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Bucket handle tears of the medial meniscus: meniscal intrusion rather than meniscal extrusion
S Schlossberg1, H Umans, G Flusser
1Department of Radiology, Jacobi Medical Center, 1400 Pelham Parkway South, Bronx, NY 10461, USA. schlossbergmd@yahoo.com
Objective:
To determine the frequency of medial meniscal extrusion (MME) versus "medial meniscal intrusion" in the setting of bucket handle tears. Images were evaluated for previously reported risk factors for MME, including: medial meniscal root tear, radial tear, degenerative joint disease and joint effusion.
Methods:
Forty-one consecutive cases of bucket handle tear of the medial meniscus were reviewed by consensus by two musculoskeletal radiologists. Imaging was performed using a 1.5 GE Signa MR unit. Patient age, gender, medial meniscal root integrity, MME, medial meniscal intrusion, degenerative joint disease, effusion and anterior cruciate ligament (ACL) tear were recorded.
Results:
Thirteen females and 27 males (age 12-62 years, median=30 years) were affected; one had bucket handle tear of each knee. Effusion was small in 13, moderate in 9 and large in 18. Degenerative joint disease was mild in three, moderate in two and severe in one. 26 ACL tears included three partial and three chronic. Medial meniscal root tear was complete in one case and partial thickness in two. None of the 40 cases with an intact or partially torn medial meniscal root demonstrated MME. MME of 3.1 mm was seen in the only full-thickness medial meniscal root tear, along with chronic ACL tear, moderate degenerative joint disease and large effusion. Medial meniscal intrusion of the central bucket handle fragment into the intercondylar notch was present in all 41 cases.
Conclusion:
Given an intact medial meniscal root in the setting of a "pure" bucket handle tear, there is no MME.
Insights
Medial meniscal extrusion (MME) is absent in bucket handle tears with an intact medial meniscal root. Medial meniscal intrusion, however, is consistently present in these cases.
Area of Science:
- Orthopedic Surgery
- Radiology
- Sports Medicine
Background:
- Bucket handle tears of the medial meniscus are common knee injuries.
- Understanding meniscal extrusion and intrusion is crucial for diagnosis and treatment planning.
Purpose of the Study:
- To compare the frequency of medial meniscal extrusion (MME) versus medial meniscal intrusion in bucket handle tears.
- To identify risk factors associated with MME in these injuries.
Main Methods:
- Retrospective review of 41 consecutive bucket handle tears of the medial meniscus.
- Consensus evaluation by two musculoskeletal radiologists using MRI.
- Analysis of MME, medial meniscal intrusion, and associated factors like root tear, degenerative joint disease, effusion, and ACL tear.
Main Results:
- Medial meniscal intrusion was present in all 41 cases.
- None of the 40 cases with an intact or partially torn medial meniscal root showed MME.
- MME (3.1 mm) was observed in only one case with a full-thickness medial meniscal root tear, chronic ACL tear, moderate degenerative joint disease, and large effusion.
Conclusions:
- Medial meniscal extrusion does not occur in bucket handle tears when the medial meniscal root is intact.
- Medial meniscal intrusion is a consistent finding in bucket handle tears.
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