Meniscal flounce on MR: correlation with arthroscopic or surgical findings

The purpose of this study was to investigate the frequency of the meniscal flounce on MR imaging in patients who underwent arthroscopy or open surgery due to symptoms related to internal derangement of the knee, and to investigate associated findings in patients with meniscal flounce by comparing and analyzing the findings from MR imaging and surgery. MR images obtained from 116 knees before surgery were reviewed retrospectively. Seven medial menisci showed buckled, wavy flounce on sagittal MR images. None of the lateral menisci showed flounce. We reviewed the surgical records of all seven patients and the videotapes of six of the patients undergoing arthroscopy or open surgery. The frequency of flounce on sagittal MR images was 6.0% in the medial meniscus and was completely absent in the lateral meniscus. On coronal MR images, the truncated appearance of the affected meniscus was demonstrated in five patients, and a valgus deformity was seen in three patients. Five patients showed a moderate to large amount of joint effusion. On MR imaging and in surgery, ligament injuries were found in six patients (six medial collateral ligament injuries, five anterior cruciate ligament injuries, and two posterior cruciate ligament injuries). Non-specific synovitis was found in the one remaining patient. In the surgery of all seven patients, no tears were found at the meniscus itself showing flounce. In conclusion, the meniscal flounce seen on sagittal MR imaging can be a rare appearance of a transient distortion of a normal meniscus due to a valgus deformity caused by a MCL tear and/or due to an external rotation induced by cruciate ligament injury or positioning of knee joint within the magnet. The meniscal flounce should be interpreted carefully because it frequently appears truncated on the coronal scan and can simulate a meniscal tear.