified according to their location within the muscle anatomy. Sprint and stretching injuries typically affect the BF and SM, respectively. MRI and US are key complementary modalities for the diagnosis, treatment, and prognosis of hamstring injuries, as injury length, connective tissue involvement, and tear location determine evolution, recovery strategies, and return to play. ©RSNA, 2025.

ROLE OF MAGNETIC RESONANCE IMAGING IN THE DETECTION AND GRADING OF MENISCAL TEAR

Background: Meniscal tears are among the most frequently encountered knee injuries, often resulting from trauma or age-related degeneration. If left undiagnosed or untreated, they can significantly impair joint function and quality of life. Magnetic Resonance Imaging (MRI) has emerged as the gold standard for non-invasive assessment of meniscal pathology due to its superior ability to visualize soft tissue structures. It facilitates accurate tear localization, classification, and grading, all of which are essential for individualized treatment planning. Objective: To evaluate the diagnostic role of MRI in detecting and grading meniscal tears, and to correlate imaging findings with clinical symptoms. Methods: A four-month prospective cross-sectional study was conducted in the Radiology Department of a tertiary care hospital in Lahore. A total of 101 patients presenting with knee pain and clinical suspicion of meniscal injury were included. Patients with contraindications to MRI or prior knee surgeries were excluded. MRI scans were performed and interpreted to identify tear presence, grade (I–IV), and location (medial or lateral meniscus). Data analysis was carried out using SPSS version 25. Chi-square tests were applied to assess the correlation between imaging findings and clinical features such as pain and mechanical symptoms. Results: Out of 101 patients (mean age range: 25–65 years), 75 (74.3%) demonstrated meniscal tears on MRI. Among these, 44 (58.7%) involved the medial meniscus and 31 (41.3%) the lateral. The most prevalent tear grade was Grade III in 35 patients (34.7%), followed by Grade II in 30 (29.7%) and Grade I in 20 (19.8%). A significant association was observed between tear presence and symptoms of pain and mechanical dysfunction (p = 0.000). Conclusion: MRI proved to be a highly effective diagnostic tool for detecting meniscal tears and determining their severity. Its ability to correlate tear characteristics with clinical presentation supports its critical role in guiding therapeutic decisions.

Impact of primary entry tear locations on outcomes in acute type A aortic dissection

Few studies have explored the impact of different primary entry tear sites in acute type A aortic dissection. We aimed to evaluate the effect of the primary entry tear location on presentation, treatment, and outcome in this condition. We retrospectively reviewed acute type A aortic dissection repair surgical records at our institution (2004 and 2020) (n = 213). The patients were classified into the ascending aorta entry (As-E), aortic arch entry (Ar-E), and descending thoracic aorta or downstream entry (Dd-E) groups. The As-E group was the oldest (P < 0.01) and included the fewest males (P < 0.01). Pre-operative neurological complication rates were highest in As-E, 16%; Ar-E, 5%; and Dd-E, 0% (P = 0.03). Malperfusion syndrome rates were as follows: As-E, 10%; Ar-E, 2%; and Dd-E, 0% (P = 0.05). As-E was associated with the highest in-hospital mortality (As-E, 13%; Ar-E, 8%; Dd-E, 0%; P = 0.27). In-hospital mortality risk factors included pre-operative neurological complications, malperfusion syndrome, and concomitant procedures. Subanalysis revealed that ascending aortic entry was an independent risk factor for pre-operative acute neurological complications. The primary entry site may indirectly affect outcomes, by mediating the risks of pre-operative complications, which are linked to mortality.

Tear Location of Superficial Medial Collateral Ligament Tears: Validation of a Magnetic Resonance Imaging–Based Classification System

Background: The superficial medial collateral ligament (sMCL) is commonly injured, with treatment varying based on associated injuries, tear grade, and location. However, the prevalence of different tear locations and the predictors of tear types have not been studied. Purpose: To evaluate the interrater and intrarater reliability for a magnetic resonance imaging (MRI)–based sMCL classification system and assess the incidence of different tear types with its predictors. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective search in a single institution’s MRI database identified patients with acute, complete sMCL tears (≤30 days between injury and MRI) between January 2018 and December 2022. Exclusion criteria included previous ligamentous knee trauma/surgery, >30 days between injury and MRI, and partial sMCL tears. MRI scans were assessed by 3 independent raters using a predefined sMCL tear location system: type I (proximal 25%), type Ib (proximal femoral bony avulsion), type II (midsubstance, 25%-75%), type III (distal 25%), type IIIb (distal tibial bony avulsion), and type IIIs (Stener-like lesion). The intraclass correlation coefficient (ICC) was used to assess interobserver and intraobserver reliability for continuous data, whereas Fleiss and Cohen kappas were used for categorical data. Univariate and multivariate logistic regression assessed predictors of tear location. Results: The study included 239 patients (49% female; mean age, 38 ± 14 years; range, 13-75 years). The MRI-based sMCL classification system showed excellent interobserver reliability (0.960; 95% CI, 0.951-0.969) and excellent intraobserver reliability (evaluator 1: 0.969 (95% CI, 0.960-0.976); evaluator 2: 0.952 (95% CI, 0.915-0.973)). Type I sMCL tears were most common (65.4%), followed by type III (14.6%), type II (14.5%), type Ib (3.4%), and type IIIs (1.7%). Binary logistic regression identified medial meniscal tears (odds ratio [OR] 7.987; P = .034) and younger age (OR 0.916; P = .0001) as predictors for distal sMCL tears and older age as a predictor for proximal tears (OR 1.048; P = .001). Conclusion: This study validates an MRI-based sMCL classification system for locating high-grade sMCL tears with excellent reliability. Proximal tears were the most common (69%) and were significantly more prevalent with increasing age, whereas distal tears were more commonly seen with younger age and midbody medial meniscal tears. These findings may guide individualized treatment strategies and refine diagnostic protocols for patients with acute sMCL tears.

FP1.6 Influence of femoral and acetabular version on the type and location of labral tears among patients treated with hip arthroscopy

Abstract Introduction: Femoral and acetabular anteversion have been recognized as contributing factors to hip pain among patients with femoro-acetabular impingement (FAI). However, to what extend version abnormalities contribute to chondrolabral damage is unclear. Some suggest that combined low version is associated with better cartilage health and less synovitis. However, low femoral version reduces range of motion, leading to impingement with less flexion. Aims: This study aimed to assess differences in the location and type of labral tears in hips with different rotational morphology amongst patients treated with hip arthroscopy. Methods: This is a prospective consecutive cohort study of 314 hips who underwent hip arthroscopy at a tertiary referral center (age 34±10 years-old, 57% females) for FAI (78%), labral tear (17%) or dysplasia (5%). Patients underwent a computed tomography (CT) scan to measure acetabular and femoral version (using Reikeras technique; normal: 5°-20°). Alpha-angle was calculated and impingement index was calculated as the alpha-angle minus femoral version. Presence, type and location of labral tears was assessed intra-operatively using an acetabular clockface system. Results: There was no difference in central (p=0.4) or cranial (p=0.8) acetabular version between different locations of a labral tear. Femoral version was the highest among patients with a labral tear in zone 3 (12°±10°), compared to those with a labral tear in zone 2 (6±9°; p=0.002), or zone 4 (8±8°; p=0.08). Patients with combined cam and low femoral version were more likely to have a labral tear in zone 2 (51%) than zone 3 (28%) (p=0.009). Mean impingement index was 42±16. Patients with an intact labrum had a lower impingement index than those with a frayed (p=0.009), torn (p=0.048) and ossified labrum (p=0.019). Based on ROC analysis, impingement index &amp;gt;36 was associated with presence of a labral tear (sensitivity 64%, specificity 86%) (AUC 0.86±0.08; p&amp;lt;0.001). Conclusion: Femoral version has an influence on the presence and location of labral tears. The low femoral version contributes to anterior impingement in patients with FAI. The combination of low femoral version and presence of CAM morphology may reduce likelilood of labral pathology. Calculating the impingement index may help to consent patients prior to hip arthroscopy.

Biologic augmentation of meniscus repair: A scoping review.

The aim of this study was to carry out a scoping review to investigate the use of biologic augmentation strategies for arthroscopic meniscal repair. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews and Arksey and O'Malley frameworks were followed. The studies were obtained and screened, with inclusion criteria comprising clinical studies evaluating the biologic augmentation of arthroscopic meniscal repair, systematic reviews, opinion pieces, and consensus statements. Studies involving any biologic therapy were included and were not limited to geographical location, participant age group, or sex. Data were extracted and presented as a descriptive analysis and thematic summary. A total of 1135 studies were initially identified, and 125 met the inclusion criteria for this scoping review. Sixty-six (52.8%) of these studies were published in the last 5 years, and 50.4% (63) originated from the United States. Most of the evidence was either Level IV or V (87 articles, 69.6%). The most frequently studied biological augmentation technique was the use of platelet-rich plasma (58 articles, 46.4%). There is diverse use of biologic therapies for the augmentation of meniscal repairs without the presence of high-quality evidence to clearly define indications and usage. Further research priorities include defining which meniscal tear types and locations might benefit from specific biologic augmentation techniques, as well as outcome measures and diagnostic modalities to detect the success of these interventions. Level IV.

Current concepts on the surgical treatment of ramp, root, and radial meniscal tears

Background and Aims Meniscus tears are among the most common sports medicine knee injuries. Proper diagnosis and treatment of ramp, root, and radial meniscus tears is critical to ultimately help improve patient outcomes. Each type of meniscus tear has unique tear locations and patterns, requiring different surgical repair techniques and rehabilitation protocols. This narrative review aims to discuss the diagnosis, treatment, and rehabilitation for ramp, root, and radial tears. Materials and Methods A narrative review was conducted to explore current surgical treatment and protocols for these three types of meniscal tears. A search was conducted on PubMed for all relevant literature. Results As the literature advances, there is growing evidence demonstrating improved outcomes for patients undergoing meniscal repairs. Ramp tears are often repaired using inside-out or all-inside techniques, while root tears require a transtibial tunnel or an all-inside repair. Radial tears are repaired using an inside-out, all-inside, or transtibial tunnel repair. Having current concepts on these repair techniques allows for surgeons to remain updated on the best treatment options. Conclusions As the important roles of the menisci for both knee biomechanics and joint health are becoming more well known, there is a greater emphasis on meniscus repair. Ramp, root, and radial tears are three common meniscus tears, and all should be repaired when possible. Proper understanding of the meniscus anatomy, tear diagnosis, treatment techniques, and rehabilitation is critical to optimize patient outcomes.

Biomechanics of Meniscus Tears and Repair Techniques.

Treatment of meniscus injuries can have a substantial effect on the intra-articular biomechanics and long-term function of the knee. Meniscus repair has become a more favorable treatment option as prior studies have demonstrated a strong correlation between meniscal preservation and restoration of intra-articular contact pressure and decreased progression of arthritis. The goal of meniscus repair is to provide a stable load bearing construct to allow for meniscal healing. Repair constructs vary by tear pattern, tear location, and repair technique. The purpose of this review is to highlight the biomechanical strength of meniscus repair techniques for frequently encountered meniscus tears. Recent literature reports that meniscus tear type and location influence which repair technique would provide the most stable construct. Prior studies report that inside-out meniscus repair is the gold standard for longitudinal tears, but more recent literature on modern all-inside repair devices suggest improvements with all-inside devices. Radial tears repaired with vertical mattress rip stop sutures added to horizontal mattress repair sutures have less suture cut-out and improved stability. Root tears repaired with a locking suture configuration result in biomechanical strength similar to a native meniscus and addition of a centralization suture may further improve this construct. No single repair technique is superior to others across meniscus repair types. Surgeons need to thoroughly understand various tear patterns and be familiar with a variety of repair techniques in order to provide the most stable construct for meniscus repair.

Variation in Layer-Specific Tear Properties of the Human Aorta Along Its Length and Circumference: Implications for Spatial Susceptibility to Dissection Initiation.

Hemodynamic variations influence the location of entry tears in aortic dissection. This study investigates whether variations in tear strength across the human aorta contribute to these clinical manifestations. Circumferential and axial strips were collected from nine axial and two circumferential sites along each autopsied aorta, yielding 1188 samples (11 aortas × 18 sites × 2 directions × 3 layers per site). These samples underwent tear testing to assess tear strength and tear energy, constituting resistance to tear propagation. Adventitial tear parameters were significantly higher than those of the intima and media, with no significant differences between the latter two, supporting the observation that entry tears typically occur in the inner wall. Tear propagation angles were approximately 15 and 75 deg for circumferential and axial medial strips, and 30 and 45 deg for circumferential and axial strips of the intima and adventitia, with minimal variation along the aorta. These findings indicate that the media, and to a lesser extent the other layers, have higher resistance to axial tearing compared to circumferential tearing, aligning with the clinical observation of circumferentially directed tears. Intimal and adventitial tear parameters increased modestly along the aorta, while medial parameters varied less, explaining why entry tears rarely originate in the abdominal aorta. Tear parameters in inner and outer quadrants were similar at most axial locations, except for dissimilar tear propagation angles of the intima and adventitia in the proximal aorta (especially the arch), explaining why entry tears seldom involve the entire circumference.

Ascending aorta over-angulation is a risk factor for acute type A aortic dissection: evidence from advanced finite element simulations.

To assess whether ascending aorta over-angulation, a morphological feature recently found to be associated with acute type A aortic dissection, precedes dissection and how it affects wall stress distribution. A baseline finite element model, previously created by a neural network tool from end-diastolic computed tomography angiography measurements in 124 healthy subjects, was modified to simulate the over-angulation accompanying aortic elongation, obtaining paradigmatic models with different ascending angulations (ascending-arch angle 145°-110°). The models were discretized and embedded in a deformable continuum representing surrounding tissues, aortic wall anisotropy and nonlinearity were accounted for, pre-tensioning at diastolic pressures was applied and peak systolic stresses were computed. Then, from 15 patients' pre-dissection geometries, patient-specific finite element models of pre-dissection aorta were created through the same framework. The sites of maximum longitudinal stress were compared with the respective sites of dissection entry tear in post-dissection imaging. Paradigmatic models showed that progressive narrowing of the ascending-arch angle was associated with increasing longitudinal stress (becoming significant for angles <130°), whereas the impact on circumferential stress was less consistent. In pre-dissection patient-specific models, the ascending-arch angle was narrowed (113°±11°), and the region of peak longitudinal stresses corresponded to the entry tear location in the respective post-dissection computed tomography angiography. This study strongly supports the hypothesis that the ascending-arch angle, as quantifier of aorta over-angulation, can be a good predictor of aortic dissection, since its narrowing below 130° increases longitudinal wall stress, and the dissection entry tears develop in the aortic wall in areas of highest longitudinal stress.

Differences in the Association Between Medial Meniscus Tears and Focal Cartilage Lesions According to Tear Configuration

Background: There are no statistical analyses on the association between the configuration of medial meniscus tears and the location of focal cartilage lesions. Purpose: To investigate the association between the configuration of medial meniscus tears and focal cartilage lesions and analyze whether the location of medial meniscus tears corresponds with that of focal cartilage lesions. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The authors retrospectively evaluated the medical records of 317 patients with isolated medial meniscus tear who underwent arthroscopic surgery from January 2016 to December 2020. The configuration of the medial meniscus tear was determined based on the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification. Patients with flap, radial, and longitudinal tears were included in the vertical tear group. For subgroup analysis, vertical tears were divided into medial meniscus posterior root tears and remaining tears. The location of the medial meniscus tear was categorized as anterior, middle, or posterior according to the ISAKOS classification. The cartilage of the medial femoral condyle (MFC) and that of the medial tibial condyle (MTC) were divided into 6 and 4 zones, respectively, and the location of cartilage lesions on the MFC and MTC was evaluated by preoperative magnetic resonance imaging. Results: There was a higher incidence of focal cartilage lesions with vertical versus horizontal medial meniscus tears ( P &lt; .001). For middle and posterior vertical tears with focal cartilage lesions, there was a significant concordance in location between the tear and the lesion ( P &lt; .001). In a subgroup analysis of medial meniscus posterior root tears, there was significantly more discordance in location between the tear and the lesion with medial meniscus posterior root tears (23/26 tears; 88.5%) compared with the remaining vertical tears (60/177 tears; 33.9%) ( P &lt; .001); instead, the focal cartilage lesions were mainly distributed in the lateral anterior and central portions of both the MFC and MTC. Conclusion: Vertical tears of the medial meniscus were significantly associated with the presence of focal cartilage lesions, whereas horizontal tears were not. Additionally, middle and posterior vertical tears with focal cartilage lesions showed significant concordance in location between the tear and the lesion.

Endovascular Treatment Options for Chronic Dissections.

Endovascular Treatment Options for Chronic Dissections.

Medial meniscus ramp tears: State of the art.

Medial meniscus ramp tears: State of the art.

Relationship between humeral head translation, spur formations, and the locations of tendon tears in massive rotator cuff tears

ObjectiveThis study aimed to clarify the relationship between the directions of humeral head translation, the presence of acromial or coracoid spurs, and the locations of tendon tears in massive rotator cuff tears. Thirty shoulders from thirty patients with massive rotator cuff tears who underwent reverse shoulder arthroplasty were included. Preoperative 3DCT classified humeral head translation into three groups: minimal type, posterosuperior type, and anterosuperior type. The presence of acromial or coracoid spurs was also assessed. Preoperative MRI and intraoperative findings determined the torn tendons in each rotator cuff, along with ruptures of the anterior fascia covering the subscapularis or the long head of the biceps tendon (LHB). Relationships between humeral head translations, spur formations, and tendon tear locations were analyzed using chi-square tests and adjusted standardized residuals.ResultsAcromial spurs were more frequent in the posterosuperior type, while coracoid spurs, subscapularis tears, anterior fascia ruptures, and LHB ruptures were significantly associated with the anterosuperior type. Anterior fascia ruptures were significantly less frequent in the minimal type. Anterosuperior humeral head translation and coracoid spurs indicate subscapularis tears, anterior fascia ruptures, and LHB ruptures.

The Effect of Retinal Tear Location and Internal Tamponade on The Success of Pars Plana Vitrectomy in Patients with Uncomplicated Retinal Detachment.

Retinal detachment is an acute sight-threatening condition that requires immediate surgical intervention. The aim of this study is to compare the outcomes of pars plana vitrectomy (PPV) for uncomplicated rhegmatogenous retinal detachment (RRD) between the different types of gases used, the position, and the number of tears. This is aretrospective non-randomized comparative study of patients with uncomplicated RRD treated at the Department of Ophthalmology from March 2018 to April 2021 using PPV. Atotal of 494 evaluated eyes were included in the study. The anatomical success of the surgery was monitored with regard to the extent of retinal detachment, the number and position of tears, and the tamponade used. The success rate of retinal reattachment with asingle operation was 90.7% (448 eyes), and the final anatomical success rate was 100%. Avery weak paired relationship was found between the success of the surgery for tears in the 4-8 hours region and the 9-3 hours region (89.1% vs. 92%). Similarly, no significant differences were observed between procedures using SF6 and C3F8 gases for RRD with atear in the 4-8 hours region (success rate 93.4% for SF6 vs. 89.1% for C3F8). The average postoperative improvement of best corrected visual acuity was 29.6 ETDRS letters, and again of 15 letters was recorded in 55.1% (272 eyes). Overall, the complication rate was very low. PPV is asafe and effective method for treating RRD. Extensive experience with this method allows the use of short-acting tamponades in selected patients.

Medial and Lateral Meniscus Root Tear: Etiopathogenesis and Morphological Pattern in Indian Population.

This study aims to enhance our understanding of the morphological pattern, causes and pathogenesis of meniscal root injuries in the Indian population. Sixty-four patients with meniscus root tears were included in the study. The patients were categorized into two groups based on the location of the meniscus tear: Group 1 (n = 41) comprised patients with lateral meniscus root injury (LMRI), and Group 2 (n = 23) included patients with medial meniscus root injury (MMRI). Demographic and patient-specific data, such as age, gender, BMI, history of injury, and injury type, were recorded. All patients underwent surgical treatment, and intraoperative findings (chondral damage grade, type of root injury, associated ligamentous injuries) were documented. Meniscus root tears are further classified into 5 categories depending upon their morphological types. A minimum 12-month follow-up assessed functional outcomes using the Lysholm and IKDC knee scores. The mean age for MMRI and LMRI was 50.3years and 29.4years, respectively. In the MMRI group, 48% (11/23) were female compared to only 15% (6/41) in the LMRI group. The mean BMI in the MMRI and LMRI groups was 30.1 and 25.4, respectively. Nine patients in MMRI and 4 patients in LMRI group exhibited grade 3 or higher chondral damage. Type 2 meniscus root tear was most common type in both the groups (51% in MMRI vs. 74% in LMRI). Both LMRI and MMRI groups demonstrated significant improvement in functional outcomes. Medial meniscus root injuries predominantly occur in the elderly without a significant history of trauma, often associated with a high grade of medial femoral chondral damage, suggesting a degenerative etiology. In contrast, lateral meniscus root injuries tend to occur in younger patients with a notable history of knee injury, indicative of a traumatic etiology for LMRI.

Magnetic Resonance Imaging Is an Effective First-Line Noninvasive Tool for Meniscal Tear Detection: A Retrospective Comparative Analysis With Knee Arthroscopy.

Magnetic Resonance Imaging Is an Effective First-Line Noninvasive Tool for Meniscal Tear Detection: A Retrospective Comparative Analysis With Knee Arthroscopy.

Comparison of Revision and Redislocation Rates After First-Time Anterior Shoulder Instability Between Subluxators and Dislocators: A Midterm Outcome Study.

Anterior shoulder instability is a common pathology seen especially in young men and highly active patient populations. Subluxation is a commonly encountered clinical issue, yet little is known about the effects of first-time subluxation compared with dislocation on shoulder stability and clinical outcomes after surgical stabilization. To compare revision and redislocation rates as well as patient-reported outcomes (PROs) between subluxators and dislocators after a first-time anterior shoulder instability event. Cohort study; Level of evidence, 3. Included were patients who underwent operative intervention for a first-time anterior instability event between 2013 and 2020 at a single institution. Exclusion criteria were posterior/multidirectional instability, revision surgery, and recurrent instability. The main outcomes of interest were the rates of redislocation and revision. Demographics and surgical details were retrospectively collected. Instability was categorized as subluxation (no documentation of formal shoulder reduction) or dislocation (documented formal shoulder reduction). Labral tear location and size were determined from preoperative magnetic resonance imaging scans. PROs and return-to-sport, redislocation, and revision rates were collected from prospective survey data. A total of 256 patients (141 subluxators and 115 dislocators) were available for analysis. There were no significant differences in baseline demographics or preoperative physical examination findings. Rates of bony Bankart lesions were comparable, but Hill-Sachs lesions were more commonly present in dislocators compared with subluxators (88.7% vs 53.9%; P < .01). There were no group differences in labral tear size, incidence of concomitant posterior or superior labrum anterior-posterior tears, or number of anchors used. Rates of remplissage were comparable between groups. Prospectively collected survey data of 60 patients (35 subluxators, 25 dislocators) were collected at 6.4 and 7.1 years of follow-up, respectively. Rates of recurrent dislocation (11.8% vs 20.0%) and revision (8.8% vs 16.0%) were comparable between subluxators and dislocators, respectively. All PROs and return-to-sport rates were comparable between groups. Subluxators and dislocators may present with comparable rates of redislocation and revision surgery even at midterm follow-up. Both cohorts may further present with comparable injury characteristics and PROs. Given the findings, future prospective studies comparing outcomes of first-time instability events are needed.