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Meniscal tears: MR and arthrographic findings after arthroscopic repair
T E Farley1, S M Howell, K F Love
1Department of Radiology, David Grant Medical Center, Travis Air Force Base, Calif.
Abstract:
Magnetic resonance (MR) imaging was performed on 29 previously repaired menisci and one conservatively treated meniscus (total, 30 menisci). Intermediate- and T1-weighted MR sequences revealed persistent signal intensity extending to an articular surface (grade 3 signal intensity) in 27 of the 30 menisci. On T2-weighted images, seven of the 30 menisci were found to contain unequivocally higher signal intensity, defined by a full-thickness defect (grade 3 signal intensity involving two articular surfaces) increasing in signal intensity to a level equivalent to that of joint fluid. The MR imaging and arthrographic appearances of 23 of the 30 menisci were compared. Arthrographic examination revealed partial or complete healing in 13 menisci and tears in 10. The presence of grade 3 signal intensity on intermediate- and T1-weighted MR images did not reliably predict a tear seen at arthrography. Unequivocally higher signal intensity on T2-weighted images is a useful sign in the prediction of a persistent meniscal tear (sensitivity, 60%; specificity, 92%; P less than .02). Since presence of grade 3 signal intensity on intermediate- and T1-weighted images does not reliably predict a tear and unequivocal T2 increase in intensity has a sensitivity of only 60%, arthrography should be considered for assessment of the symptomatic, previously repaired meniscus.
Insights
Magnetic resonance (MR) imaging shows that intermediate- and T1-weighted signals do not reliably predict meniscal tears. T2-weighted imaging is more useful for identifying persistent meniscal tears, but arthrography may still be needed.
Area of Science:
- Orthopedics
- Radiology
- Biomedical Engineering
Background:
- Meniscal tears are common knee injuries.
- Assessing the healing and integrity of previously repaired menisci is clinically important.
- Magnetic resonance (MR) imaging is a primary tool for evaluating meniscal pathology.
Purpose of the Study:
- To evaluate the diagnostic accuracy of different magnetic resonance (MR) imaging sequences for detecting persistent meniscal tears.
- To compare MR imaging findings with arthrography in previously treated menisci.
Main Methods:
- MR imaging was performed on 30 menisci (29 repaired, 1 conservatively treated).
- Intermediate-, T1-, and T2-weighted MR sequences were analyzed for signal intensity and defects.
- MR findings were compared with arthrographic results in 23 menisci.
Main Results:
- Grade 3 signal intensity on intermediate- and T1-weighted images did not reliably predict arthrographic tears.
- Unequivocally higher signal intensity on T2-weighted images predicted persistent tears with 60% sensitivity and 92% specificity (P < .02).
- Arthrography revealed healing in 13 menisci and tears in 10.
Conclusions:
- Intermediate- and T1-weighted MR signals are insufficient for reliably diagnosing persistent meniscal tears.
- T2-weighted imaging offers better prediction of meniscal tears but has limited sensitivity.
- Arthrography remains a valuable tool for assessing symptomatic, previously repaired menisci when MR findings are equivocal.
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