medial meniscal extrusion: detection, evaluation and clinical implications

This study used open MRI with flexion sagittal view and included 324 medial-type . 28. . However, studies on the exact relationship between alignment parameters and medial meniscus extrusion are limited. Medial meniscal extrusion: detection, evaluation and clinical implications. Medial meniscal extrusion: Detection, evaluation and clinical implications. meniscal extrusion is an imaging finding commonly observed in patients >50 years of age assessed for other knee pathology and hence is often overlooked. N Swamy, V Wadhwa, G Bajaj, A Chhabra, T Pandey. Other causes include large radial tear (>50% of meniscal width) and large complex tears (>1 cleavage plane through the meniscus). Medial meniscus extrusion (MME) is the decisive progressive factor for knee OA [ 3, 35 ]. Arthroscopic . J. Multimodality imaging appearances and implications of presence of . Medial meniscal extrusion: Detection, evaluation and clinical implications European Journal of Radiology, Vol. Varus malalignment increases loading of the medial tibiofemoral compartment during gait by increasing the external adduction moments (force toward the sagittal plane) acting on the . Eur J Radiol 2018; 102:115-124 [Google Scholar] 2. In this article, the authors illustrate the role of meniscus kinematics, and the identification and quantification of medial meniscal extrusion. All anatomical descriptions were clearly illustrated by MRI, arthroscopy, and/or drawings. Meniscal biology in health and disease. (38.) Swamy N, Wadhwa V, Bajaj G, Chhabra A, Pandey T. Medial meniscal extrusion: Detection, evaluation and clinical implications. Skeletal Radiol 2004; 33 (10) 569-574 ; 36 Krych AJ, Reardon PJ, Johnson NR. mme is the result of increased pressure and repetitive stresses that can severely weaken the meniscus tissue during the inflammatory process caused by osteoarthritis. Some authors have described palpable medial meniscal extrusion with varus force in extension in those with posterior medial root tears. The clinical problem. V Wadhwa, H Omar, K Coyner, M Khazzam, W Robertson, A Chhabra . . By Thomas Link. Magnetic resonance imaging (MRI) is the most powerful, accurate, noninvasive method for diagnosing meniscal tears.It is more accurate than physical examination and has influenced clinical practice and patient care by eliminating unnecessary diagnostic arthroscopies or by identifying an alternative diagnosis whose clinical presentation may mimic meniscal tears. Half of adults will experience knee pain at some point during their lives, resulting in approximately 4 million primary care office visits in the USA annually.1 The majority of these visits for knee pain evaluation are due to osteoarthritis (OA).2 As of 2015, it was estimated that 14 million people in the USA have symptomatic knee OA,3 and this number is expected to . Magee T. MR findings of meniscal extrusion correlated with arthroscopy. 2018;102:115-24. The medial meniscus is more frequently torn, partly because of this different shape but also because of its attachment to the medial collateral ligament, whereas the lateral is pulled out of the way of compression between femur and tibia by politeus. 48. Non-operative management of medial meniscus posterior horn root tears is associated with worsening arthritis and poor clinical outcome at 5-year follow-up. Normal meniscus has limited movement at its margin [ 34] to diffuse the load effectively based on the knee movement. Methods: Bajaj G, Chhabra A, Pandey T. Medial meniscal extrusion: detection, evaluation and clinical implications. 2 A common cause of meniscal extrusion is root tear. Conclusions: Meniscal tear and extrusion appear to be associated with progression of symptomatic knee osteoarthritis. (A) Medial meniscus in coronal images of proton-weighted MRI. Eur J Radiol. 2 , 3 The meniscal extrusion is caused by root tear, radial tear, and degeneration of the meniscus [ 12, 13, 14 ]. Proprioception After Knee Injury, Surgery and Rehabilitation. Similarly, a major difference was found between the presence of a medial meniscal extrusion and loss of medial compartment cartilage volume (-15.4 (4.1)% in the presence of extrusion v -4.5 (1.7 . Meniscal damage, meniscal extrusion, varus-valgus malalignment, and medial-lateral laxity are local factors that may be present in primary knee osteoarthritis . the lateral tubercle and just lateral to the anterior The posterior medial meniscal root is clearly visible cruciate ligament (ACL) insertion, with which it on 2 contiguous . Magnetic Resonance Imaging is not suitable for interpretation of meniscal status ten years after arthroscopic repair . Eur J Radiol. (A) Medial meniscus in coronal images of proton-weighted MRI. The decision to perform repair has improved clinical outcomes in many situations, although the healing rate is approximately 64% and the repair strength is roughly one-third of the native root strength, with meniscal extrusion being common. European Journal of Radiology, Vol. Knee Surg . Saarakkala S, Waris P, Waris V, Tarkiainen I, Karvanen E, Aarnio J, et al. Eur J Radiol 102:115-124 CrossRef Swamy N, Wadhwa V, Bajaj G, Chhabra A, Pandey T (2018) Medial meniscal extrusion: detection, evaluation and clinical implications. 36 pain Meniscal extrusion is defined when it extends beyond the medial margin of tibial plateau and osteophytes are excluded for determining the margin. All patients were symptomatic at the time of diagnosis. Eur J Radiol 2018; 102 . Eur. Abstract. Mean medial meniscal extrusion measured at US for a normal meniscus ( n = 36) was 0.8 mm when supine, increasing to 1.6 mm on weight-bearing. McMurray's test is sometimes used, though it has poor sensitivity. Magee T, Williams D. Detection of meniscal tears and marrow lesions using coronal MRI. Bin SI, Kim JM, Shin SJ. N Swamy, V Wadhwa, G Bajaj, A Chhabra, T Pandey. 102 An anatomic study on the attachment of the joint capsule to the tibia in the lateral side of the knee Swamy N, Wadhwa V, Bajaj G, Chhabra A, Pandey T (2018) Medial meniscal extrusion: detection, evaluation and clinical implications. 58, No. Swamy N, Wadhwa V, Bajaj G, Chhabra A, Pandey T. Medial meniscal extrusion: detection, evaluation and clinical implications. Article Google Scholar Crema MD, Guermazi A, Li L, Nogueira-Barbosa MH, Marra MD, Roemer FW, et al. All MRI scans were analyzed independently by 2 board-certified musculoskeletal radiologists. References; 1 Swamy N, Wadhwa V, Bajaj G, Chhabra A, Pandey T. Medial meniscal extrusion: detection, evaluation and clinical implications.Eur J Radiol 2018; 102: 115-124 ; 2 Bloecker K, Englund M, Wirth W. et al. Meniscal extrusion typically occurs in medial meniscus, [13] where the outer margin of the meniscal body is markedly located outside the tibial joint margin, and, typically 3 mm or more is considered as major. Medial meniscus (MM) extrusion determined by 2D MRI. Medial meniscus extrusion also plays a critical role in the in the development of OA. Medial meniscal extrusion: Detection, evaluation and clinical implications. J Orthop Surg Res 13(1):181 CrossRef Kim JH, Lee S, Ha DH, Lee SM, Jung K, Choi W (2018) The effects of graft shrinkage and extrusion on early clinical outcomes . 29 patients may have features consistent with meniscal tear, such as pain, swelling, clicking, effusion, joint line tenderness, or painful flexion on the involved side of the knee. In knees with medial compartment OA, combined meniscal and articular cartilage damage would account for detection of radiographic joint space loss and not meniscal extrusion only. CLINICAL IMPACT. Medial meniscal extrusion: detection, evaluation and clinical implications. This threshold could be used to standardize the diagnostic criterion of extrusion and to better characterize the risk for subsequent structural and symptomatic progression of knee osteoarthritis. 37: 2018: ISAKOS classification of meniscal tearsillustration on 2D and 3D isotropic spin echo MR imaging. 2018;102:115-24. Article PubMed Google Scholar Eckstein F, Burstein D, Link TM (2006) Quantitative MRI of cartilage and bone: degenerative changes in osteoarthritis. Swamy, N., Wadhwa, V., Bajaj, G., Chhabra, A., & Pandey, T. (2018). Zurck zum Zitat Kim JH, Lee S, Ha DH, Lee SM, Jung K, Choi W (2018) The effects of graft shrinkage and extrusion on early clinical outcomes after meniscal allograft transplantation. The medial and lateral menisci vary in size, attachments and load transmission, and the medial meniscus is more susceptible to injury. Both absolute extrusion (AE) and relative percentage of extrusion (RPE) were measured, and meniscal tear patterns were evaluated in the early stages of SONK (I and II). Results Sagittal image showing a ghost sign (arrow). Medial meniscal posterior root repair techniques have shown positive yet varied results in the literature. Surgical Treatment of Meniscal Extrusion: A Biomechanical Study on the Role of the Medial Meniscotibial Ligaments With Early Clinical Validation - George A. Paletta, David M. Crane, John Konicek, Marina Piepenbrink, Laurence D. Higgins, John D. Milner, Coen A. Wijdicks, 2020 Intended for healthcare professionals 0 Cart MENU Search Browse Journals In the lateral compartment, meniscal damage precedes tibial and femoral articular cartilage changes. As for the the meniscal root, thereby allowing us to more accu- lateral meniscus, the anterior root inserts in front of rately define both normal and pathologic anatomy. View in: PubMed Swamy's Networks Click the "See All" links for more information and interactive visualizations! Meta-analyses have shown it to have a pooled sensitivity and specificity for diagnosing meniscal injury of 91-93% and 81-88%, respectively, for medial meniscus tears and 76-79% and 93-95%, respectively, for lateral meniscus tears. While known risk factors for development of OA in the knee include abnormal tibial coronal alignment, obesity and female gender, PMMRTs have emerged in . The increasing rate of meniscus extrusion was studied by okazaki et al. 9, 12 although the results of most studies corroborate the hypothesis that mme is a risk factor for the development of osteoarthritis, there is no proven and accurate value that may Meniscus tears of the knee are among the most common orthopedic knee injury. Radial tears of the posterior horn of the medial meniscus. Table 1. The meniscus root attachment aids meniscal function by securing the meniscus in place and allowing for optimal shock-absorbing function in the knee. 7 October 2016 | Connective Tissue Research, Vol. Combined medial and lateral meniscal tears and isolated medial meniscal tears are common with chronic ACL tears (considered to be over 6 weeks after injury), and are felt to be the result of repetitive microtrauma associated with joint laxity. Swamy N, Wadhwa V, Bajaj G, Chhabra A, Pandey T. Medial meniscal extrusion: detection, evaluation and clinical implications. European Journal of Radiology 102, 115-124, 2018. Eur J Radiol. MR imaging characteristics and clinical symptoms related to displaced meniscal flap tears. 3-4. The medial and lateral menisci vary in size, attachments and load transmission, and the medial meniscus is more susceptible to injury. Arthrosc J Arthrosc Relat Surg. 2018 May; 102:115-124. Some combination of positive results from these physical examination maneuvers is present in 50-60% of meniscal root tears. Knee brace and knee exercise are quite helpful for meniscal tear patient and also are helpful to the knee injured patient. Between January 2005 and May 2007, 37 patients with this tear verified by magnetic resonance imaging (MRI) and osteoarthritis grade 1-2 by . Posterior horn medial meniscal root tear: the prequel. 2004;20:373-8. Posterior medial meniscus root tears (PMMRTs) make up a relatively notable proportion of all meniscus pathology and have been definitively linked to the progression of osteoarthritis (OA). Type II Medial Meniscus Root Repair With Peripheral Release for Addressing Meniscal Extrusion Influence of Medial Meniscus Bucket-Handle Repair in Setting of Anterior Cruciate Ligament Reconstruction on Tibiofemoral Contact Mechanics: A Biomechanical Study Clinical Outcomes of Inside-Out Meniscal Repair According to Anatomic Zone of the . Choi SH, Bae S, Ji SK, Chang MJ. The association of prevalent medial meniscal pathology with cartilage loss in the medial . Methods Twenty-four patients who underwent MM posterior root repair were retrospectively reviewed. Introduction. The rela- tionship between prevalent medial meniscal intrasu- bstance signal changes and incident medial meniscal tears in women over a 1-year period assessed with 3.0 T MRI. Radiol . Swamy N, Wadhwa V, Bajaj G, et al. Medial meniscal extrusion: Detection, evaluation and clinical implications European Journal of Radiology, Vol. The value of standard radiography is extremely limited for the assessment of meniscal injuries but may be indicated to obtain a . . It has been shown, that excessive meniscal extrusion is an indirect sign for radial tears as well as for meniscal root lesions [24, 29]. The cryopreserved . It is known that the meniscal extrusion results in a loss of the normal meniscal functions and an increase of the contact load at the joint surface [ 15, 16, 17, 18, 19 ]. Specifically, tears of the posterior root can result in abnormal meniscal extrusion leading to decreased function and progressive osteoarthritis. This review had shortly reviewed all concepts and management, and treatment on meniscus tear. The role of meniscal root pathology and radial meniscal tear in medial meniscal extrusion. The presence of medial meniscal extrusion has been described as having a high correlation with the presence of a posterior root tear (Fig. Zurck zum Zitat Swamy N, Wadhwa V, Bajaj G, Chhabra A, Pandey T (2018) Medial meniscal extrusion: detection, evaluation and clinical implications. Tears of the medial meniscus posterior root can lead to progressive arthritis, and its management has no consensus. To order printed copies, contact [email protected] Reviews and Commentary n State Imaging of Athletic Injuries . When the meniscal root tears, the meniscus is no longer held within the joint, possibly resulting in meniscal extrusion, which will render . Medial meniscal extrusion: detection, evaluation and clinical implications. Revision 1 size and position of the healthy meniscus, and its correlation with sex, height, weight, and bone area- a cross-sectional study. 102. Conclusions: Meniscal tear and extrusion appear to be associated with progression of symptomatic knee osteoarthritis. Eur J Radiol 102:115-124. 37: 2018: ISAKOS classification of meniscal tearsillustration on 2D and 3D isotropic spin echo MR imaging. While known risk factors for development of OA in the knee include abnormal tibial coronal alignment, obesity and female gender, PMMRTs have emerged in recent years as another significant driver of . The implication of the ability to visualize meniscal extrusions is that it enables more precise classification of knee pathology than is possible with plain radiographs and could permit sub-typing of KL3 phenotypes, which are poorly characterized on radiographs, as well as risk for incident radiographic knee OA and progression of cartilage loss . Ultrasound performed significantly better than radiography in the detection of medial and lateral femoral osteophytes (P < 0.001) and medial meniscal extrusion (P = 0.003) with excellent and good . Scrutinizing the cut-off for "pathological" meniscal body extrusion on knee MRI. 102 An anatomic study on the attachment of the joint capsule to the tibia in the lateral side of the knee Swamy N, Wadhwa V, Bajaj G, Chhabra A, Pandey T. Medial meniscal extrusion: detection, evaluation and clinical implications. Barrett GR. Skeletal Radiol 2011;40(8):1017-1023. 6 December 2017. Therefore, this study aimed to investigate this relationship in patients with knee OA. Svensson F, Felson DT, Turkiewicz A, et al. Radial meniscal displacement of > 3 mm is often considered as a cut-off value from physiologic to . . The dysfunction of the medial meniscus is recognized as an aggravating factor in knee OA affecting the medial compartment [].Although total meniscectomy has been shown to predispose to premature knee OA [], it remains to be elucidated how other factors, including medial meniscal subluxation (MMS), may impact the evolution and clinical presentation of the disease. MR imaging of the meniscus: review, current trends and clinical implications. By Frank Roemer. Medial meniscus transplants done concurrently with high tibial osteotomy had a cumulative survival rate of 83.3%. of medial meniscus posterior horn avulsion and repair on tibiofemoral contact area and peak contact pressure with . The main objective of this review was to present a synthesis of the current literature in order to provide a useful tool to clinician in radiologic analysis of the meniscus. The ESSKA consensus group proposed that APM in DML should only be considered after a proper standardized clinical and radiological evaluation and when the response to non-operative management has not been satisfactory . Mean intra- and interobserver reliability for cartilage damage, medial meniscal damage and osteophytes ranged from fair to good (0.55 and 0.34, 0.75 and 0.56, 0.73 and 0.60, respectively). Tears of the medial posterior meniscal root are not unusual in daily clinical practice, while tears of the lateral posterior root are less common and tears of the anterior meniscal root are extremely rare 9. Arthroscopy. Article Google Scholar Crema MD, Guermazi A, Li L, Nogueira-Barbosa MH, Marra MD, Roemer FW, et al. Arthroscopic pullout suture repair of posterior root tear of the medial meniscus: radiographic and clinical results with a 2-year follow-up. Posterior medial meniscus root tears (PMMRTs) make up a relatively notable proportion of all meniscus pathology and have been definitively linked to the progression of osteoarthritis (OA). Eur J Radiol. Swamy N, Wadhwa V, Bajaj G, Chhabra A, Pandey T. Medial meniscal extrusion: Detection, evaluation and clinical implications. which reviewed MRI of 33 patients who were diagnosed with medial meniscus posterior root tear and had done MRI twice at a mean interval of 48 days, the mean extrusion increased from 3.4 mm to 4.5 mm. V Wadhwa, H Omar, K Coyner, M Khazzam, W Robertson, A Chhabra . Similarly, a major difference was found between the presence of a medial meniscal extrusion and loss of medial compartment cartilage volume (-15.4 (4.1)% in the presence of extrusion v -4.5 (1.7)% with no extrusion; p0.001). Meniscal extrusion on MRI scan is defined as 3 mm of external displacement of the meniscus with respect to the central outer rim or edge of the tibial plateau quantified in the midcoronal plane for. Despite contemporary surgical treatments of posterior meniscus root tears, there is a low rate of healing and an incidence of residual meniscus extrusion approaching 30% . The injury can heal within months. With root tears, meniscal extrusion often occurs, and the transmission . European Journal of Radiology 102, 115-124, 2018. Meniscal root tears, less common than meniscal body tears and frequently unrecognized, are a subset of meniscal injuries that often result in significant knee joint disorders. AJR Am J Roent- genol 2004;183(5):1469 . 5,21,22 A normal, healthy meniscus will show low intensity on all imaging sequences. We previously described the results of 40 consecutive cryopreserved and 96 fresh-frozen irradiated medial and lateral meniscus transplants. The association of prevalent medial meniscal pathology with cartilage loss in the medial . Prospective evaluation of 1485 meniscal tear patterns in patients with stable . Serial magnetic resonance imaging (MRI) scans were reviewed for patients who showed evidence of medial meniscal extrusion and MMPRTs on at least 1 of 2 available MRI scans. We present a technique based on biomechanical . Therefore, meniscus instability both in anteroposterior and medial-lateral directions has a harmful influence on the cartilage. The images are ordered from highest to lowest cartilage area ratios at the medial . However, a recent report has shown an association between the medial tibial osteophyte width measured in Magnetic resonance imaging (MRI) T2 mapping and medial meniscus extrusion (MME), 5 one of the key pathologies in medial knee OA. Lee JH, Lim YJ, Kim KB, et al. Mean meniscal extrusion in subjects with mucoid degeneration ( n = 20) and those with meniscal tears ( n = 43) was 1.6 mm, increasing to 2.3 mm with weight bearing. Similarly, a major difference was found between the presence of a medial meniscal extrusion and loss of medial compartment cartilage volume (15.4 (4.1)% in the presence of extrusion v 4.5 (1.7)% with no extrusion; p<0.001). Surgery is rarely required only in most severe cases. 42, 45, 46, 53 A 100% follow-up was obtained in these prospective studies. 2009;25:951-8. Eur J Radiol 2018;102:115-24. et al. . Skeletal Radiology, 2014 . The MRI findings of meniscal root tear of the medial meniscus: emphasis on coronal, sagittal and axial images. This copy is for personal use only. Conclusions Using a standardised protocol, dichotomous and semiquantitative US scoring of pathological changes in knee OA can be reliable. The purpose of this study was to compare the medial meniscus (MM) degeneration, meniscus extrusion, and tibial joint inclination by using MRI to consider the pathogenesis of posterior root tear (PRT) in medial-type knee osteoarthritis (KOA) both with and without medial meniscus posterior root tear (MMPRT). [14-18] This can result in hoop strain failure under axial loading, leading to a condition biomechanically similar to a total meniscectomy. 7) Meniscal extrusion is defined as partial or total displacement of the meniscus from the tibial articular cartilage. The meniscus plays a significant role in overall knee biomechanics, including force transmission, load distribution, and stability. The images are ordered from highest to lowest cartilage area ratios at the medial . The volume of medial meniscus (MM) extrusion at 10 and 90 knee flexions using three-dimensional (3D) magnetic resonance imaging (MRI) and assessed relevant clinical outcomes at 1-year follow-up were evaluated. The aim of our study was to evaluate the effect of supervised exercise therapy on patients with medial meniscus posterior root tears. Medial meniscus (MM) extrusion determined by 2D MRI. 2018;102:115-24. Meniscal extrusion has gained interest in recent years and can be quantified by MRI or ultrasound [24, 28, 29]. Coronal T2-weighted image showing medial meniscus extrusion with left arthroscopic panel. 1, 2 Meniscal tears are one of the most common knee injuries, accounting for 12% to 14% of all orthopaedic presentations involving the knee.3, 4, 5 Meniscal root tears were first described in 1991 by Pagnani et al., 6 and meniscal root tears posteriorly constitute . PMID: 29685524. Pandey, T. Medial meniscal extrusion: Detection, evaluation and clinical implications. Figure 3. 6 Joint space width in the medial compartment is anatomically composed of the femoral cartilage, medial meniscus . 15 Tears of the medial meniscus in the setting of a chronic ACL tear are most often seen in the . Clinical Diagnosis and MRI Evaluation of Medial Meniscus Root Tears . Detection and quantification of meniscus extrusion is important given its association with underlying pathological processes and internal derangements such as cartilage loss, osteoarthritis and meniscal tears. Medial meniscus extrusion is considered significant if there is more than 3 mm of displacement with respect to the central margin of the medial tibial plateau. The objective of this study was to examine the association between preoperative meniscal extrusion of patients undergoing partial medial meniscectomy with clinical outco Diagnostic performance of knee ultrasonography for detecting degenerative changes of articular cartilage.

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