四肢关节专用MRI对膝关节半月板桶柄样撕裂的诊断价值

目的探讨膝关节半月板桶柄样撕裂的MRI征象及其诊断价值。方法回顾分析膝关节半月板桶柄样撕裂23例,所有病例均经过四肢关节专用MRI检查并经关节镜证实。由2名有经验的放射科医师进行盲法阅片,记录并评价各征象的诊断价值。结果23例共见半月板桶柄样撕裂23个,其中发生于内侧半月板者16例(69.6%),外侧半月板者7例(30.4%)。出现领结消失征15例(65.2%),双前角征9例(39.1%),半月板翻转征3例(13.0%),髁间碎片征19例(82.6%),双后交叉韧带征7例(30.4%),后角比例失调征8例(34.8%)。序列试验显示各征象联合诊断时特异性明显提高,其中髁间碎片征和双后交叉韧带征联合的特异度达100%。结论MRI是半月板桶柄样撕裂理想的无创检查方法,有利于该疾病的术前诊断和手术计划制定。     

关节镜下修补半月板桶柄样撕裂的临床疗效分析

目的 探讨关节镜下修补半月板桶柄样撕裂的临床疗效.方法 关节镜下对61例63个桶柄样撕裂的半月板行修补手术,男38例,女23例;年龄16～47岁,平均27岁.内侧半月板后体部至前体部区域撕裂及外侧半月板胴肌腱前方区域撕裂采用标准的白内向外缝合技术;内侧半月板后角区域撕裂采用经两个后内侧入路的全关节内缝合技术;外侧半月板后角区域撕裂采用经前方关节镜入路的全关节内缝合技术.结果 61例63个半月板随访时间24～66个月,平均38个月.其中51例(53个半月板)行二次关节镜检.44个半月板(83%)完全愈合,5个半月板(9.4%)部分愈合,4个半月板(7.5%)不愈合.61例患者均进行临床评估,其中53例(87%)无临床症状,4例(6.5%)有部分临床症状,4例(6.5%)绞锁复发.总体评估:失效率为7.9%(5/63),成功率92.1%(包括完全愈合、部分愈合、无临床症状及部分临床症状者).结论 对于发生在红一红区或红一白区的半月板桶柄样撕裂,采用多种缝合技术进行牢靠的修补缝合,并且与前十字韧带重建同期进行,可以获得约92%的成功率.     

The relationship between intra-articular meniscal,chondral, and ACL lesions: finding from 1,774 knee arthroscopy patients and evaluation by gender

Knowing the relationship between diagnoses is important in knee arthroscopy in terms of defining possible treatment modalities preoperatively. The purpose of our study was to define the diagnoses made intraoperatively through knee arthroscopy and the relationships between them. We evaluated the results of knee arthroscopies performed over a 10-year period. The sites and sizes of chondral lesions, the existence of anterior cruciate ligament (ACL) injury, and the sites of meniscal lesions were noted for a total of 1,774 patients. The relationships between these lesions were evaluated statistically. Chondral lesions and posterior medial meniscal tears were predominant in females, whereas complete ACL tears were predominant in males. ACL tears were commonly accompanied by medial and lateral meniscal bucket-handle tears. In cases with advanced chondral lesions, medial and lateral posterior meniscal and lateral anterior meniscal tears were more common. According to our results, posterior tears of the medial menisci, medial and lateral femoral condyles, lateral tibial plateau type 3 or 4 cartilage lesions, and the rate of diagnostic arthroscopy were higher in females, while middle substance and bucket-handle tears of medial menisci and total rupture of the ACL were more common in males. ACL injuries were seen to coexist with medial or lateral menisci bucket-handle tears, with no relationship between the site or size of the chondral lesions. A relationship between medial and lateral meniscal tears and the site of femoral and tibial chondral surface lesions was detected.     

Repair of meniscal tears with the absorbable Clearfix screw: results after 1–3 years

Introduction Total meniscus resection usually leads to osteoarthritis of the knee joint. Preservation and refixation of the injured menisci are therefore of great clinical importance.Materials and methods The present study examines 40 meniscal injuries in 37 patients that were arthroscopically treated with Clearfix meniscal screws (Mitek, Norderstedt, Germany) in the period from August 1999 to December 2002. The mean patient age was 27.7 (range 16–62) years. Nine patients were female. A total of 24 patients (27 meniscal tears) also had an anterior cruciate ligament (ACL) lesion, and 5 patients had cartilage injuries. Twenty-two patients were treated within the first 2 weeks following the trauma, 10 patients within 8 weeks, and 5 patients after 8 weeks. The lesions were a bucket-handle tear of the medial meniscus in 11 cases and a bucket-handle tear of the lateral meniscus in 2 cases. The posterior horn of the medial meniscus was torn in 13 cases, and the pars intermedia in 3 cases. The posterior horn of the lateral meniscus was torn in 8 cases, and the pars intermedia in 3 cases. The mean tear length was 2.9 (±1.5) cm and was fixed with an average of 1.8 (±0.7) screws. In 7 cases, the anterior horn was treated with an additional meniscal suture. A total of 35 patients were examined after an average of 18 (range 7–45) months.Results In the event of a moderate outcome, MRI was performed as part of the follow-up investigation. The average Lysholm score was 93 (±7.4), the Tegner activity index was 6.3 (±2.0) before the accident and 5.8 (±2.0) at the follow-up, the Marshall knee score was 47 (±3.8). The VAS pain assessment was 1.6 (±1.3) and the VAS function assessment was 7.9 (±1.6). Of the 7 patients with a moderate result, 2 patients without additional ligament lesions suffered re-ruptures after 6 and 13 months, respectively. The other 5 patients with a moderate result each had multiple accompanying injuries or pre-existing damage to the affected knee joint.Conclusion The Clearfix screws achieved a clinical success rate of 82% in isolated meniscal tears in stable knee joints and a clinical success rate of 100% with additional ACL reconstruction. In view of the good clinical results and the simple procedure for use, the implant should be recommended for meniscal refixation.     

Meniscus repair: results of an arthroscopic technique

A prospective study of arthroscopically repaired peripheral meniscal tears in 24 patients (19 men and five women) was initiated in 1983. Two patients were lost to follow-up. Seventeen medial and five lateral tears were followed an average of 29 months (15-42 months) with 17 having clinically apparent healing (77%). Sixteen had ACL tears, 10 of which were stabilized. Thirteen of 16 stable knees healed their menisci (81%), whereas only 4 of 6 unstable knees had healed menisci (67%). Fifteen were acute tears repaired within 2 weeks of injury, and 7 were chronic tears. Four acutely repaired menisci failed. One lateral meniscus tore in the previously sutured site 12 months later, whereas 1 medial meniscus tore 24 months after repair in a new area associated with significant trauma. Repair of a longitudinal peripheral meniscal tear permits salvage of this structure in a high percentage of cases. No serious complications such as peroneal nerve or popliteal vascular damage occurred. Transient saphenous neuropraxia (22%) and posterior portal adhesions (9%) were temporary problems. The procedure is recommended only for the advanced arthroscopist, who is advised first to establish the anatomical relationships clearly by cadaver dissections.     

Both medial and lateral bucket-handle meniscus tears associated with chronic ACL injury: A rare presentation of triple-PCL sign

BackgroundSeveral types of meniscal tear could be presented in both acute and chronic anterior cruciate ligament injury. The incidence of bucket-handle meniscus tears can be up to 30% of the overall meniscus tears cases. The case of both compartment (medial and lateral) bucket-handle meniscus is rarely occurred.CaseA case of both medial and lateral bucket-handle meniscus tears was reported in a male of 21 years old. The patient also had a chronic anterior cruciate ligament injury. The magnetic resonance imaging also showed a rare presentation of the triple-PCL sign with the sagittal view. Arthroscopic surgery with a meniscus repair and anterior cruciate ligament reconstruction was performed on the patient.ConclusionsSeveral specific imaging signs including triple-PCL sign could be presented in a rare case of both medial and lateral bucket-handle meniscus tears. Recognition of this sign is important to have accurate preoperative diagnosis and proper treatment plan.     

Arthroscopic meniscal repair with two-year follow-up: a clinical review

The potential for healing of meniscal tissue has been historically underappreciated, but is currently more widely acknowledged. We have reviewed our experience with arthroscopic meniscal repair in 29 patients who had had a minimum of 2 years' follow-up. Between September 1983 and November 1986, 31 patients who had undergone arthroscopic meniscal repair with a minimum of 2-years' follow-up were identified. Of the 31 patients, 29 were available for additional follow-up. The patient population averaged 31 years of age, with 15 men and 14 women. Utilizing a closed arthroscopic cannulated technique, 16 lateral and 15 medial menisci were repaired. The majority of lesions were vertical bucket-handle tears involving the posterior horn and averaged 2.5 cm in length. Of the 31 tears, 29 were in the red-red or red-white zones. Clinical healing was present in 27 (87%) of the 31 repaired menisci. Nine patients underwent relook arthroscopy at which time healing was confirmed in eight, and a retear noted in one. Four reruptures occurred and the menisci required removal. Of the 29 patients, 16 had concomitant anterior cruciate ligament injuries ranging from partial tears to complete disruptions. Seven patients underwent immediate or delayed anterior cruciate ligament stabilization. Healing occurred in six of the seven patients whose anterior cruciate ligaments had been reconstructed. Among those patients with reruptures, chronic anterolateral rotatory instability was identified as a significant risk factor for rerupture. A complication rate of 13% was noted. Three patients underwent manipulation under anesthesia for postoperative ankylosis and one patient experienced a transient saphenous nerve neuropraxia.(ABSTRACT TRUNCATED AT 250 WORDS)     

Meniscus repair and transplantation techniques

Modern meniscal repair incorporates multiple techniques and adjunctive measures. The classic inside-out repair remains the gold standard and is most appropriate for a bucket-handle type tear of the medial or lateral meniscus. The all-inside technique has gained in popularity recently and has outcomes that approach those of the inside-out repair with decreased morbidity but increased cost. The choice of this technique is most appropriate for small tears requiring few sutures to repair. Outside-in repair can also be employed and is preferred for anterior horn tears. Surgeons may use a hybrid technique that incorporates all techniques in some challenging cases. Meniscal debridement is used for degenerative tears that are not amenable to repair. Meniscal transplantation is an option for symptomatic meniscal deficiency in young, active patients. This article discusses the technical considerations for meniscal debridement, repair, and transplantation.     

Meniscal Root Tears

Meniscus root tears are a specific type of meniscal injury that have gained attention over the past 5 years and have been reported to account for 10% to 21% of all meniscal tears, affecting nearly 100,000 patients annually. Meniscal root tears either are defined as an avulsion of the insertion of the meniscus attachment or complete radial tears that are located within 1 cm of the meniscus insertion. Biomechanical studies have demonstrated that meniscal root injuries interrupt the continuity of the circumferential fibers, and hence lead to failure of the normal meniscal function to convert axial loads into transverse hoop stresses. The most common presenting symptoms in meniscal root tears are posterior knee pain and joint line tenderness, especially with deep squatting.Another common symptom is a popping sound heard while participating in light activities such as ascending stairs or squatting. Magnetic resonance imaging signs of medial meniscus root tears include: (1) medial meniscal extrusion of ≥3 mm in a coronal section; (2) high signal indicating a disruption of the posterior meniscal root region in an axial view; and (3) a “ghost sign,” which is the absence of an identifiable meniscus in the sagittal plane, or increased signal replacing the normally dark meniscal tissue signal at the posterior root attachment. Active patients, regardless of age, should be referred early and considered for a meniscal root repair. Indications for a meniscal root repair include acute, traumatic root tears in patients with nearly normal or normal cartilage and chronic symptomatic root tears in young or middle-aged patients without significant preexisting osteoarthritis.Meniscal root repair has been demonstrated to have high satisfaction rates and superior outcomes to arthroscopic meniscectomy for root tears. To restore the function of the meniscus after medial meniscus root tears, a transosseous meniscal root repair technique is most commonly used. The advantage of this technique is the ability to reduce and fix the meniscal root to the broad anatomic footprint to maximize its healing potential. In addition, the transtibial tunnels may contribute to the release of biological factors that can enhance the healing of the meniscal root repair.     

Die arthroskopische Meniskusrefixation mit einem All-inside-Nahtsystem

OBJECTIVE: Application of an arthroscopic suture system to restore the form and function of the meniscus by adaptation of a longitudinal tear close to the base. INDICATIONS: Unstable longitudinal tears near the base of the meniscus, mainly in the posterior horn of the medial or lateral of the meniscus. Dislocated bucket-handle tears of the medial and lateral meniscus close to the base. CONTRAINDICATIONS: Poor tissue quality with fibrillated meniscal tissue. Meniscal tears in the avascular zone (zone I). Insufficient blood supply from the joint capsule and the base of the meniscus. Degenerative meniscal lesions. Anterior or posterior knee joint instability. Allergic reactions to nonresorbable suture material. SURGICAL TECHNIQUE: Standard anterior arthroscopic portals. Arthroscopic assessment of the meniscal tear using the probe. Revitalization of the tear margins and perforation of the meniscal base to induce bleeding. Adaptation of the tear margins and fixation with a suture-anchor system using an ipsilateral standard portal for tears in the posterior horn or by way of a contralateral standard portal for tears in the lateral horn. POSTOPERATIVE MANAGEMENT: Full weight bearing with the knee in extension in a knee immobilizer, relative to the pain threshold in the 1st postoperative week. Range of motion exercises without weight bearing from full extension to 90 degrees knee flexion (0/0/90). If simultaneous reconstruction of the anterior cruciate ligament (ACL) is being performed, rehabilitation protocols follow the principles for ACL reconstruction. RESULTS: Since the year 2000, meniscal tears in more than 300 patients have been repaired with the all-inside suture system. In the context of a multicenter study by ESSKA (European Society for Sports Medicine, Surgery and Arthroscopy) involving 20 patients, the result was evaluated by direct MRI arthrography (gadolinium). The suture bar anchors were generally not detectable, the incision channels produced a hypodense signal in the meniscus tissue. If re-rupture occurred, it was because the meniscus had pulled out of the suture loop. Cartilaginous lesions were not found. There were no complications related to the nonresorbable suture bar anchors.     

前十字韧带断裂继发半月板损害的临床研究

目的研究前十字韧带(anteriorcruciateligament,ACL)断裂对半月板的影响。方法回顾分析1984年12月～1999年12月间收治的419例ACL断裂患者半月板的损伤情况及其与软骨损伤的关系。结果外侧半月板的损伤率随病程增加无显著变化,而内侧半月板的损伤率随病程增加显著增加,由急性期的31.1%增至亚慢性期的48.2%(P<0.01),又增至慢性期的78.8%(P<0.001)。内侧半月板后角损伤率较前角高,差异有显著性意义(P<0.05)。损伤形态以纵裂最常见,随着病程的增加,半月板损伤也越发复杂。内侧半月板损伤患者的内髁软骨损伤的发生率要高于内侧半月板正常者的内髁软骨损伤发生率,但差异无显著性意义(P>0.05);而外侧半月板损伤患者的外髁软骨损伤的发生率却显著高于外侧半月板正常者,差异有非常显著性意义(P<0.01)。结论ACL断裂可伴发和继发半月板的损害,ACL断裂时伴发的多为外侧半月板的损伤,而继发的半月板损害却以内侧为重。内髁软骨损害主要由股胫关节前后向不稳、异常活动增加造成,而与内侧半月板的损伤关系不大。     

Zone-specific inside-out meniscal repair: technical limitations of repair of posterior horns of medial and lateral menisci

Arthroscopy was performed on 15 cadaveric knees to assess the technical limitations of a zone-specific inside-out meniscal repair system (Linvatec Zone Specific II; Linvatec Corp, Largo, Fla) for accessing the posterior regions of the menisci. In addition, this system was compared with an all-inside technique (Bionx Arrows; Bionx Implants Inc, Blue Bell, Pa). Linvatec meniscal sutures and Bionx Arrows were placed arthroscopically in both medial and lateral menisci in all 15 cadaveric knees before open dissection was performed to evaluate device placement. Results showed that the Linvatec sutures may not adequately access a longitudinal 16.1-mm region of the posterior horn of the medial meniscus that is accessible with Bionx Arrows. In addition, the zone-specific inside-out technique excluded a statistically significantly larger region of the posterior horns of both menisci. With the Linvatec sutures, placement was difficult in the most posterior 14.9 mm of the medial meniscus and 10.8 mm of the lateral meniscus; with the Bionx Arrows, placement was difficult in only the most posterior 6.1 mm of the medial meniscus (P = .004) and 5.3 mm of the lateral meniscus (P < .006).     

膝关节骨关节炎内侧半月板突出的临床意义

目的 探讨膝关节骨关节炎患者内侧半月板突出的病因及影响.方法 选取2011年1月至2012年3月诊断为膝关节退行性骨关节炎并经MRI确认有内侧半月板突出的60例患者为半月板突出组,无突出的60例为对照组.在MRI上测量内侧半月板突出距离、胫股角,分析突出组胫股角与突出距离的相关性,比较两组膝内翻、内侧半月板及胫股关节软骨损伤的发生率,分析内侧半月板突出对半月板损伤、膝内翻对半月板突出的影响.结果 突出组:半月板突出距离平均(8.30±1.79) mm;60例有膝内翻,胫股角平均179.0°±2.2°;内侧半月板损伤发生率:前角50.0％ (30/60),体部93.3％ (56/60),后角93.3％ (56/60);内侧半月板后角根部撕裂14例,发生率23.3％(14/60);胫股内侧关节软骨退变发生率:胫骨内侧平台100％(60/60),股骨内髁100％(60/60);胫股角与内侧半月板突出距离呈负相关.对照组:内侧半月板超出胫骨内侧平台边缘的距离平均(0.57±0.80) mm;4例膝内翻;内侧半月板损伤发生率:前角0,体部16.7％(10/60),后角70.0％ (42/60);无内侧半月板后角根部撕裂;胫股内侧关节软骨退变发生率:胫骨内侧平台26.7％(16/60),股骨内髁30.0％ (18/60).半月板突出组与对照组半月板损伤比值比为6.0、膝内翻例数比值比为15.0.半月板突出组内侧半月板各部位及胫股内侧关节软骨损伤的发生率和严重程度高于对照组.结论 膝内翻可能是内侧半月板突出的原因之一,内侧半月板突出显著增加半月板损伤的发生率,其对膝胫股内侧关节骨关节炎的发生、发展有重要影响.     

Prevalence of abnormal findings in magnetic resonance images of asymptomatic knees

 One hundred fifteen asymptomatic Japanese volunteers aged from 13 to 76 years were examined by magnetic resonance imaging (MRI) to evaluate age-related meniscal degeneration and to determine the prevalence of discoid menisci. Each meniscus was graded in the anterior and posterior portions according to intrameniscal MRI signals. Discoid meniscus was diagnosed if a bow-tie configuration was noted on three or more contiguous sagittal sections. Meniscal abnormalities on MRI became more prevalent with age in both men and women. The posterior horn of the medial meniscus showed a significantly higher prevalence of degeneration than other parts of the meniscus. Discoid menisci were noted in 15 subjects (13% prevalence), always representing the lateral meniscus. Subchondral changes were observed in 13 subjects more than 40 years old, mostly women, and were located in the medial compartment. These abnormalities were not correlated with severity of degeneration in the posterior portion of the medial meniscus. This study demonstrates considerable prevalence of meniscal abnormalities in asymptomatic Japanese subjects. Received: January 15, 2001 / Accepted: December 13, 2001     

膝关节半月板撕裂的磁共振表现

目的进一步认识膝关节半月板撕裂的磁共振成像(MRI)表现。方法回顾分析50例膝关节半月板撕裂的MRI资料,所有病例均经关节镜手术证实。采用永磁型MRI机,场强0.2T。结果50例半月板撕裂中,按照部位分类,半月板撕裂位于内侧半月板前角2例,内侧后角37例,外侧半月板前角5例,外侧后角3例,同时累及半月板前角、体部和后角者内侧2例,外侧1例。按照半月板撕裂的形式分为:水平撕裂8例;垂直撕裂4例;斜形撕裂26例;纵形撕裂3例;放射状撕裂4例;桶柄状撕裂2例;复杂撕裂3例。结论MRI能够清楚显示膝关节半月板撕裂的部位和形式,为临床治疗提供可靠的依据,是目前诊断半月板撕裂的最好的影像学检查方法。     

中老年膝内侧半月板后角放射裂的临床研究

目的讨论膝内侧半月板后角放射状撕裂的临床特点和关节镜下半月板部分切除术后的随访结果。方法自2000年6月至2006年6月对386例（418膝）关节镜下治疗的膝内侧半月板撕裂患者进行回顾性研究,其中后角放射状撕裂93膝（22．2％）,全部行半月板部分切除术。在详细的手术记录和关节镜图像资料基础上,分析患者术前体征、MRI结果、术中所见和术后Lysholm膝关节评分。结果中老年患者中膝内侧半月板后角放射状撕裂有较高的发生率,大多数患者表现出机械卡压或撞击症状,MRI很难发现这种撕裂,有特点的疼痛症状和物理检查有助于诊断。虽然大多数患者年龄较大,关节软骨已发生退变,但关节镜下半月板部分切除术后,症状会明显改善。结论膝内侧半月板放射状撕裂比较常见,但因为多数患者同时伴有骨关节炎症状,且MRI上假阴性率较高,诊断比较困难。在严格掌握手术指征下,关节镜下半月板部分切除术有助于改善症状。     

Femoro-tibial and menisco-tibial translation patterns in patients with unilateral anterior cruciate ligament deficiency--a potential cause of secondary meniscal tears.

OBJECTIVE: To analyze menisco-tibial and femoro-tibial translation patterns in healthy and ACL-deficient knees in different knee flexion angles under muscle activity. METHODS: The ACL-deficient and contralateral healthy knees of 10 patients were examined with an open MRI system at 30 degrees and 90 degrees of knee flexion, under isometric contraction of the extensors or flexor muscle groups. Translations between the tibia, the femoral condyles and the menisci were analyzed by three-dimensional image postprocessing. RESULTS: Posterior translation of the femur and menisci relative to the tibia occurred during knee flexion (30-90 degrees) in all knees. In ACL-deficient knees, posterior translation of the medial femoral condyle (+1.3 +/- 3.8 mm) was significantly larger than in healthy knee (-0.9 +/- 2.9 mm; p<0.05), while the translation pattern of the menisci was similar (med. meniscus 0.6 +/- 2.3 mm vs. 0.6 +/- 2.7 mm). Under isometric contraction of the extensors (relative to the flexor muscle group), an increased posterior position of the femur and menisci was observed at 30 degrees knee flexion, but not at 90 degrees. This applied to ACL-deficient and healthy knees. CONCLUSIONS: This study shows a significant increase of translation of the medial femoral condyle in ACL-deficient knees, whereas menisco-tibial translation remains almost unchanged. This difference in translation patterns indicates that the posterior horn of the medial meniscus might encounter shear, potentially explaining the high rate of secondary medial meniscal tears in patients with ACL-deficiency.     

Arthroscopic management of degenerative meniscus tears in patients with degenerative arthritis

Frequently, meniscal pathology accompanies degenerative changes affecting the articular surface of the knee. The attritional changes in the meniscus lead to fragmentation of the meniscus and a variety of tears, usually of the posterior horn of the medial meniscus. A prospective study of the results of arthroscopic partial meniscectomy in the presence of at least Outerbridge Grade III chondromalacia of the accompanying joint surface was performed between 1980 and 1984. Eighty-seven knees in 84 patients were studied. The mean age was 62 (29-84) years. The right knee was involved in 44 patients, and 47 were men. Preoperative radiographs demonstrated osteoarthritis in 53 patients. The medial meniscus was involved in 82, while the lateral meniscus was affected in nine knees. Four knees had involvement of both menisci. In 72 knees, the most frequent lesion was a tear of the posterior horn of the medial meniscus. The most frequent configuration of the tears was a flap in 42. The morbidity was small with the use of ambulatory aids being 10 +/- 13 (mean +/- SD) days. Subsequent surgery was performed on six knees consisting of two total knee arthroplasties, two upper-tibial osteotomies, one repeat arthroscopic meniscectomy, and one popliteal cyst excision. Two patients had poor results related to progression of their arthritis and one developed osteonecrosis. Five patients were unchanged from their preoperative status. Subchondral sclerosis or osteophytes on the preoperative radiographs correlated with 72% compared to 90% satisfactory results in the absence of these findings (p less than 0.03). Complications consisted of superficial thrombophlebitis in three, hemarthrosis in one, and superficial infection in one patient.(ABSTRACT TRUNCATED AT 250 WORDS)     

Diagnostics of degenerative meniscal tears at 3-Tesla MRI compared to arthroscopy as reference standard

Introduction The goal of this study was to evaluate the diagnostic performance of 3-Tesla MRI for the assessment of degenerative meniscal tears in clinical practice. Materials and methods In patients with chronic knee pain, a negative history of acute trauma and a mean age of 52 years, 3-Tesla MRI were performed a few days prior to arthroscopy. In 86 menisci, diagnostic values of 3-Tesla MRI for the detection of degenerative tears were evaluated using arthroscopy as reference standard. The MRI classification, for meniscus diagnostics, described by Crues was used. Results At arthroscopy, all tears identified (19 horizontal, 7 complex, 3 radial) were degenerative as confirmed by histological examination. MRI grade II lesions had a prevalence of 24% and a rate of 24% of missed tears, whereas grade I lesions were not associated with a torn meniscus at arthroscopy. For meniscal tears, (grade III) sensitivity and specificity of 3-Telsa MRI was 79 and 95% for both menisci, 86 and 100% for the medial meniscus, and 57 and 92% for the lateral meniscus. The best diagnostic performance was found for complex tears, horizontal tears showed relatively good results, poor results were documented for radial tears. Conclusion For the medial meniscus, where horizontal and complex tears were more prevalent, 3-Tesla MRI shows a higher accuracy than for the lateral meniscus. Particularly with regard to the medial meniscus, 3-Tesla MRI could be effectively used when a degenerative tear is suspected. Nevertheless, in regard to a remarkable number of false positive and false negative findings the diagnostic value of a 3-Tesla MRI investigation should not be overestimated.     

Editorial Commentary: Caveat Medicus—Beware of Meniscal Repair

Perform meniscal repair with care and beware! Because of the well-known adverse consequences of meniscectomy, especially in the lateral compartment, meniscal repair should be considered for every meniscal tear even if it requires pushing the envelope. Nevertheless, the surgeon must be keenly aware of neuromuscular risks associated with this technique. For the posterior horn of the lateral meniscus, extreme caution must be exercised, particularly in younger and presumably smaller female patients. When a surgeon is performing all-inside repair of the posterior horn of the lateral meniscus, a medial portal 1 cm medial to the patellar tendon is recommended for placement of sutures. In addition, he or she should limit the depth of penetration of all-inside needles and exercise extreme vigilance during and after surgery (checking for potential neurovascular injury in the recovery room).