scholarly journals Investigating the Chronology of Meniscus Root Tears: Do Medial Meniscus Posterior Root Tears Cause Extrusion or the Other Way Around?

2021 ◽  
Vol 9 (7_suppl4) ◽  
pp. 2325967121S0020
Author(s):  
Matthew LaPrade ◽  
Mario Hevesi ◽  
Ryan Wilbur ◽  
Bryant Song ◽  
Nicholas Rhodes ◽  
...  
Keyword(s):  
Medial Meniscus ◽  
Subsequent Development ◽  
Posterior Root ◽  
Meniscus Root ◽  
Before And After ◽  
Ligament Disruption ◽  
The Relationship ◽  
Meniscus Root Repair ◽  
Medial Meniscus Extrusion ◽  
Meniscus Extrusion

Objectives: Meniscus root tears are increasingly being recognized. Meniscus extrusion has previously been associated with medial root tears; however, the relationship between secondary meniscus restraints, such as the meniscotibial (MT) ligament, extrusion, and root tears has yet to be formally evaluated. The purpose of this study was to better understand the association between MT ligament competence, medial meniscus extrusion, and medial meniscus posterior root tears (MMPRT), as well as to determine the progression of meniscus extrusion over time. Methods: Serial MRI’s from our institution were reviewed for patients who showed evidence of medial meniscus extrusion and MMPRT on at least one of 2+ available MRI’s. All patients were symptomatic at the time of diagnosis. All MRI’s were analyzed independently by two board-certified musculoskeletal radiologists. MT ligament disruption, medial meniscus extrusion, and MMPRT presence was recorded for each MRI. The time between MRI’s, presence of insufficiency fractures, and Outerbridge classification for the medial femur and tibia were also evaluated. Results: 27 knees in 26 patients were included in this study, with a total of 63 MRI’s analyzed (21 knees with 2 MRI’s, 3 with 3 MRI’s, and 3 with 4 MRI’s). All patients demonstrated clear medial meniscus extrusion and meniscotibial ligament disruption prior to the subsequent development of MMPRTs (p < 0.001). Mean extrusion at the time of initial MRI was 3.3 ± 1.1 mm, and increased significantly to 5.5 ± 1.8 mm at the time of first imaging with an identified MMPRT (p < 0.001). The average time between initial MRI and the first identification of MMPRT on a later MRI was 1.7 ± 1.6 years. Conclusions: In a sample of 27 symptomatic knees with serial MRI’s both before and after MMPRT diagnosis, all patients demonstrated MT ligament disruption and associated meniscus extrusion prior to the development of subsequent medial meniscus root tears. These findings suggest that MT ligament disruption and medial meniscus extrusion represent early and predisposing events contributing to MMPRT. Therefore, this provides a possible explanation of why meniscus extrusion is not corrected with medial meniscus root repair.

scholarly journals Investigating the Chronology of Meniscus Root Tears: Do Medial Meniscus Posterior Root Tears Cause Extrusion or the Other Way Around?

2020 ◽  
Vol 8 (11) ◽  
pp. 232596712096136
Author(s):  
Aaron J. Krych ◽  
Matthew D. LaPrade ◽  
Mario Hevesi ◽  
Nicholas G. Rhodes ◽  
Adam C. Johnson ◽  
...  
Keyword(s):  
Medial Meniscus ◽  
Case Series ◽  
Subsequent Development ◽  
Posterior Root ◽  
Meniscal Extrusion ◽  
Level Of Evidence ◽  
Meniscus Root ◽  
Before And After ◽  
Mri Scans ◽  
Ligament Disruption

Background: Meniscus root tears are increasingly being recognized. Meniscal extrusion has previously been associated with medial root tears; however, the relationship between secondary meniscal restraints, such as the meniscotibial (MT) ligament, extrusion, and root tears has yet to be formally evaluated. Purpose: To better understand the association between MT ligament competence, medial meniscal extrusion, and medial meniscus posterior root tears (MMPRTs) as well as to determine the progression of meniscal extrusion over time. Study Design: Case series; Level of evidence, 4. Methods: 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. All patients were symptomatic at the time of diagnosis. All MRI scans were analyzed independently by 2 board-certified musculoskeletal radiologists. MT ligament disruption, medial meniscal extrusion, and MMPRTs were recorded for each MRI scan. The time between MRI scans, presence of insufficiency fractures, and Outerbridge classification for the medial femur and tibia were also evaluated. Results: Overall, 27 knees in 26 patients were included in this study, with a total of 63 MRI scans analyzed (21 knees with 2 MRI scans, 3 with 3 MRI scans, and 3 with 4 MRI scans). All patients demonstrated clear medial meniscal extrusion and MT ligament disruption before the subsequent development of MMPRTs ( P < .001). Mean extrusion at the time of initial MRI was 3.3 ± 1.1 mm and increased significantly to 5.5 ± 1.8 mm at the time of first imaging with an identified MMPRT ( P < .001). The mean time between initial MRI and the first identification of an MMPRT on later MRI was 1.7 ± 1.6 years. Conclusion: In a sample of 27 symptomatic knees with serial MRI scans both before and after an MMPRT diagnosis, all patients demonstrated MT ligament disruption and associated meniscal extrusion before the development of subsequent medial meniscus root tears. These findings suggest that MT ligament disruption and medial meniscal extrusion represent early and predisposing events contributing to MMPRTs. Therefore, this provides a possible explanation of why meniscal extrusion is not corrected with medial meniscus root repair.

scholarly journals Greater Medial Meniscus Extrusion Seen on Ultrasonography Indicates the Risk of Posterior Root Tear in Non-radiographic Knee Osteoarthritis Population

2021 ◽  
Author(s):  
Daisuke Chiba ◽  
Tomoyuki Sasaki ◽  
Yasuyuki Ishibashi
Keyword(s):  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Medial Meniscus ◽  
Roc Curves ◽  
Posterior Root ◽  
Root Tear ◽  
Cross Sectional ◽  
Posterior Root Tear ◽  
Medial Meniscus Extrusion ◽  
Meniscus Extrusion

Abstract Purpose: To elucidate the association between medial meniscus extrusion measured on ultrasonography (MMEUS) and the prevalence of medial meniscus posterior root tear detected on magnetic resonance imaging (MMPRTMRI). Methods: We recruited 127 patients (135 knees) in this cross-sectional study. All participants had medial knee pain without a knee trauma or surgery history. Knee osteoarthritis (KOA) severity was evaluated using Kellgren-Lawrence grade (KLG) scores. Patients with KLG scores 0-1 and ≥2 were classified in non-radiographic (non-ROA) and radiographic KOA (ROA) groups, respectively. MMEUS was measured with patients in the supine position. Based on T2*-weighted images, MMPRTMRI was defined as the presence of “Ghost meniscus sign” and “Creft/truncation sign”, indicating an abnormal high signal intensity of a disrupted posterior root. MMEUS was compared between MMPRT+ and MMPRT– patients using a non-paired t-test. Receiver operating characteristic (ROC) curves were used to determine the optimal cut-off MMEUS to predict MMPRT+.Results: The prevalence of MMPRT+ was 31.3% (25/80 knees) and 29.1% (16/55 knees) in the non-ROA and ROA groups. The MMEUS of MMPRT+ patients were significantly greater than that of MMPRT– patients in both the non-ROA (5.9±1.4 mm vs. 4.4±1.0 mm, P<0.001) and ROA (7.8±1.3 mm vs. 6.3±1.3 mm, P<0.001) groups. ROC curves demonstrated that 5-mm and 7-mm MMEUS were the optimal cut-off values in non-ROA (adjusted odds ratio: 6.280; area under the curve [AUC]: 0.809; P<0.001) and ROA (adjusted odds ratio: 15.003; AUC: 0.797; P=0.001) groups.Conclusions: In early non-radiographic KOA stages, a greater MMEUS was associated with a higher MMPRTMRI prevalence.Level of evidence: III, Cross-sectional cohort study

scholarly journals Relationship between medial meniscus extrusion and cartilage measurements in the knee by fully automatic three-dimensional MRI analysis

2020 ◽  
Author(s):  
Hayato Aoki ◽  
Nobutake Ozeki ◽  
Hisako Katano ◽  
Akinobu Hyodo ◽  
Yugo Miura ◽  
...  
Keyword(s):  
Medial Meniscus ◽  
Three Dimensional ◽  
Study Data ◽  
Cartilage Thickness ◽  
Similarity Coefficients ◽  
Tibial Cartilage ◽  
The Relationship ◽  
Medial Meniscus Extrusion ◽  
Meniscus Extrusion ◽  
And Cartilage

Abstract Background: We developed a fully automatic three-dimensional knee MRI analysis software that can quantify meniscus extrusion and cartilage measurements, including the projected cartilage area ratio (PCAR), which represents the ratio of the subject’s actual cartilage area to their ideal cartilage area. We also collected 3D MRI knee data from 561 volunteers (aged 30–79 years) from the “Kanagawa Knee Study.” Our purposes were to verify the accuracy of the software for automatic cartilage and meniscus segmentation using knee MRI and to examine the relationship between medial meniscus extrusion measurements and cartilage measurements from Kanagawa Knee Study data. Methods: We constructed a neural network for the software by randomly choosing 10 healthy volunteers and 103 patients with knee pain. We validated the algorithm by randomly selecting 108 of these 113 subjects for training, and determined Dice similarity coefficients from five other subjects. We constructed a neural network using all data (113 subjects) for training. Cartilage thickness, cartilage volume, and PCAR in the medial femoral, lateral femoral, medial tibial, and lateral tibial regions were quantified by using the trained software on Kanagawa Knee Study data and their relationship with subject height was investigated. We also quantified the medial meniscus coverage ratio (MMCR), defined as the ratio of the overlapping area between the medial meniscus area and the medial tibial cartilage area to the medial tibial cartilage area. Finally, we examined the relationship between MMCR and PCAR at middle central medial tibial (mcMT) subregion located in the center of nine subregions in the medial tibial cartilage. Results: Dice similarity coefficients for cartilage and meniscus were both approximately 0.9. The femoral and tibial cartilage thickness and volume at each region correlated with height, but PCAR did not correlate with height in most settings. PCAR at the mcMT was significantly correlated with MMCR. Conclusions: Our software showed high segmentation accuracy for the knee cartilage and meniscus. PCAR was more useful than cartilage thickness or volume since it was less affected by height. A relationship was observed between the medial tibial cartilage measurements and the medial meniscus extrusion measurement in our cross-sectional study.

scholarly journals Relationship between medial meniscus extrusion and cartilage measurements in the knee by fully automatic three-dimensional MRI analysis

2020 ◽  
Author(s):  
Hayato Aoki ◽  
Nobutake Ozeki ◽  
Hisako Katano ◽  
Akinobu Hyodo ◽  
Yugo Miura ◽  
...  
Keyword(s):  
Medial Meniscus ◽  
Three Dimensional ◽  
Cartilage Thickness ◽  
Similarity Coefficients ◽  
Tibial Cartilage ◽  
Fully Automatic ◽  
The Relationship ◽  
Medial Meniscus Extrusion ◽  
Meniscus Extrusion ◽  
And Cartilage

Abstract BackgroundWe developed a fully automatic three-dimensional knee MRI analysis software that can quantify meniscus extrusion and cartilage measurements, including the projected cartilage area ratio (PCAR), which represents the ratio of the subject’s actual cartilage area to their ideal cartilage area. We also collected 3D MRI knee data from 561 volunteers (aged 30–79 years) from the “Kanagawa Knee Study.” Our purposes were to verify the accuracy of the software for automatic cartilage and meniscus segmentation using knee MRI and to examine the relationship between medial meniscus extrusion measurements and cartilage measurements from Kanagawa Knee Study data.MethodsWe constructed a neural network for the software by randomly choosing 10 healthy volunteers and 103 patients with knee pain. We validated the algorithm by randomly selecting 108 of these 113 subjects for training, and determined Dice similarity coefficients from five other subjects. We constructed a neural network using all data (113 subjects) for training. Cartilage thickness, cartilage volume, and PCAR in the medial femoral, lateral femoral, medial tibial, and lateral tibial regions were quantified by using the trained software on Kanagawa Knee Study data and their relationship with subject height was investigated. We also quantified the medial meniscus coverage ratio (MMCR), defined as the ratio of the overlapping area between the medial meniscus area and the medial tibial cartilage area to the medial tibial cartilage area. Finally, we examined the relationship between MMCR and PCAR at middle central medial tibial (mcMT) subregion located in the center of nine subregions in the medial tibial cartilage.ResultsDice similarity coefficients for cartilage and meniscus were both approximately 0.9. The femoral and tibial cartilage thickness and volume at each region correlated with height, but PCAR did not correlate with height in most settings. PCAR at the mcMT was significantly correlated with MMCR.ConclusionsOur software showed high segmentation accuracy for the knee cartilage and meniscus. PCAR was more useful than cartilage thickness or volume since it was less affected by height. A relationship was observed between the medial tibial cartilage measurements and the medial meniscus extrusion measurement in our cross-sectional study.Trial registration: UMIN, UMIN000032826; 1 September 2018,https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000037299

scholarly journals Correlation between meniscal extrusion and symptom duration, alignment, and arthritic changes in medial meniscus posterior root tear: research article

2020 ◽  
Vol 32 (1) ◽  
Author(s):  
Dong Hwi Kim ◽  
Gwang Chul Lee ◽  
Hyun Hak Kim ◽  
Dong Hyuk Cha
Keyword(s):  
Medial Meniscus ◽  
Posterior Root ◽  
Root Tear ◽  
X Ray ◽  
Posterior Root Tear ◽  
Grade Ii ◽  
The Mean ◽  
Medial Meniscus Extrusion ◽  
Meniscus Extrusion ◽  
Grade Iii

Abstract Background Medial meniscus posterior root tear can result in medial meniscus extrusion. However, the severity of medial meniscus extrusion is different in each root tear patient. The purpose of this study was to identify the factors that contribute to the severity of medial meniscus extrusion with medial meniscus posterior root tear, such as duration of disease, the degree of arthritis—chondral wear, subchondral edema, osteophyte size, and Kellgren–Lawrence (K/L) grade—and mechanical alignment for appropriate treatment method. Methods From January 2009 to August 2014, we retrospectively analyzed magnetic resonance imaging (MRI) and simple x-ray of 99 patients with medial meniscus posterior root tear. The duration of the disease was identified through retrospective chart review. The severity of medial meniscus extrusion, the presence of subchondral edema, the degree of chondral wear, and the size of the osteophyte were measured on MRI. K/L grade was confirmed on simple x-ray, and the mechanical axis was measured on whole extremity radiographs. Statistical analysis was performed by using bivariate correlation analysis and one-way analysis of variance. Results The mean medial meniscus extrusion was 4.61 mm, and the mean duration of the disease was 15.52 months. The mean degree of chondral wear was 25.8%, and 63 out of 99 cases showed subchondral edema. The average alignment was 4.30 degrees, and the average size of the osteophyte was 1.48 mm. There were 40 cases (40.4%) with K/L grade I, 48 cases (48.5%) with grade II, 11 cases (11.1%) with grade III, and no cases with grade IV. In the group mean analysis between the K/L grade and the severity of medial meniscus extrusion, the average medial meniscus extrusions were 3.97 mm in grade I, 4.93 mm in grade II, and 5.59 mm in grade III. There was a statistical significance between the size of the osteophyte and the severity of medial meniscus extrusion (P = 0.000), K/L grade, and the severity of medial meniscus extrusion (P = 0.001). Conclusions The severity of medial meniscus extrusion with medial meniscus posterior horn root tear is associated with the size of the osteophyte and K/L grade.

scholarly journals Quantifying the differential functional behavior between the medial and lateral meniscus after posterior meniscus root tears

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259678
Author(s):  
Brian E. Walczak ◽  
Kyle Miller ◽  
Michael A. Behun ◽  
Lisa Sienkiewicz ◽  
Heather Hartwig Stokes ◽  
...  
Keyword(s):  
Axial Compression ◽  
Knee Flexion ◽  
Medial Meniscus ◽  
Lateral Meniscus ◽  
P Value ◽  
Posterior Root ◽  
Functional Responses ◽  
Meniscus Root ◽  
Functional Behavior ◽  
Meniscus Extrusion

Meniscus tears of the knee are among the most common orthopedic knee injury. Specifically, tears of the posterior root can result in abnormal meniscal extrusion leading to decreased function and progressive osteoarthritis. 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%, illustrating an inability to recapitulate native meniscus function. Here, we characterized the differential functional behavior of the medial and lateral meniscus during axial compression load and dynamic knee motion using a cadaveric model. We hypothesized essential differences in extrusion between the medial and lateral meniscus in response to axial compression and knee range of motion. We found no differences in the amount of meniscus extrusion between the medial and lateral meniscus with a competent posterior root (0.338mm vs. 0.235mm; p-value = 0.181). However, posterior root detachment resulted in a consistently increased meniscus extrusion for the medial meniscus compared to the lateral meniscus (2.233mm vs. 0.4705mm; p-value < 0.0001). Moreover, detachment of the posterior root of the medial meniscus resulted in an increase in extrusion at all angles of knee flexion and was most pronounced (4.00mm ± 1.26mm) at 30-degrees of knee flexion. In contrast, the maximum mean extrusion of the lateral meniscus was 1.65mm ± 0.97mm, occurring in full extension. Furthermore, only the medial meniscus extruded during dynamic knee flexion after posterior root detachment. Given the differential functional behaviors between the medial and lateral meniscus, these findings suggest that posterior root repair requires reducing overall meniscus extrusion and recapitulating the native functional responses specific to each meniscus.

scholarly journals Extrusion of the medial meniscus is a potential predisposing factor for post-arthroscopy osteonecrosis of the knee

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jun Yamaguchi ◽  
Kazunori Yasuda ◽  
Eiji Kondo ◽  
Takuma Kaibara ◽  
Daisuke Ueda ◽  
...  
Keyword(s):  
Medial Meniscus ◽  
Matched Control ◽  
Rare Condition ◽  
Control Group ◽  
Predisposing Factor ◽  
Before And After ◽  
Coronal Section ◽  
Magnetic Resonance Imaging Mri ◽  
The Relationship ◽  
Meniscus Extrusion

Abstract Background Post-arthroscopic osteonecrosis of the knee (PAONK) is a rare condition. No studies have analyzed the relationship between the meniscus extrusion and PAONK. The purpose of this retrospective study is to test a hypothesis that the degree of the medial meniscus (MM) extrusion might be significantly greater in the knees with PAONK than in the matched control knees both before and after the meniscectomy. Methods Ten knees with PAONK were detected out of a total of 876 knees which had undergone arthroscopic partial meniscectomy of the MM. Ten matched control knees were randomly selected out of the remaining 866 knees without PAONK. The clinical data of these 20 patients were retrospectively collected from the medical records. To evaluate the location of the menisci on the joint line, Extrusion width and Inner width were defined on a coronal section of magnetic resonance imaging (MRI). The intra- and inter-rater reliability was evaluated by calculating the intra- and inter-class coefficients. Statistical comparisons between the 2 groups were made using the 3 non-parametric tests. Results Before the meniscectomy, the Extrusion width of the MM (mean 4.7 ± 1.4 mm) was significantly greater than that (3.0 ± 1.3 mm) in the Control group (P = 0.0195). In the MRI taken in a range from 3 to 50 weeks after the meniscectomy, the Extrusion width of the MM (5.9 ± 1.1 mm) in the PAONK group was significantly greater than that (3.4 ± 1.4 mm) in the Control group (P = 0.0009), and the Inner width of the MM (0.6 ± 1.7 mm) in the PAONK group was significantly less than that (3.9 ± 1.0 mm) in the Control group (P = 0.0001). Conclusion A significant relationship was found between the degree of the MM extrusion and the onset of PAONK. This study suggested that the extrusion of the MM is a potential predisposing factor for PAONK.

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