Top

Published in:

01-05-2020 | Magnetic Resonance Imaging | Review Article

Magnetic resonance imaging of the meniscal roots

Authors: Ban Sharif, Tanweer Ashraf, Asif Saifuddin

Published in: Skeletal Radiology | Issue 5/2020

Abstract

The meniscal roots and supporting structures anchor the menisci to the tibial plateau and resist hoop stress, thereby preventing radial displacement of the menisci and secondary degenerative tibiofemoral compartment changes that may occur if this is compromised. The anatomy of the four meniscal roots and their supporting structures on magnetic resonance imaging (MRI) will be outlined in this review article, as well as the imaging appearances of meniscal root–related pathology, namely meniscal root degeneration and tears, meniscal extrusion and tibial plateau cystic lesions.

Fox AJS, Wanivenhaus F, Burge AJ, Warren RF, Rodeo SA. The human meniscus: a review of anatomy, function, injury, and advances in treatment: the meniscus: anatomy, function, injury and treatment. Clin Anat. 2015;28(2):269–87.PubMedCrossRef

Andrews SHJ, Rattner JB, Abusara Z, Adesida A, Shrive NG, Ronsky JL. Tie-fibre structure and organization in the knee menisci. J Anat. 2014;224(5):531–7.PubMedPubMedCentralCrossRef

El-Khoury GY, Usta HY, Berger RA. Meniscotibial (coronary) ligament tears. Skelet Radiol. 1984;11(3):191–6.CrossRef

Brody JM, Lin HM, Hulstyn MJ, Tung GA. Lateral meniscus root tear and meniscus extrusion with anterior cruciate ligament tear. Radiology. 2006;239(3):805–10.PubMedCrossRef

Brody JM, Hulstyn MJ, Fleming BC, Tung GA. The meniscal roots: gross anatomic correlation with 3-T MRI findings. Am J Roentgenol. 2007;188(5):W446–50.CrossRef

Andrews SHJ, Rattner JB, Jamniczky HA, Shrive NG, Adesida AB. The structural and compositional transition of the meniscal roots into the fibrocartilage of the menisci. J Anat. 2015;226(2):169–74.PubMedPubMedCentralCrossRef

Choi C-J, Choi Y-J, Lee J-J, Choi C-H. Magnetic resonance imaging evidence of meniscal extrusion in medial meniscus posterior root tear. Arthrosc J Arthrosc Relat Surg. 2010;26(12):1602–6.CrossRef

De Smet AA. How I diagnose meniscal tears on knee MRI. Am J Roentgenol. 2012;199(3):481–99.CrossRef

Wang P, Zhang C-Z, Zhang D, Liu Q-Y, Zhong X-F, Yin Z-J, et al. The imaging features of the meniscal roots on isotropic 3D MRI in young asymptomatic volunteers. Medicine (Baltimore). 2018;97(18):e0624.CrossRef

10.

Berlet GC, Fowler PJ. The anterior horn of the medial meniscus. Am J Sports Med. 1998;26(4):540–3.PubMedCrossRef

11.

Nelson EW, LaPrade RF. The anterior intermeniscal ligament of the knee. An anatomic study. Am J Sports Med. 2000;28(1):74–6.PubMedCrossRef

12.

Cha J-G, Min K-D, Han J-K, Hong H-S, Park S-J, Park J-S, et al. Anomalous insertion of the medial meniscus into the anterior cruciate ligament: the MR appearance. Br J Radiol. 2008;81(961):20–4.PubMedCrossRef

13.

Rainio P, Sarimo J, Rantanen J, Alanen J, Orava S. Observation of anomalous insertion of the medial meniscus on the anterior cruciate ligament. Arthroscopy. 2002;18(2):E9.PubMedCrossRef

14.

Kim YM, Joo Y-B. Anteromedial meniscofemoral ligament of the anterior horn of the medial meniscus: clinical, magnetic resonance imaging, and arthroscopic features. Arthrosc J Arthrosc Relat Surg. 2018;34(5):1590–600.CrossRef

15.

You M-W, Park J, Park S, Jin W, Ryu K. Posterior root of lateral meniscus: the detailed anatomic description on 3T MRI. Acta Radiol. 2014;55(3):359–65.PubMedCrossRef

16.

Choi N-H, Yang B-S, Lee S-Y, Lee C-C, Lee C-Y, Victoroff BN. Comparison of the insertion of the posterior horn of the lateral meniscus: discoid versus non-discoid. Knee Surg Sports Traumatol Arthrosc. 2017;25(2):397–402.PubMedCrossRef

17.

Vahey TN, Bennett HT, Arrington LE, Shelbourne KD, Ng J. MR imaging of the knee: pseudo tear of the lateral meniscus caused by the meniscofemoral ligament. Am J Roentgenol. 1990;154(6):1237–9.CrossRef

18.

Park LS, Jacobson JA, Jamadar DA, Caoili E, Kalume-Brigido M, Wojtys E. Posterior horn lateral meniscal tears simulating meniscofemoral ligament attachment in the setting of ACL tear: MRI findings. Skelet Radiol. 2007;36(5):399–403.CrossRef

19.

Ebrecht J, Krasny A, Hartmann DM, Rückbeil MV, Ritz T, Prescher A. 3-Tesla MRI: beneficial visualization of the meniscofemoral ligaments? Knee. 2017;24(5):1090–8.PubMedCrossRef

20.

Röhrich S, Kainberger F, Hirtler L. Evaluation of age-dependent morphometrics of the meniscofemoral ligaments in reference to the posterior cruciate ligament in routine MRI. Eur Radiol. 2018;28(6):2369–79.PubMedPubMedCentralCrossRef

21.

Venkatanarasimha N, Kamath A, Mukherjee K, Kamath S. Potential pitfalls of a double PCL sign. Skelet Radiol. 2009;38(8):735–9.CrossRef

22.

Franke J, Mueckner K, Alt V, Schnettler R, Franke AP, Griewing S, et al. Anterior intermeniscal ligament: frequency in MRI studies and spatial relationship to the entry point for intramedullary tibial nailing related to the risk of iatrogenic violation. Eur J Trauma Emerg Surg [Internet]. 2018 Sep 29 [cited 2019 Sep 21]; Available from: http://link.springer.com/10.1007/s00068-018-1019-3

23.

Aydıngöz Ü, Kaya A, Atay AÖ, Öztürk HM, Doral NM. MR imaging of the anterior intermeniscal ligament: classification according to insertion sites. Eur Radiol. 2002;12(4):824–9.PubMedCrossRef

24.

Sanders TG, Linares RC, Lawhorn KW, Tirman PFJ, Houser C. Oblique meniscomeniscal ligament: another potential pitfall for a meniscal tear—anatomic description and appearance at MR imaging in three cases. Radiology. 1999;213(1):213–6.PubMedCrossRef

25.

Choi J-Y, Chang EY, Cunha GM, Tafur M, Statum S, Chung CB. Posterior medial meniscus root ligament lesions: MRI classification and associated findings. Am J Roentgenol. 2014s;203(6):1286–92.CrossRef

26.

Jones A, Houang M, Low R, Wood D. Medial meniscus posterior root attachment injury and degeneration: MRI findings. Australas Radiol. 2006;50(4):306–13.PubMedCrossRef

27.

Lerer DB, Umans HR, Hu MX, Jones MH. The role of meniscal root pathology and radial meniscal tear in medial meniscal extrusion. Skeletal Radiol. 2004 Oct [cited 2019 Jul 25];33(10). Available from: http://link.springer.com/10.1007/s00256-004-0761-2

28.

Allaire R, Muriuki M, Gilbertson L, Harner CD. Biomechanical consequences of a tear of the posterior root of the medial meniscus: similar to total meniscectomy. J Bone Jt Surg-Am Vol. 2008;90(9):1922–31.CrossRef

29.

Guermazi A, Hayashi D, Jarraya M, Roemer FW, Zhang Y, Niu J, et al. Medial posterior meniscal root tears are associated with development or worsening of medial tibiofemoral cartilage damage: the multicenter osteoarthritis study. Radiology. 2013;268(3):814–21.PubMedPubMedCentralCrossRef

30.

Shybut TB, Vega CE, Haddad J, Alexander JW, Gold JE, Noble PC, et al. Effect of lateral meniscal root tear on the stability of the anterior cruciate ligament–deficient knee. Am J Sports Med. 2015;43(4):905–11.PubMedCrossRef

31.

Frank JM, Moatshe G, Brady AW, Dornan GJ, Coggins A, Muckenhirn KJ, et al. Lateral meniscus posterior root and meniscofemoral ligaments as stabilizing structures in the ACL-deficient knee: a biomechanical study. Orthop J Sports Med. 2017;5(6):232596711769575.CrossRef

32.

Pache S, Aman ZS, Kennedy M, Nakama GY, Moatshe G, Ziegler C, et al. Meniscal root tears: current concepts review. Arch Bone Jt Surg. 2018;6(4):250–9.PubMedPubMedCentral

33.

LaPrade CM, Jansson KS, Dornan G, Smith SD, Wijdicks CA, LaPrade RF. Altered tibiofemoral contact mechanics due to lateral meniscus posterior horn root avulsions and radial tears can be restored with in situ pull-out suture repairs. J Bone Jt Surg. 2014;96(6):471–9.CrossRef

34.

Forkel P, Herbort M, Schulze M, Rosenbaum D, Kirstein L, Raschke M, et al. Biomechanical consequences of a posterior root tear of the lateral meniscus: stabilizing effect of the meniscofemoral ligament. Arch Orthop Trauma Surg. 2013;133(5):621–6.PubMedCrossRef

35.

Yildirim FB, Soyuncu Y, Oguz N, Aydin AT, Sindel M, Ustunel I. Anterior intermeniscal ligament: an ultrastructural study. Ann Anat Anat Anz Off Organ Anat Ges. 2007;189(5):510–4.

36.

De Smet AA, Blankenbaker DG, Kijowski R, Graf BK, Shinki K. MR diagnosis of posterior root tears of the lateral meniscus using arthroscopy as the reference standard. Am J Roentgenol. 2009;192(2):480–6.CrossRef

37.

Choi S-H, Bae S, Ji SK, Chang MJ. The MRI findings of meniscal root tear of the medial meniscus: emphasis on coronal, sagittal and axial images. Knee Surg Sports Traumatol Arthrosc. 2012;20(10):2098–103.PubMedCrossRef

38.

Matheny LM, Ockuly AC, Steadman JR, LaPrade RF. Posterior meniscus root tears: associated pathologies to assist as diagnostic tools. Knee Surg Sports Traumatol Arthrosc. 2015;23(10):3127–31.PubMedCrossRef

39.

Padalecki JR, Jansson KS, Smith SD, Dornan GJ, Pierce CM, Wijdicks CA, et al. Biomechanical consequences of a complete radial tear adjacent to the medial meniscus posterior root attachment site: in situ pull-out repair restores derangement of joint mechanics. Am J Sports Med. 2014;42(3):699–707.PubMedCrossRef

40.

LaPrade RF, Ho CP, James E, Crespo B, LaPrade CM, Matheny LM. Diagnostic accuracy of 3.0 T magnetic resonance imaging for the detection of meniscus posterior root pathology. Knee Surg Sports Traumatol Arthrosc. 2015;23(1):152–7.PubMedCrossRef

41.

LaPrade CM, James EW, Cram TR, Feagin JA, Engebretsen L, LaPrade RF. Meniscal root tears: a classification system based on tear morphology. Am J Sports Med. 2015;43(2):363–9.PubMedCrossRef

42.

Zheng J, Zhai W, Li Q, Jia Q, Lin D. A special tear pattern of anterior horn of the lateral meniscus: macerated tear. Nazarian A, editor. PLOS ONE. 2017 Jan 26;12(1):e0170710.

43.

Robertson DD, Armfield DR, Towers JD, Irrgang JJ, Maloney WJ, Harner CD. Meniscal root injury and spontaneous osteonecrosis of the knee: an observation. J Bone Joint Surg Br. 2009;91-B(2):190–5.CrossRef

44.

Krych AJ, Wu IT, Desai VS, Murthy NS, Collins MS, Saris DBF, et al. High rate of missed lateral meniscus posterior root tears on preoperative magnetic resonance imaging. Orthop J Sports Med. 2018;6(4):232596711876572.CrossRef

45.

Papalia R, Vasta S, Franceschi F, D’Adamio S, Maffulli N, Denaro V. Meniscal root tears: from basic science to ultimate surgery. Br Med Bull. 2013;106(1):91–115.PubMedCrossRef

46.

Hwang B-Y, Kim S-J, Lee S-W, Lee H-E, Lee C-K, Hunter DJ, et al. Risk factors for medial meniscus posterior root tear. Am J Sports Med. 2012;40(7):1606–10.PubMedCrossRef

47.

Ozkoc G, Circi E, Gonc U, Irgit K, Pourbagher A, Tandogan RN. Radial tears in the root of the posterior horn of the medial meniscus. Knee Surg Sports Traumatol Arthrosc. 2008;16(9):849–54.PubMedCrossRef

48.

Kim YJ, Kim JG, Chang SH, Shim JC, Kim SB, Lee MY. Posterior root tear of the medial meniscus in multiple knee ligament injuries. Knee. 2010;17(5):324–8.PubMedCrossRef

49.

Park DY, Min B-H, Choi BH, Kim YJ, Kim M, Suh-Kim H, et al. The degeneration of meniscus roots is accompanied by fibrocartilage formation, which may precede meniscus root tears in osteoarthritic knees. Am J Sports Med. 2015;43(12):3034–44.PubMedCrossRef

50.

Lee JH, Lim YJ, Kim KB, Kim KH, Song JH. Arthroscopic pullout suture repair of posterior root tear of the medial meniscus: radiographic and clinical results with a 2-year follow-up. Arthrosc J Arthrosc Relat Surg. 2009;25(9):951–8.CrossRef

51.

Lee DW, Ha JK, Kim JG. Medial meniscus posterior root tear: a comprehensive review. Knee Surg Relat Res. 2014;26(3):125–34.PubMedPubMedCentralCrossRef

52.

Habata T, Uematsu K, Hattori K, Takakura Y, Fujisawa Y. Clinical features of the posterior horn tear in the medial meniscus. Arch Orthop Trauma Surg. 2004;124(9):642–5.PubMedCrossRef

53.

Kim SB, Ha JK, Lee SW, Kim DW, Shim JC, Kim JG, et al. Medial meniscus root tear refixation: comparison of clinical, radiologic, and arthroscopic findings with medial meniscectomy. Arthrosc J Arthrosc Relat Surg. 2011;27(3):346–54.CrossRef

54.

Palisch AR, Winters RR, Willis MH, Bray CD, Shybut TB. Posterior root meniscal tears: preoperative, intraoperative, and postoperative imaging for transtibial pullout repair. RadioGraphics. 2016;36(6):1792–806.PubMedCrossRef

55.

Harper KW, Helms CA, Lambert HS, Higgins LD. Radial meniscal tears: significance, incidence, and MR appearance. AJR Am J Roentgenol. 2005;185(6):1429–34.PubMedCrossRef

56.

Furumatsu T, Fujii M, Kodama Y, Ozaki T. A giraffe neck sign of the medial meniscus: a characteristic finding of the medial meniscus posterior root tear on magnetic resonance imaging. J Orthop Sci. 2017;22(4):731–6.PubMedCrossRef

57.

Umans H, Morrison W, DiFelice GS, Vaidya N, Winalski CS. Posterior horn medial meniscal root tear: the prequel. Skelet Radiol. 2014;43(6):775–80.CrossRef

58.

Gray JC. Neural and vascular anatomy of the menisci of the human knee. J Orthop Sports Phys Ther. 1999;29(1):23–30.PubMedCrossRef

59.

Jeon S-W, Jung M, Choi CH, Kim S-G, Kim S-H. Factors related to meniscal extrusion and cartilage lesions in medial meniscus root tears. J Knee Surg. 2019;s-0039-1693708.

60.

Matava MJ, Kim Y-M. Tibial avulsion fracture of the posterior root of the medial meniscus in a skeletally-immature child — a case report. Knee. 2011;18(1):62–5.PubMedCrossRef

61.

Mohankumar R, Palisch A, Khan W, White LM, Morrison WB. Meniscal ossicle: posttraumatic origin and association with posterior meniscal root tears. Am J Roentgenol. 2014;203(5):1040–6.CrossRef

62.

Koo JH, Choi S-H, Lee SA, Wang JH. Comparison of medial and lateral meniscus root tears. Williams BO, editor. PLOS ONE. 2015;10(10):e0141021.

63.

Feucht MJ, Bigdon S, Bode G, Salzmann GM, Dovi-Akue D, Südkamp NP, et al. Associated tears of the lateral meniscus in anterior cruciate ligament injuries: risk factors for different tear patterns. J Orthop Surg. 2015;10(1):34.CrossRef

64.

Feucht MJ, Bigdon S, Mehl J, Bode G, Müller-Lantzsch C, Südkamp NP, et al. Risk factors for posterior lateral meniscus root tears in anterior cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc. 2015;23(1):140–5.PubMedCrossRef

65.

LaPrade CM, Smith SD, Rasmussen MT, Hamming MG, Wijdicks CA, Engebretsen L, et al. Consequences of tibial tunnel reaming on the meniscal roots during cruciate ligament reconstruction in a cadaveric model, part 2: the posterior cruciate ligament. Am J Sports Med. 2015;43(1):207–12.PubMedCrossRef

66.

Ellman MB, James EW, LaPrade CM, LaPrade RF. Anterior meniscus root avulsion following intramedullary nailing for a tibial shaft fracture. Knee Surg Sports Traumatol Arthrosc. 2015;23(4):1188–91.PubMedCrossRef

67.

Moon H-K, Koh Y-G, Kim Y-C, Park Y-S, Jo S-B, Kwon S-K. Prognostic factors of arthroscopic pull-out repair for a posterior root tear of the medial meniscus. Am J Sports Med. 2012;40(5):1138–43.PubMedCrossRef

68.

Kim J-H, Chung J-H, Lee D-H, Lee Y-S, Kim J-R, Ryu K-J. Arthroscopic suture anchor repair versus pullout suture repair in posterior root tear of the medial meniscus: a prospective comparison study. Arthrosc J Arthrosc Relat Surg. 2011;27(12):1644–53.CrossRef

69.

Bonasia DE, Pellegrino P, D’Amelio A, Cottino U, Rossi R. Meniscal root tear repair: why, when and how? Orthop Rev. 2015;7(2):5792.

70.

Bin S-I, Kim J-M, Shin S-J. Radial tears of the posterior horn of the medial meniscus. Arthrosc J Arthrosc Relat Surg. 2004;20(4):373–8.CrossRef

71.

Bhatia S, LaPrade CM, Ellman MB, LaPrade RF. Meniscal root tears: significance, diagnosis, and treatment. Am J Sports Med. 2014;42(12):3016–30.PubMedCrossRef

72.

Swamy N, Wadhwa V, Bajaj G, Chhabra A, Pandey T. Medial meniscal extrusion: detection, evaluation and clinical implications. Eur J Radiol. 2018;102:115–24.PubMedCrossRef

73.

Magee T. MR findings of meniscal extrusion correlated with arthroscopy. J Magn Reson Imaging. 2008;28(2):466–70.PubMedCrossRef

74.

Hein CN, Deperio JG, Ehrensberger MT, Marzo JM. Effects of medial meniscal posterior horn avulsion and repair on meniscal displacement. Knee. 2011;18(3):189–92.PubMedCrossRef

75.

Chung KS, Ha JK, Ra HJ, Kim JG. A meta-analysis of clinical and radiographic outcomes of posterior horn medial meniscus root repairs. Knee Surg Sports Traumatol Arthrosc. 2016;24(5):1455–68.PubMedCrossRef

76.

Lektrakul N, Skaf A, Yeh L, Roger B, Schweitzer M, Blasbalg R, et al. Pericruciate meniscal cysts arising from tears of the posterior horn of the medial meniscus: MR imaging features that simulate posterior cruciate ganglion cysts. Am J Roentgenol. 1999;172(6):1575–9.CrossRef

77.

England E, Wissman RD, Mehta K, Burch M, Kaiser A, Li T. Cysts of the anterior horn lateral meniscus and the ACL: is there a relationship? Skelet Radiol. 2015;44(3):369–73.CrossRef

78.

Didolkar MM, Vinson EN. Tibial plateau cysts at the meniscal root insertions: incidence and association. Duke Orthop J. 2011;1(1):45–9.CrossRef

79.

Son JY, Yoon YC, Jin W, Cha JG. The prevalence and characteristics of a subcortical cystic lesion at the subspinous region of the knee. Acta Radiol. 2018;59(1):97–104.PubMedCrossRef

Title: Magnetic resonance imaging of the meniscal roots
Authors: Ban Sharif
Tanweer Ashraf
Asif Saifuddin
Publication date: 01-05-2020
Publisher: Springer Berlin Heidelberg
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Published in: Skeletal Radiology / Issue 5/2020
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI: https://doi.org/10.1007/s00256-020-03374-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Magnetic resonance imaging of the meniscal roots

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 5/2020

Intra-articular steroid for adhesive capsulitis: does hydrodilatation give any additional benefit? A randomized control trial

Effects of intra-articular corticosteroid injections on lumbar trabecular density

Sonographically guided botulinum toxin injections in patients with neurogenic thoracic outlet syndrome: correlation with surgical outcomes

Bipartite medial cuneiform: magnetic resonance imaging findings and prevalence of this rare anatomical variant

Perfusion in bone marrow lesions assessed on DCE-MRI and its association with pain in knee osteoarthritis: a cross-sectional study

Single-source dual-energy computed tomography for the detection of bone marrow lesions: impact of iterative reconstruction and algorithms