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Clinical significance of intrasubstance meniscal lesions on MRI
A K Low1, M R Chia, D J Carmody
1Sydney Adventist Hospital, Sydney, New South Wales, Australia. adrianklow@gmail.com
Abstract:
Grade 2 meniscal changes on MRI are linear signals confined within the meniscus thought to represent areas of meniscal degeneration or intrasubstance tears. It has been reported that in only 10% of cases is a meniscal tear detected during subsequent arthroscopy. Usually non-operative management is appropriate, but in some cases, grade 2 meniscal changes are seen on MRI in patients with a typical presentation of a meniscal tear. In this circumstance, an arthroscopic partial meniscectomy may be indicated and an MRI report, which describes the meniscus as being normal, may be confusing. A pilot study of 10 consecutive symptomatic patients (mean age 28.1 years) with a grade 2 meniscal signal on MRI was performed. At arthroscopy, with thorough examination of the meniscus using a probe, an intrasubstance tear was detected in all 10 patients. Partial meniscectomy was performed, with a mean follow-up of 6.7 months. All but one patient (due to other pathology) had marked improvement in pain and function. Thus, the authors believe that grade 2 signal changes should be reported in a manner that raises the possibility that they may cause symptoms and that the presence of any intrasubstance changes should be clearly conveyed in the report.
Insights
Grade 2 meniscal changes on MRI scans often indicate degeneration but can signify tears. This study found intrasubstance tears in all patients with grade 2 signals, leading to improved pain and function after surgery.
Area of Science:
- Orthopedic Surgery
- Radiology
- Sports Medicine
Background:
- Grade 2 meniscal changes on MRI (magnetic resonance imaging) represent linear signals within the meniscus, often attributed to degeneration.
- Arthroscopic detection of meniscal tears in these cases is historically low (around 10%).
- Non-operative management is typical, but symptomatic patients with grade 2 signals may require surgical intervention.
Purpose of the Study:
- To investigate the prevalence of intrasubstance meniscal tears in symptomatic patients with grade 2 meniscal signals on MRI.
- To evaluate the efficacy of arthroscopic partial meniscectomy in this patient cohort.
Main Methods:
- A pilot study involving 10 consecutive symptomatic patients with grade 2 meniscal signals on MRI.
- Thorough arthroscopic examination using a probe to assess the meniscus.
- Arthroscopic partial meniscectomy performed for detected intrasubstance tears.
Main Results:
- Intrasubstance meniscal tears were detected in all 10 patients during arthroscopy.
- Following partial meniscectomy, 9 out of 10 patients experienced significant improvement in pain and function.
- One patient had persistent symptoms due to unrelated pathology.
Conclusions:
- Grade 2 meniscal signals on MRI should be reported cautiously, highlighting the potential for symptomatic intrasubstance tears.
- Clear communication of intrasubstance changes in MRI reports is crucial for appropriate patient management.
- Arthroscopic partial meniscectomy can be an effective treatment for symptomatic grade 2 meniscal changes indicative of tears.
