Meniscal tear

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Meniscal tears involve damage to the fibrocartilaginous menisci of the knee. They ~~comprehend~~are several types and can occur in an acute or chronic setting. Meniscal tears are best ~~evalauted~~evaluated with MRI.

Clinical presentation

Acute meniscal tears occur after rotatory trauma of the knee, whereas chronic degenerative meniscal tears often occur in the elderly after minimal rotatory trauma or stress on the knee.

Types

There are different types of meniscal tears. Identifying and accurately describing the type of meniscal tear can help the surgeon in patient education and planning of the surgical procedure.

~~Meniscal~~ Meniscal tear types include ¹:

Radiographic features

Plain film

On plain radiographs meniscal tears are not visible. In rare cases secondary signs can be seen, such as a soft tissue swelling next to the meniscus when a meniscal cyst is present ⁴. Only when associated with more complex injuries plain film may suggest a meniscal tear, e.g. arcuate sign, reverse Segond fracture, tibial plateau fracture.

MRI

With a sensitivity of 91~95% and a specificity of 81% for medial meniscal tears~~² ~~and~~~~ and a sensitivity of 76~85% and a specificity of 93% for lateral meniscal tears ^2,5, MRI is the modality of choice when a meniscal tear is suspected, with sagittal images being the most sensitive ⁵.

There are two basic MR characteristics of meniscal tears ⁵:

high intrameniscal signal extending to at least one (if not both) articular surfaces on two slices (do not have to be contiguous, e.g. sagittal and coronal slices)

distortion of the normal meniscal morphology

Each type of meniscal tear has its own characteristics on MRI, but in most cases the following can be seen ³:

T1: a hyperintense line in the meniscus can be seen, but it is difficult to differentiate between degeneration and meniscal tear on this sequence~~. In~~; in the case of a bucket-handle tear an empty groove can sometimes be seen.
T2 ~~SPAIR~~: hyperintense line in the meniscus, which indicates synovial fluid in the meniscus.

Associated features that are suggestive of a meniscal tear include ⁵:

tibial subchondral bone oedema
parameniscal cyst

Treatment and prognosis

Surgical arthroscopy is done in most of the cases. Meniscopexy or complete or partial meniscectomy can be performed, depending on the degree and type of meniscal tear.

Differential diagnosis

-<p><strong>Meniscal tears </strong>involve damage to the fibrocartilaginous menisci of the knee. They comprehend several types and can occur in an acute or chronic setting. Meniscal tears are best evalauted with MRI.</p><h4>Clinical presentation</h4><p>Acute meniscal tears occur after rotatory trauma of the knee whereas chronic degenerative meniscal tears often occur in the elderly after minimal rotatory trauma or stress on the knee.</p><h5>Types</h5><p>There are different types of meniscal tears. Identifying and accurately describing the type of meniscal tear can help the surgeon in patient education and planning of the surgical procedure.</p><p>Meniscal tear types include <sup>1</sup>:</p><ul>
+<p><strong>Meniscal tears </strong>involve damage to the fibrocartilaginous <a href="/articles/knee-menisci">menisci of the knee</a>. They are several types and can occur in an acute or chronic setting. Meniscal tears are best evaluated with MRI.</p><h4>Clinical presentation</h4><p>Acute meniscal tears occur after rotatory trauma of the knee, whereas chronic degenerative meniscal tears often occur in the elderly after minimal rotatory trauma or stress on the knee.</p><h5>Types</h5><p>There are different types of meniscal tears. Identifying and accurately describing the type of meniscal tear can help the surgeon in patient education and planning of the surgical procedure. Meniscal tear types include <sup>1</sup>:</p><ul>
~~-<li><a href="/articles/double-pcl-sign">bucket-handle tear</a></li>~~
-</ul><h4>Radiographic features</h4><h5>Plain film</h5><p>On plain radiographs meniscal tears are not visible. In rare cases secondary signs can be seen, such as a soft tissue swelling next to the meniscus when a <a href="/articles/meniscal-cyst">meniscal cyst </a>is present <sup>4</sup>. Only when associated with more complex injuries plain film may suggest a meniscal tear, e.g. <a href="/articles/arcuate-sign">arcuate sign</a>, <a href="/articles/reverse-segond-fracture">reverse Segond</a><a href="/articles/reverse-segond-fracture"> fracture</a>, <a href="/articles/tibial-plateau-fracture">tibial plateau</a> fracture. </p><h5>MRI</h5><p>With a sensitivity of 91% and a specificity of 81% for medial meniscal tears <sup>2</sup> and a sensitivity of 76% and a specificity of 93% for lateral meniscal tears <sup>2</sup>, MRI is the modality of choice when a meniscal tear is suspected. Each type of meniscal tear has its own characteristics on MRI, but in most cases the following can be seen <sup>3</sup>:</p><ul>
+<li><a title="bucket-handle tear" href="/articles/bucket-handle-tear">bucket-handle tear</a></li>
+</ul><h4>Radiographic features</h4><h5>Plain film</h5><p>On plain radiographs meniscal tears are not visible. In rare cases secondary signs can be seen, such as a soft tissue swelling next to the meniscus when a <a href="/articles/meniscal-cyst">meniscal cyst </a>is present <sup>4</sup>. Only when associated with more complex injuries plain film may suggest a meniscal tear, e.g. <a href="/articles/arcuate-sign">arcuate sign</a>, <a href="/articles/reverse-segond-fracture">reverse Segond</a><a href="/articles/reverse-segond-fracture"> fracture</a>, <a href="/articles/tibial-plateau-fracture">tibial plateau</a> fracture. </p><h5>MRI</h5><p>With a sensitivity of ~95% and a specificity of 81% for medial meniscal tears and a sensitivity of ~85% and a specificity of 93% for lateral meniscal tears <sup>2,5</sup>, MRI is the modality of choice when a meniscal tear is suspected, with sagittal images being the most sensitive <sup>5</sup>.</p><p>There are two basic MR characteristics of meniscal tears <sup>5</sup>:</p><ul>
+<li>high intrameniscal signal extending to at least one (if not both) articular surfaces on <a href="/articles/two-slice-touch-rule-1">two slices</a> (do not have to be contiguous, e.g. sagittal and coronal slices)</li>
+<li>distortion of the normal meniscal morphology</li>
+</ul><p>Each type of meniscal tear has its own characteristics on MRI, but in most cases the following can be seen <sup>3</sup>:</p><ul>
-<strong>T1:</strong> a hyperintense line in the meniscus can be seen, but it is difficult to differentiate between degeneration and meniscal tear on this sequence. In case of a bucket-handle tear an empty groove can sometimes be seen.</li>
+<strong>T1:</strong> a hyperintense line in the meniscus can be seen, but it is difficult to differentiate between degeneration and meniscal tear on this sequence; in the case of a bucket-handle tear an empty groove can sometimes be seen</li>
~~-<strong>T2 SPAIR: </strong> hyperintense line in the meniscus, which indicates synovial fluid in the meniscus.</li>~~
-</ul><h4>Treatment and prognosis</h4><p>Surgical arthroscopy is done in most of the cases. Meniscopexy or complete or partial meniscectomy can be performed, depending on the degree and type of meniscal tear.</p>
+<strong>T2: </strong> hyperintense line in the meniscus, which indicates synovial fluid in the meniscus</li>
+</ul><p>Associated features that are suggestive of a meniscal tear include <sup>5</sup>:</p><ul>
+<li>tibial subchondral bone oedema</li>
+<li><a href="/articles/meniscal-cyst">parameniscal cyst</a></li>
+</ul><h4>Treatment and prognosis</h4><p>Surgical arthroscopy is done in most of the cases. Meniscopexy or complete or partial meniscectomy can be performed, depending on the degree and type of meniscal tear.</p><h4>Differential diagnosis</h4><ul>
+<li><a title="meniscal degeneration" href="/articles/meniscal-degeneration">meniscal degeneration</a></li>
+<li><a href="/articles/meniscal-contusion">meniscal contusion</a></li>
+<li><a href="/articles/discoid-meniscus">discoid meniscus</a></li>
+<li>
+<a href="/articles/ring-meniscus">ring meniscus</a> (rare)</li>
+</ul>

References changed:

5. De Smet AA. How I diagnose meniscal tears on knee MRI. AJR Am J Roentgenol. 2012;199 (3): 481-99. <a href="http://dx.doi.org/10.2214/AJR.12.8663">doi:10.2214/AJR.12.8663</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/22915388">Pubmed citation</a><span class="auto"></span>

Tags changed:

orthopaediac
knee

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