Thursday, October 29, 2009

Meniscal Tears




Figure 1 – The menisci are located in the medial and lateral compartments of the knee. Their surfaces conform to the femoral and tibial contours. Both the medial meniscus and lateral meniscus have anterior and posterior bony attachment sites. Tears can result from trauma or degeneration. Common meniscal tear patterns (A, flap tear; B, radial tear; C, longitudinal tear) are shown. Collagen fiber bundles in the meniscus, which serve to absorb compressive loads, have a circumferential pattern, and radially oriented "tie fibers" provide structural rigidity (inset).


Figure 2 – This sagittal MRI scan depicts a grade 3 signal change within the medial meniscus (arrow) that is consistent with a tear.



Figure 3 – In this coronal MRI scan, a grade 3 signal change within the medial meniscus (arrow) consistent with a tear is shown.




Altered signals do not necessarily represent gross pathology (Table). In fact, abnormal signal has been found in up to 30% of asymptomatic patients who did not have a history of knee injury.6 A finding of solid meniscal tissue on 3 or more contiguous sagittal cuts suggests a diskoid meniscus. False-positive results occur more frequently than false-negative results, thus emphasizing the need for clinical correlation.






References1. Greis PE, Bardana DD, Holmstrom MC, Burks RT. Meniscal injury, I: basic science and evaluation. J Am Acad Orthop Surg. 2002;10:168-176.2. Klimkiewicz JJ, Shaffer B. Meniscal surgery 2002 update: indications and techniques for resection, repair, regeneration, and replacement. Arthroscopy. 2002;18:14-25.3. Fairbank TJ. Knee joint changes after meniscectomy. J Bone Joint Surg. 1948;30B:664-670.4. van Tienen TG, Hannink G, Buma P. Meniscus replacement using synthetic materials. Clin Sports Med. 2009;28:143-156.5. Arnoczky SP, McDevitt CA. The meniscus: structure, function, repair, and replacement. In: Buckwalter JA, Einhorn TA, Simon SR, eds. Orthopaedic Basic Science: Biology and Biomechanics of the Musculoskeletal System. 2nd ed. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2000:531-545.6. Rath E, Richmond JC. The menisci: basic science and advances in treatment. Br J Sports Med. 2000;34:252-257.7. Lo IK, Thornton G, Miniaci A, et al. Structure and function of diarthrodial joints. In: McGinty JB, ed. Operative Arthroscopy. 3rd ed. Philadelphia: Lippincott, Williams and Wilkins; 2003:41-126.8. Greis PE, Holmstrom MC, Bardana DD, Burks RT. Meniscal injury, II: management. J Am Acad Orthop Surg. 2002;10:177-187.9. Packer JD, Rodeo SA. Meniscal allograft transplantation. Clin Sports Med. 2009:28:259-283, viii.10. Andersson-Molina H, Karlsson H, Rockborn P. Arthroscopic partial and total meniscectomy: a long-term follow-up study with matched controls. Arthroscopy. 2002;18:183-189.11. Simon SR, Alaranta H, An KN, et al. Kinesiology. In: Buckwalter JA, Einhorn TA, Simon SR, eds. Orthopaedic Basic Science: Biology and Biomechanics of the Musculoskeletal System. 2nd ed. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2000:730-827. 12. Levy IM, Torzilli PA, Warren RF. The effect of medial meniscectomy on anterior-posterior motion of the knee. J Bone Joint Surg. 1982;64A:883-888.13. Levy IM, Torzilli PA, Gould JD, Warren RF. The effect of lateral meniscectomy on motion of the knee. J Bone Joint Surg. 1989;71A:401-406.14. Karachalios T, Hantes M, Zibis AH, et al. Diagnostic accuracy of a new clinical test (the Thessaly test) for early detection of meniscal tears. J Bone Joint Surg. 2005;87A:955-962.15. Ciliz D, Ciliz A, Elverici E, et al. Evaluation of post-operative menisci with MR arthrography and routine conventional MRI. Clin Imaging. 2008;32:212-219. 16. Miller GK. A prospective study comparing the accuracy of the clinical diagnosis of meniscus tear with magnetic resonance imaging and its effect on clinical outcome. Arthroscopy. 1996;12:406-413.

2 comments:

  1. Hello,
    Thank. It makes me feel great when I read all these stories. It helps me from hopelessness and make me more stronger to fly… thank… for everything.

    Meniscus surgery

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