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Knee, Meniscal Tears (MRI): Multimedia
Updated: Jan 26, 2009
Multimedia
 | Media file 1: Sagittal fat-saturated proton density–weighted image demonstrates the concave superior meniscal surface (arrows), which improves contact with the femoral epicondyles, and a flat undersurface, which improves contact with the tibial plateau. The periphery (outer edges) is thicker than the central portion (arrowhead), allowing for firm attachment to the joint capsule. Note the normal bow-tie appearance of the meniscal body. |
 | Media file 2: Coronal fat-saturated proton density–weighted image shows the relative size of the posterior horns of the medial and lateral menisci. The posterior horn of the medial meniscus (left arrow) is thicker than the posterior horn of the lateral meniscus (right arrow). Note the normal dark appearance (relative lack of signal intensity) in the menisci. The medial portion of the posterior horn of the lateral meniscus (ie, the meniscus on top of the fibula) is directed upward obliquely, from a lateral to medial direction. This is its normal course. |
 | Media file 3: Axial fat-saturated proton density–weighted image demonstrates the transverse (intermeniscal) ligament (arrows) connecting the anterior portions of the medial and lateral menisci. |
 | Media file 4: Coronal proton density–weighted image shows the intermeniscal ligament (arrow) connecting the anterior horns of the medial and lateral menisci. |
 | Media file 5: Coronal fat-saturated proton density–weighted image shows the popliteus recess containing joint fluid and located between the lateral aspect of the posterior horn of the lateral meniscus and the joint capsule. An extensive tear is present in the posterior horn of the medial meniscus (arrow). Note the normal oblique upward orientation of the posterior medial horn of the lateral meniscus. |
 | Media file 6: Coronal fat-saturated proton density–weighted image shows the dark appearing popliteus tendon (arrows) passing through the popliteus recess. The posterior medial horn of the lateral meniscus is directed obliquely upward. |
 | Media file 7: Sagittal proton density–weighted image of the lateral knee compartment. It shows the superior fascicle (arrow) attaching the posterior horn of the lateral meniscus with the joint capsule. Hyperintense (bright) fluid is present in the popliteus recess. The inferior fascicle is not yet visualized. |
 | Media file 8: Sagittal fat-saturated proton density–weighted image shows the inferior fascicle. In this location, the superior fascicle is not present. Note the normal bow-tie appearance of the meniscal body. |
 | Media file 9: Coronal proton density–weighted image shows the ligament of Wrisberg originating from the posterior medial horn of the medial meniscus and passing obliquely upwards (arrow) to attach to the posterolateral aspect of the medial femoral epicondyle. |
 | Media file 10: Coronal fat-saturated proton density–weighted image shows the popliteus tendon originating from an undulation of the lateral femoral condyle. From there, it passes through the popliteus recess to insert on the proximal posterior tibial metaphysis. A radial tear (arrow) is present in the posterior horn of the medical meniscus. |
 | Media file 11: Coronal proton density–weighted image posterior to the knee joint shows the normal junction of the popliteus tendon and muscle passing obliquely downwards to insert on the posterior tibial metaphysis. There is a tear to the conjoint tendon of the biceps muscle and lateral collateral ligament (LCL, arrow). |
 | Media file 12: Coronal proton density–weighted image of the popliteus tendon (outer arrows), which passes obliquely caudal, left to right, becoming the popliteus muscle (lower central arrow) and inserting on the proximal posterior metaphysis. |
 | Media file 13: Coronal fat-saturated proton density–weighted image of the mid knee shows the normal appearance of the body of the medial and lateral menisci. The apices (inner portions) are the thinnest part of the meniscus and are more central in the knee joint. The periphery, meniscal bases, outer portion (arrow and arrowhead) is the thickest part and contains the blood vessels supplying the meniscus. |
 | Media file 14: Coronal fat-saturated proton density–weighted image of the anterior knee shows the horizontal attachment of the anterior horn of the lateral meniscus (arrow) attaching near the intercondylar eminence. |
 | Media file 15: Coronal fat-saturated proton density–weighted image shows the attachment of the anterior horn of the lateral meniscus. In this patient, the anterior horn attachment is near the tibial attachment of the anterior cruciate ligament (ACL, arrow). |
 | Media file 16: Sagittal fat-saturated proton density–weighted image of the lateral compartment shows the relative equal size of the anterior and posterior horns of the lateral meniscus. The meniscal body has the normal configuration of a bow tie. |
 | Media file 17: Sagittal fat-saturated proton density–weighted image of the medial compartment shows the larger posterior horn (arrowhead) and the smaller anterior horn. |
 | Media file 18: Sagittal proton density–weighted image of the medial compartment. The thin apex of the meniscal body connects the large anterior and posterior horns at this level, giving the appearance of a bow-tie configuration (arrow). |
 | Media file 19: Sagittal proton density–weighted shows a small amount of abnormal signal intensity in the anterior horn of the medial meniscus (arrow). This represents a grade 1 change in signal intensity. |
 | Media file 20: Coronal proton density–weighted image shows extensive grade 2 signal intensity in the anterior and posterior horns of the medial meniscus. However, the signal intensity does not extend to a joint surface. |
 | Media file 21: Sagittal fat-saturated proton density–weighted image shows abnormal signal intensity in the posterior horn of the medial meniscus, which appears to extend close to the inferior surface. This represents grade 2C changes in signal intensity. It can be difficult to differentiate grade 2 and grade 3 changes. Injuries causing grade 2C signal intensity can progress to degenerative tears. |
 | Media file 22: Coronal fat-saturated proton density–weighted image of the knee shows a bucket tear of the posterior horn of the medial meniscus. It is a full-thickness tear involving both the superior and inferior articular surfaces. The wide separation of the margins of the tear usually results in poor outcomes with surgical repair. Also present is a horizontal tear of the meniscal body extending from the margin of the bucket handle tear to the meniscal base. Such tears usually occur in older patients and are not usually amenable to surgical repair. |
 | Media file 23: Coronal fat-saturated proton density–weighted image of the knee shows a full-thickness radial tear in a location similar to that in Image above. The ability of fat saturation to remove the high signal intensity of fat from the signal intensity bone marrow and subcutaneous tissue makes it an excellent way to highlight meniscal tears. |
 | Media file 24: Sagittal proton density–weighted image of the mid portion of the medial compartment shows a full-thickness horizontal tear of the posterior horn of the medial meniscus extending from the base to the superior surface. In addition, image shows amputation of the inferior apex of the posterior horn. The combination of these 2 tears involving the same part of the meniscus makes this injury a complex tear. |
 | Media file 25: Sagittal proton density–weighted image shows an amputated inferior base of the posterior horn of the lateral meniscus; this represents a partial tear. |
 | Media file 26: Sagittal proton density–weighted image shows almost complete disappearance of the posterior horn of the medial meniscus. The loss of the normal shock-absorbing function of the meniscus predisposes the person to the loss of cartilage and subsequent bone abnormalities typical of degenerative arthritis. |
 | Media file 27: Sagittal fat-saturated proton density–weighted image shows amputation of the apex of the posterior horn of the lateral meniscus. The anterior horn is deformed, and the image shows irregularity and deformity of the adjacent portion of the femur, which may have occurred with the injury to the anterior horn. |
 | Media file 28: Sagittal proton density–weighted image shows an enlarged, abnormal, globular posterior horn of the medial meniscus with abnormal signal intensity. The abnormal appearance is related to edema from the meniscal tear. |
 | Media file 29: Image shows a uniform decrease in the size of the body of the medial meniscus (arrow). The superior apex of the body of the lateral meniscus (arrowhead) has been amputated. |
 | Media file 30: Image shows amputation of much of the inferior portion of the apex and part of the base of the body of the medial meniscus. |
 | Media file 31: Coronal proton density–weighted image shows that most of the posterior horn of the lateral meniscus has been amputated (vertical arrow). An extensive partial-thickness tear is present on the undersurface of the body of the medial meniscus and extends to the meniscal base (oblique arrow). |
 | Media file 32: Sagittal fat-saturated proton density–weighted image of the medial compartment showing a large area of increased signal intensity (arrow) representing joint fluid which, occupies the site where the normal meniscus should be located. This cleft within the meniscus represents a large,, full-thickness radial tear of the meniscal body. It is full thickness because the tear involves the superior and inferior articular surfaces of the meniscus. The radial tear divides the meniscal body into anterior and posterior portions. |
 | Media file 33: Sagittal fat-saturated proton density–weighted image of the same patient as in Image 24, slightly more medial in the knee joint. Image shows the horizontal tear in the posterior horn of the medial meniscus (arrow). The amputation of the apex of the inferior horn is more evident on this image than on the other one. When a meniscal tear is visualized on at least 2 consecutive images, the accuracy that the tear is real and not an artifact approaches 100%. Its presence is almost always verified on arthroscopy. |
 | Media file 34: Coronal fat-saturated proton density–weighted image shows abnormal signal intensity in the posterior horn of the medial meniscus (MM) extending to the undersurface near the junction with the joint capsule. Such tears may be missed on arthroscopy because that part of the knee joint is difficult to access. Also present is a tear to the posterior medial horn of the lateral meniscus (LM) as it slopes obliquely inward. A false-positive diagnosis of meniscal tear can be made when one evaluates this region because of the magic angle effect. Tears persist when the echo time (TE) is varied and when T2-weighted images are obtained. True tears can also be confirmed by visualizing them on sagittal or axial projections. |
 | Media file 35: Sagittal proton density–weighted image shows the tibial insertion site of the posterior horn of the medial meniscus (MM). |
 | Media file 36: Sagittal fat-saturated proton density–weighted image shows the tibial insertion of the posterior horn of the medial meniscus (MM). This portion of the meniscus has a normal, speckled appearance. |
 | Media file 37: Sagittal fat-saturated proton density–weighted image of the posterior knee compartment shows the normal insertion (arrow) of the semimembranosus tendon. The insertion site is near the posterior horn of the medial meniscus (MM), and it is not to be mistaken for a displaced meniscal fragment. |
 | Media file 38: Sagittal fat-saturated proton density–weighted image shows a full-thickness tear to the periphery of the anterior horn of the medial meniscus (MM). Tears in this location have a good likelihood of healing without surgical repair because they occur in the zone with a good blood supply to the meniscus. Also present is a partial thickness tear to the undersurface of the posterior horn of the MM. |
 | Media file 39: Coronal proton density–weighted image shows a full-thickness,, vertical bucket handle tear (arrow) through the base of the medial meniscus (MM). |
 | Media file 40: Coronal fat-saturated proton density–weighted image shows the tibial insertion of the anterior horn of the lateral meniscus (LM, arrows) and the intimate association sometimes seen between the insertion of the meniscus and the tibial insertion of the anterior cruciate ligament (ACL). Normal interdigitations of the ACL are present at this site. Fat is also present and appears hyperintense on T1- and proton density–weighted images. This is not to be confused with a meniscal or ACL tear. |
 | Media file 41: Coronal fat-saturated proton density–weighted image shows irregularity to the upper (femoral) surface of the body of the lateral meniscus (LM, outer arrow), indicating fraying. Fraying usually occurs at the meniscal apex. Soft tissue densities (inner arrow) are present under the apex of the meniscus, indicating debris or a free meniscal fragment at this level. The body of the LM is unusually thick and longer than usual, indicating a discoid meniscus. The normal-sized medial meniscal body is present for comparison. Discoid menisci occur about 5 times more often here than in the LM, and they are more prone to injury. |
 | Media file 42: Sagittal proton density–weighted image shows a vertical bucket handle tear (arrow) through the periphery of the posterior horn of the medial meniscus (MM). Tears in this location do not usually heal spontaneously because this portion of the meniscus lacks blood supply. |
 | Media file 43: Sagittal fat-saturated proton density–weighted image of the paramedian portion of the lateral joint compartment. The transverse intermeniscal ligament (arrowhead) is about to unite with the anterior horn of the medial meniscus (MM, arrow). Fat is normally present in this region and can mimic a ligament or meniscal tear. By carefully following the course of the ligament on sequential images and by observing a uniformly well-defined, hypointense structure on every image, this pitfall can be avoided. A small, ill-defined, linear soft tissue density is present under the anterior horn. It is separated from the anterior horn by bright fluid. This is a rare tear in this region. The brightness is joint fluid in the tear. |
 | Media file 44: Sagittal fat-saturated proton density–weighted image of the paramedian portion of the medial knee. The transverse intermeniscal ligament is about to insert on the anterior horn of the medial meniscus (MM). The anterior horn is normally speckled. The anterior horn is partially displaced off the anterior surface of the tibia by a radial tear more laterally (picture is not shown). A tear involves the posterior horn of the MM (arrow). |
 | Media file 45: Sagittal proton density–weighted image shows a full-thickness horizontal tear of the posterior horn of the lateral meniscus (LM, arrow) involving the superior articular surface. |
 | Media file 46: Sagittal fat-saturated proton density–weighted image shows a well-defined,, soft tissue density in front of the posterior cruciate ligament (PCL). It is speckled and looks like the normal posterior medial horn of the medial meniscus (MM), but it is in the wrong place. This finding represents a displaced meniscal tear involving the posterior medial horn. The position of the meniscus is referred to as a double PCL because it looks like 2 of these ligaments are present. |
 | Media file 47: Coronal fat-saturated proton density–weighted image of the same patient as in Image 46 shows the same speckled displaced meniscal fragment (inner arrows). Also present is an extensive horizontal tear to the body of the medial meniscus (MM) with a lot of hyperintensity at the periphery (outer arrows). This represents a meniscal cyst. Repair of the cyst without repair of the underlying meniscal tear results in recurrence of the cyst. |
 | Media file 48: Sagittal fat-saturated proton density–weighted image shows soft tissue (arrows) lying on top of the anterior horn of the medial meniscus (MM), separated from it by high signal intensity (bright joint fluid). This finding represents a displaced meniscal fragment. The posterior horn of the MM is abnormally shaped and has abnormal signal intensity. This is the origin of the displaced fragment. The height of the combination of the displaced fragment and the anterior meniscus is greater than 8 mm. The height of the meniscal tissue equal to or greater than this number is a good sign of a displaced meniscal fragment. |
 | Media file 49: Coronal fat-saturated proton density–weighted image of the same patient as in Image 48 shows a different view of the meniscal fragment and the anterior horn. As in Image 48, an appearance of a double anterior meniscus is shown. |
 | Media file 50: Coronal fat-saturated proton density–weighted image of the posterior knee Shows an extensive horizontal tear involving the undersurface of the posterior meniscus. Also present is a flap on the undersurface of the meniscus that has been displaced medially and that is now directed vertically and inferiorly. Note the normal insertion site of the semimembranosus tendon (arrow) that might be confused for a displaced meniscal fragment. |
 | Media file 51: More anterior image of the same patient as in Image 50 shows the tear to the undersurface of the posterior horn of the medial meniscus (MM, large solid arrow). Image also shows a displaced meniscal fragment lying on top of the body of the lateral meniscus (LM, small solid arrow). The lateral meniscal tear was located more anterior in the body (picture not shown). Open arrow indicates abnormal signal at the origin of the popliteus tendon, representing a partial tear. |
 | Media file 52: Sagittal proton density–weighted image of the outer portion of the lateral side of the knee shows an absence of the body of the lateral meniscus (LM, arrow). The body of the meniscus should be visualized peripherally (see Images 1, 8, 16, and 20). The normal appearance of the meniscus has the appearance of a bow tie; the bow tie is absent here. |
 | Media file 53: Sagittal fat-saturated proton density–weighted image shows an unusually tall anterior meniscal horn. On closer inspection, a separation is present between the upper (arrowhead) and lower (arrow) portions. The upper portion is a displaced meniscal fragment from the posterior meniscus lying on top of the anterior horn. Most of the posterior meniscus is absent from its usual location. When the height of a meniscus is greater than 8 mm, it likely represents the combination of a displaced meniscal fragment and a normal meniscus. |
 | Media file 54: Coronal fat-saturated proton density–weighted image of the posterior portion of the knee joint. A circular, fluid-filled structure (arrow) is present in the upper portion of the most medial portion of the posterior horn of the medial meniscus; it represents a meniscal cyst. |
 | Media file 55: Axial fat-saturated proton density–weighted image shows the location of the cyst in the most medial portion of the medial meniscus. |
 | Media file 56: Sagittal fat-saturated proton density–weighted image shows the cyst (arrow) in a different projection. |
 | Media file 57: Coronal fat-saturated proton density–weighted image obtained more posteriorly in the same patient as in Image 47. Abnormal signal intensity (small arrows) is present medial to the base of the posterior horn of the medial meniscus (MM). No medial collateral ligament (MCL) is discernible at this level; this appearance indicates a tear. This is fluid of the meniscus from its normal attachment with the MCL, representing meniscocapsular separation. The insertion of the semimembranosus tendon (large arrow) has abnormal signal intensity, ie, it is whiter and less well defined than it is in Image 37; this finding indicates a tear. |
 | Media file 58: Coronal fat-saturated proton density–weighted image obtained more posteriorly than Image 57. The separation of the base of the meniscus from the medial collateral ligament (MCL, large solid arrow) is evident. Image shows interruption and abnormal signal intensity in the MCL (small arrows), indicating a tear. Large open arrow indicates a soft tissue density, either blood products or a free meniscal fragment below the joint space between the tibia and MCL. It is easy to see how inferomedial displaced tears from the medial meniscus (MM) can go unnoticed on arthroscopy. The tear is hidden,, and it is difficult to bend the arthroscope around the tibia to see below the joint. A fracture is present in the central portion of the articular surface of the tibia (oblique central arrow in the tibia),, and another tear is present in the posterior medial horn of the medial meniscus near the tibial insertion site. |
 | Media file 59: Image in a different patient shows a cyst in the body of the medial meniscus (MM) with meniscocapsular separation. At this level, the medial collateral ligament (MCL, arrow) is intact. |
 | Media file 60: Sagittal proton density–weighted image obtained from the outer portion of the lateral aspect of the knee. Image shows interruption of the inferior fascicle (arrow) of the lateral meniscus (LM). Compare this with the normal inferior fascicle in Image 8. No pericapsular edema is present. |
 | Media file 61: Sagittal proton density–weighted image of the same patient as in Image 60 but slightly more medial. Image shows abnormal signal intensity with interruption of the superior fascicle of the lateral meniscus (LM). Compare this finding with the normal superior fascicle in Image 7. No pericapsular edema is present. |
 | Media file 62: Sagittal proton density–weighted image of a patient who underwent partial meniscectomy of the body and posterior horn of the medial meniscus (MM). Image shows slight hypertrophy and increased signal intensity to the posterior femur, indicating secondary degenerative arthritis related to removal of the meniscus. |
 | Media file 63: Coronal fat-saturated proton density–weighted image of the posterior aspect of the knee. A soft tissue density (arrow) lies between the lateral portion of the medial femoral epicondyle and the posterior cruciate ligament (PCL). This represents the notch fragment. A horizontal tear is present on undersurface of the body of the medial meniscus (MM). The difference between the notch fragment sign and the double PCL sign is merely one of position of the meniscal fragment. The fragment is more medial with the notch fragment sign than in the double PCL sign. |
 | Media file 64: Oblique radiograph of the right knee demonstrates bright triangular lines on either side of the joint. This finding represents calcium in the triangular menisci, which represents chondrocalcinosis. A globular calcium opacity (arrow) is above the periphery of the body of the lateral meniscus; this might represent a calcified loose body, either in the joint proper or in the popliteus recess. The presence of chondrocalcinosis can result in a false-positive diagnosis of a meniscal tear. |
 | Media file 65: Coronal fat-saturated proton density–weighted image of the posterior aspect of the knee shows the normal vertically oblique course of the popliteus recess. Immediately medial to the recess is a longitudinally oblique area of high signal intensity (arrow) located in the posterior horn of the lateral meniscus (LM), communicating with the recess and representing an oblique tear. |
 | Media file 66: Coronal proton density–weighted image shows a displaced medial meniscal body (arrow) bowing the medial collateral ligament (MCL). The thin meniscus apex is pointing upward, and the thicker base is more caudal in position, indicating meniscocapsular separation with reorientation of the position of the meniscus. In addition, the meniscus has twisted 180° because the concave femoral surface is directed toward the femur. If it had simply flipped upward, it would face the MCL. |
 | Media file 67: Axial illustration of a full-thickness longitudinal tear of the posterior horn. The meniscus is viewed from above in (a), sagittal in (b), and coronal in (c). For Image 67-70, A = anterior, L = lateral, M = medial, and P = posterior. |
 | Media file 68: Axial illustration of a full-thickness radial tear of the posterior horn. The meniscus is viewed from above. The orientation is the same as in Image 67. |
 | Media file 69: Axial illustration of a full-thickness horizontal tear of the posterior horn. The meniscus is viewed from above. The orientation is the same as in Image 67. |
 | Media file 70: Axial illustration of an oblique (parrot beak) tear of the posterior horn. The meniscus is viewed from above. The orientation is the same as in Image 67. In B, image 1 is most lateral, image 2 is middle, and image 3 is most medial. In C, image 1 is most anterior, image 2 is middle, and image 3 is most posterior. |
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Further Reading
Keywords
meniscal tears, knee menisci, meniscal injury, medial meniscus, lateral meniscus, meniscomeniscal ligament, discoid meniscus, transverse ligament, intermeniscal ligament, meniscofemoral ligament, Appley test, McMurray test, Boehler test, Apley grinding test, Payr test
