Arthroscopic repair for a flap tear of the posterior horn of the lateral meniscus adjacent to its tibial insertion

Purpose All-inside posterior horn lateral meniscal (PHLM) repair puts the popliteal neurovascular bundle (PVNB) at risk of injury by meniscal repair devices. The purpose of this study was to establish a safe zone of all-inside meniscal fixation in pediatric patients using MRI measurements between the popliteus tendon (PT) and popliteal neurovascular bundle (PNVB). We hypothesize that males and older age groups will have a larger distance between PT and PNVB. Methods Axial MRIs of 250 pediatric (5-16 yrs.) patients were retrospectively reviewed. Patients were grouped by age: group I (5-7yrs.): 61; II (8-10yrs.): 59; III (11-13yrs.): 60; IV (14-16yrs.): 70. At the level of the lateral meniscus, two lines starting at the lateral patella tendon border ending at the medial edge of the PT (D1) and the lateral edge of the PNVB (D2) were made on an axial knee MRI. D3 connected D1 to D2 at the meniscocapsular junction of the PHLM. D4 was derived geometrically, parallel and 8 mm anterior to D3 simulating the anterior edge of the PHLM. Results Analysis showed significant correlation between age and sex for D3 (p<0.0001). For D3, there were significant differences among all age groups, except between groups III and IV. Average (STD) D3 for age groups was: 14.1mm(3.1), 15.8(2.5), 17.0(3.3), 17.2(3.1). For D4, the average (STD) was: 11.9 mm(2.9); 13.9(2.5); 15.4(3.0); 15.2(2.9). There was significant difference in D3 and D4 in males versus females (17.6 vs 15.7 mm; p <0.001; 14.9 vs 13.2; p <0.001), particularly in III and IV (17.0 vs 13.8 and 16.8 vs 13.9). Conclusions This study provides normative data of the distance between popliteal neurovascular bundle and popliteus tendon at the meniscocapsular junction (D3) and anterior edge of the posterior horn lateral meniscus (D4) with the knee in full extension. Combined with previous studies showing the addition of knee flexion increases the distance between the meniscus and the neurovascular bundle, surgeons can use this data to improve safety of posterior horn lateral meniscus repair in pediatric patients.

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Evaluation of Meniscal Tissue after Meniscal Repair Using Ultrahigh Field MRI

The Journal of Knee Surgery ◽

10.1055/s-0040-1709135 ◽

2020 ◽

Author(s):

Beate Stelzeneder ◽

Bernhard Michael Trabauer ◽

Silke Aldrian ◽

David Stelzeneder ◽

Vladimir Juras ◽

...

Keyword(s):

T2 Mapping ◽

Lateral Meniscus ◽

Posterior Horn ◽

Anterior Horn ◽

7 Tesla ◽

Control Group ◽

White Zone ◽

Meniscal Tissue ◽

Lateral Posterior

AbstractThe study evaluates the meniscal tissue after primary meniscal suturing using 7-Tesla (T) magnetic resonance imaging with T2* mapping at 6 and 12 months after surgery to investigate the differences between repaired meniscal tissue and healthy meniscal tissue in the medial and lateral compartment. This prospective study included 11 patients (9m/2f) with a mean age of 30.6 years (standard deviation 9.0). Patients with a meniscal tear that was treated arthroscopically with meniscus suturing, using an all-inside technique, were included. All patients and seven healthy volunteers were imaged on a 7-T whole-body system. T2* mapping of the meniscus was applied on sagittal slices. Regions-of-interest were defined manually in the red and white zone of each medial and lateral meniscus to measure T2*-values. In the medial posterior and medial anterior horn similar T2*-values were measured in the red and white zone at 6- and 12-month follow-up. Compared with the control group higher T2*-values were found in the repaired medial meniscus. After 12-months T2*-values decreased to normal values in the anterior horn and remained elevated in the posterior horn. In the red zone of the lateral posterior horn a significant decrease in the T2*-values (from 8.2 milliseconds to 5.9 milliseconds) (p = 0.04), indicates successful repair; a tendency toward a decrease in the white zone between the 6 and 12 months follow-up was observed. In the red zone of the lateral anterior horn the T2*-values decreased significantly during follow-up and in the white zone of the lateral anterior horn T2*-values were comparable. In comparison to the control group higher T2*-values were measured at 6-months; however, the T2*-values showed comparable values in the repaired lateral meniscus after 12 months. The T2* mapping results of the current study indicated a better healing response of the red zone of the lateral posterior horn compared with the medial posterior horn.

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A case of meniscal ossicle in the posterior horn of the lateral meniscus

Arthroscopy and Orthopedic Sports Medicine ◽

10.14517/aosm15017 ◽

2016 ◽

Vol 3 (1) ◽

pp. 54-57 ◽

Cited By ~ 1

Author(s):

Seung-Suk Seo ◽

Jin-Hyeok Seo ◽

Dong-Wook Jung ◽

Do-Hun Kim

Keyword(s):

Lateral Meniscus ◽

Posterior Horn ◽

Meniscal Ossicle

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Arthroscopic repair of bucket-handle tears of the lateral meniscus

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-013-2764-9 ◽

2013 ◽

Vol 23 (1) ◽

pp. 205-210 ◽

Cited By ~ 25

Author(s):

Jin Hwan Ahn ◽

Kang-Il Kim ◽

Joon Ho Wang ◽

Bong Soo Kyung ◽

Min Chul Seo ◽

...

Keyword(s):

Lateral Meniscus ◽

Arthroscopic Repair ◽

Bucket Handle

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Nonoperative Management of an Extra-Articular Dislocation of the Posterior Horn of the Lateral Meniscus with Clinical and MRI Correlation: A Case Report

Clinical Journal of Sport Medicine ◽

10.1097/jsm.0b013e3181b20921 ◽

2009 ◽

Vol 19 (4) ◽

pp. 333-335

Author(s):

Daniel Hesse ◽

Jaskarndip Chahal ◽

Lawrence M White ◽

Daniel B Whelan

Keyword(s):

Case Report ◽

Nonoperative Management ◽

Lateral Meniscus ◽

Posterior Horn

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An 11-Year-Old Girl Presenting with Chronic Knee Pain: A Case Report with Diagnostic Dilemma

Acta Medica (Hradec Kralove Czech Republic) ◽

10.14712/18059694.2016.86 ◽

2010 ◽

Vol 53 (4) ◽

pp. 247-249

Author(s):

Muhammad Kamal Maj ◽

Abdul Halim Ar ◽

Syed A. Faisal ◽

Johan Ahmad ◽

Srijit Das

Keyword(s):

Lateral Meniscus ◽

Knee Extension ◽

Posterior Horn ◽

Discoid Meniscus ◽

Diagnostic Challenge ◽

Diagnostic Dilemma ◽

Chronic Knee Pain ◽

Sport Activities ◽

Partial Deficiency ◽

Joint Line Tenderness

Discoid meniscus is the commonest anatomical aberration of the knee joint, among rare cases such as bilateral separated lateral meniscus, accessory lateral meniscus, partial deficiency of the lateral meniscus and double-layered lateral meniscus. An 11-year- old girl presented with history of chronic pain in her right knee for the last 6 months. The problem disturbed her involvement in the sport activities at school. Clinical examination revealed a clicking sensation on knee extension with lateral joint line tenderness. Magnetic resonance imaging (MRI) of her right knee showed torn posterior horn of lateral meniscus. Arthroscopy examination revealed a discoid meniscus with absence posterior horn. Posterior horn deficient discoid meniscus is a rare form of a congenital meniscus anomaly. We as clinicians believe that the abnormal shaped meniscus may pose a diagnostic challenge clinically and radiologically. Presentation of this case may be beneficial for orthopaedicians in their daily clinical practice.

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Correlation Between CT Images of Lateral Plateau and Lateral Meniscus Injuries in Patients With Schatzker II Tibial Plateau Fractures：A Retrospective Study

10.21203/rs.3.rs-543373/v1 ◽

2021 ◽

Author(s):

Pu Ying ◽

Lei Zhu ◽

Wenge Ding ◽

Yue Xu ◽

Xiaowei Jiang ◽

...

Keyword(s):

Tibial Plateau ◽

Lateral Meniscus ◽

Ct Images ◽

Tibial Plateau Fractures ◽

Posterior Horn ◽

Operating Point ◽

Optimal Operating ◽

Meniscus Injury ◽

Lateral Plateau ◽

Meniscus Injuries

Abstract Background: There is a great deal of controversy on whether routine MRI examination is needed for fresh fractures while the vast majority of patients with tibial plateau fractures receive preoperative X-ray and CT examinations. The purpose of the study was to analyze the exact correlation between CT images of lateral plateau and lateral meniscus injuries in Schatzker II tibial plateau fractures. Methods: Two hundred and ninety-six Schatzker II tibial plateau fracture patients from August 2012 to January 2021 in two trauma centers were enrolled for the analysis. According to the actual situation during open reduction internal fixation (ORIF) and knee arthroscopic surgery, patients were divided into meniscus injury (including rupture, incarceration, etc.) and non-meniscus injury groups. By measuring the value of both lateral plateau depression (LPD) and lateral plateau widening (LPW) of lateral tibial plateau on the coronary CT images, the correlation of which and lateral meniscus injury was analyzed. Meanwhile, the relevant receiver operating characteristic (ROC) curve was drawn to evaluate the optimal operating point of these two indicators which could predict meniscus injury. Results: Meniscus injury group mainly showed injuries involving the mid-body and posterior horn of the meniscus (98.1%, 157/160). The average LPD was 13.2 ± 3.2 mm, while the average value of the group without meniscus injury was 9.4 ± 3.2 mm. The difference was statistically significant (P < 0.05). The average LPW was 8.0 ± 1.4 mm and 6.8 ± 1.6 mm in two groups with a significant difference (P < 0.05). The optimal operating point of LPD and LPW was 7.9 mm (sensitivity-95.0%, specificity-58.8%, area under the curve (AUC-0.818) and 7.5 mm (sensitivity-70.0%, specificity-70.6%, AUC-0.724), respectively. Conclusions: The mid-body and posterior horn of lateral meniscus injury is more likely to occur in patients who had Schatzker II tibial plateau fractures when LPD > 7.9 mm and/or LPW > 7.5 mm on CT manifestations and these findings will definitely provide guidance for orthopedic surgeons in treating such injuries. During the operation, more attention should be paid to the treatment of the meniscus and full consideration is needed be taken to situations such as meniscus rupture, incarceration and other possible fracture reduction difficulties, poor vertical line, etc., in order to achieve better surgical results.

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Study of reliability of meniscus damage signs using high intensity 1,5 tesla mri compared to the results of arthroscopic interventions in acute and obsolete knee injury

Reports of Vinnytsia National Medical University ◽

10.31393/reports-vnmedical-2020-24(3)-10 ◽

2020 ◽

Vol 24 (3) ◽

pp. 425-432

Author(s):

Y.O. Hrubar ◽

M.Y. Hrubar ◽

I.Y. Kuziv ◽

O. V. Kuziv

Keyword(s):

Knee Joint ◽

High Intensity ◽

Medial Meniscus ◽

Human Life ◽

Lateral Meniscus ◽

The Body ◽

Posterior Horn ◽

Anterior Horn ◽

Steady Increase ◽

Orthopedic Procedure

Annotation. Among the large joints, the knee joint is most often injured, which is due to the peculiarities of its structure and functional loads in the process of human life. The most common injuries are meniscus damages of the knee joint, that is the evidence of steady increase in the number of partial arthroscopic meniscectomies, which have become the most common orthopedic procedure. Diagnosis of meniscus damage is based on the results of clinical examination, sonography and MRI. Increasing the resolution of MRI machines, improving the technique of their implementation allows to improve the quality of diagnosis of meniscus ruptures and improve the results of surgical arthroscopic interventions on the knee joint. The aim of the study – to demonstrate the capabilities of high-intensity 1.5 Tesla MRI and to study the reliability of MRI signs of meniscus damage in comparison with the results of arthroscopic interventions in acute and chronic knee joint injury. The work is based on the results of MRI examinations and arthroscopic interventions of 247 patients with acute and chronic knee joint injuries aged 14 to 59 years. Medial meniscus damage was diagnosed in 206 (83.41%) patients. Lateral meniscus ruptures were diagnosed in 34 patients (13.76%). Simultaneous damage of both menisci was found in 7 (2.83%) patients. It was found that ruptures of the medial meniscus by location were: the root of the posterior horn of the medial meniscus in 4 (1.94%) patients, ruptures of the posterior horn in 82 (39.81%) patients. Injury of the posterior horn with the transition to the body of the meniscus was diagnosed in 117 (56.79%) patients. Anterior horn ruptures were detected in 3 (1.46%) patients. With ruptures of the lateral meniscus: damage of the root of the posterior horn of the lateral meniscus was found in 2 (5.88%) patients, damage of the posterior horn in 9 (26.47%) patients. Posterior horn rupture with transition to the body of the meniscus was diagnosed in 19 (55.89%) patients. Isolated ruptures of the anterior horn were found in 4 (11.76%) patients. Simultaneous damage to both menisci was found in 7 (2.83%) patients. 206 (83.40%) partial meniscectomies were performed during arthroscopic interventions and meniscus suturings were performed over 41 (16.60%) patients. In order to identify meniscus damage and their location during MRI knee joint investigations 21 pseudo-positive and 18 pseudo-negative cases of diagnosis were revealed. The sensitivity of MRI for defining damage and localization of meniscus rupture was 91,7%, specificity 92,6%, diagnostic accuracy 94,8%. Discrepancies in the evaluation of meniscal damage most often occurred in cases of their combined ruptures and degenerative changes in the menisci.

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