Peripheral meniscal tears: MR findings after conservative treatment or arthroscopic repair.

Abstract

Follow-up knee magnetic resonance (MR) examinations were performed on 17 patients (18 menisci) with arthroscopically proved tears of the outer third of the meniscus who were treated either conservatively (six patients) or with surgical repair (11 patients). All patients satisfied accepted clinical orthopedic criteria for meniscal healing. MR examinations obtained 3-27 months after injury revealed persistent signal intensity (grade 3), unchanged from that seen on the preoperative study, in all 15 patients in whom both pre- and postoperative studies were obtained and in three of four menisci that were proved to be healed at second-look arthroscopy. It appears that grade 3 signal from both conservatively treated and repaired menisci may persist long after the tear has become asymptomatic and has presumably healed. The presence of such signal should not be interpreted as necessarily indicating meniscal retear in these patients. Persistent signal intensity at the site of previous injuries may account for some reported cases of disagreement between MR and arthroscopic findings.

Bone Contusions of the Posterior Lip of the Medial Tibial Plateau (Contrecoup Injury) and Associated Internal Derangements of the Knee at MR Imaging

“…The periphery of the meniscus and the meniscocapsular junction is well vascularized. Thus, injuries to these regions have a good chance of healing either spontaneously or with surgical repair at arthroscopy (19,20). If these lesions are unrecognized and patients continue unrestricted activity, the tears or the separation may propagate, leading to a free-floating, dysfunctional meniscus and to knee pain, locking, and instability.…”

Direct magnetic resonance arthrography

“…Although the study is considered to be more reliable than conventional MR imaging in the evaluation of osteochondral lesions, detection of loose bodies, and delineation of synovial plicae [47,52], it is usually used in the symptomatic postoperative knee to differentiate residual or recurrent meniscal tear from other causes of postoperative pain, such as ligamentous injury, articular cartilage lesions and loose bodies. While conventional MR imaging is valuable in the diagnosis of meniscal injuries in non-operated knees, it has been shown to be less reliable in the demonstration of recurrent or residual tears after meniscectomy or surgical repair [53][54][55]. Because the postoperative meniscus is decreased in size, irregular in contour and increased in signal intensity, standard criteria are less accurate for distinguishing healing tears in stable meniscal remnants from recurrent tears in unstable remnants [1].…”

Contribution of thin-slice (1 mm) axial proton density MR images for identification and classification of meniscal tears: correlative study with arthroscopy

“…Meniscal injuries may be associated with a history of twisting, squatting or cutting [9]. Abnormal shear forces that may occur as a result of knee compression-rotation are known to lead to meniscal damage [5].…”

“…Radial, horizontal or complex tears are generally not suitable for repair [7,8]. Meniscal tears over the peripheral and vascularised portion of the meniscus can heal owing to ingrowth of capillaries and may subsequently have an appearance similar to that of fibrocartilage [4,9]. The majority of small, acute tears may heal spontaneously and render arthroscopy unnecessary [4].…”