Meniscal tears

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Meniscal tears

  1. 1. Menisci Dr / Hytham Nafady
  2. 2. Anatomy of the meniscus
  3. 3.   The posterior horn medial meniscus is larger than the anterior horn. Both horns of lateral meniscus are of the same size, but the posterior horn is slightly higher in position.
  4. 4. Signs of meniscal tear Abnormal signal Morphological changes Grade I Abnormal size Grade II Blunting of free edge Grade III Displacement of meniscal fragemnt Interrupted appearance
  5. 5. Abnormal mensicus signal
  6. 6. Normal meniscus Small meniscus Truncated free edge Displaced meniscal fragment
  7. 7. Types of meniscal tears according to plane of cleavage Meniscal tears Vertical Longitudinal Horizontal Radial
  8. 8. Horizontal tear  Is parallel to the tibial plateau and divide the meniscus into upper and lower segments.
  9. 9. Horizontal tear
  10. 10. Horizontal tear with parameniscal cyst
  11. 11. Longitudinal vertical tear  Is perpendicular to the tibial plateau & parallel to the long axis of the meniscus.
  12. 12. Longitudinal vertical tear
  13. 13. Longitudinal vertical tear
  14. 14. Peripheral longitudinal tear
  15. 15. Peripheral longitudinal tear
  16. 16. Radial tear  is perpendicular to the tibial plateau & perpendicular to the long axis of the meniscus.
  17. 17. Radial tear
  18. 18. Body radial tear
  19. 19. Full thickness body radial tear
  20. 20. Posterior horn radial tear
  21. 21. Meniscal extrusion
  22. 22. Displaced meniscal tears
  23. 23. Types of displaced meniscal tears according to the original plane of cleavage Displaced meniscal tears Vertical Displaced Longitudinal tear (bucket handle tear) Dislaced Horizontal tear (Flap tear) Displaced Radial tear (Parrot beak tear)
  24. 24. Types of displaced meniscal fragment according the direction of displaced fragment Displaced Displaced mensical fragment mensical fragment intercondylar intercondylar notch notch Mensico-capsular Mensico-capsular recesses recesses
  25. 25. MCL
  26. 26. Flap tear
  27. 27. Flap tear Biceps tendon LCL
  28. 28. Flap tear
  29. 29. Bucket handle tear
  30. 30. Normal bow tie appearnace of the meniscal body
  31. 31. Flipped variant of bucket handle tear
  32. 32. Double anterior horn sign
  33. 33. Parrot beak tear (radial oblique tear)
  34. 34. Meniscal tear pitfalls    Anatomical structures. Physiological changes. Arifacts.
  35. 35. Artifacts   Magic angle phenomenon. Truncation artifact.
  36. 36. Magic angle phenomenon 55
  37. 37. Closed MRI Open MRI
  38. 38. In closed MRI scanner, magic angle artifact can be found in one location: The up-sloping of the posterior horn lateral meniscus. in open, vertical field magnets, magic angle artifact will be found in two locations: 1) junction of anterior horn and body of meniscus and 2) junction of posterior horn and body of meniscus
  39. 39. Truncation artifact
  40. 40. How to avoid truncation artifact: Use acquisition matrix that is larger than 128 x 256 (i.e 192 x 256 or 256 x 256). Costs of increasing the matrix: Increased acquisition time. Decreased S/N ratio.
  41. 41. Anatomical structures        Anterior meniscal ligament. Oblique meniscal ligament. Meniscal root ligament. Meniscofemoral ligaments. Popliteus tendon. Semimembranosis tendon ACL insertion.
  42. 42. Anterior intermeniscal ligament
  43. 43. Meniscofemoral ligament
  44. 44. Popliteal tendon
  45. 45. Adjacent crossing fibers of the ACL  May give the anterior horn of lateral meniscus speckled appearance.
  46. 46. Oblique intermeniscal ligament
  47. 47. Oblique intermeniscal ligament Vs Bucket handle tear
  48. 48. Olique intermeniscal ligament
  49. 49. Semimembranosis tendon
  50. 50. Physilogical changes     Meniscal flounce. Vacuum phenomenon. Normal vascualrity. Meniscal ossicle
  51. 51. Meniscal flounce
  52. 52. Vacuum phenomenon Vacuum phenomenon is accumulation of nitrogen gas within the joint due to negative pressure
  53. 53. Meniscal ossicle
  54. 54. Normal vascularity

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