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Meniscal morphologic changes on magnetic resonance imaging are associated with symptomatic discoid lateral meniscal
Won Joon Yoo1, Kang Lee, Hyuk Ju Moon
1Department of Orthopaedic Surgery, Seoul National University Children's Hospital, Seoul, South Korea.
Purpose:
To determine whether meniscal deformation and displacement on magnetic resonance imaging (MRI) are associated with tears by use of arthroscopic findings as a standard of reference in children with discoid lateral meniscus (DLM).
Methods:
We reviewed MRI scans and intraoperative videos of 69 consecutive patients (79 knees) treated arthroscopically for suspicious DLM tears. The mean age at surgery was 10.9 years (range, 4.3 to 17.6 years). Signal changes and morphologic changes (deformation or displacement) of DLM on magnetic resonance (MR) images were graded by 2 independent observers using our modifications of previously described classification schemes, and then the grades were determined by consensus of the observers. Meniscal tears were assessed by an observer, blinded to the MRI studies, based on arthroscopic findings. Signal changes and morphologic changes of DLM on MR images were correlated with tears.
Results:
Tears were found more frequently in menisci showing morphologic changes on MR images (P = .001). Of the 25 menisci with a grade 3 signal change (linear or band-like signal intensity extending to the superior or inferior meniscal surface), 24 had tears, and a horizontal cleavage was the most commonly associated tear type. Of the 50 menisci with a grade 1 (dot-like intrameniscal signal change), grade 2 (linear or band-like intrameniscal signal change), or diffuse signal change, 34 were morphologically changed on MR images, and 29 of these (85%) were torn, whereas 9 of the 16 menisci (56%) not morphologically changed were torn (P = .036).
Conclusions:
Preoperative MRI evaluations based on signal intensities do not accurately predict the presence of a DLM tear in children, except when a DLM shows a grade 3 signal change. Meniscal deformation or displacement observed on preoperative MR images suggests a higher risk of meniscal tears, even in menisci with signal changes other than grade 3 changes.
Level Of Evidence:
Level IV, therapeutic case series.
Insights
Meniscal deformation and displacement on MRI in children with discoid lateral meniscus (DLM) suggest a higher risk of tears. However, MRI signal changes alone, except for grade 3, do not reliably predict tears.
Area of Science:
- Pediatric Orthopedics
- Radiology
- Sports Medicine
Background:
- Discoid lateral meniscus (DLM) is a congenital anomaly that can predispose children to meniscal tears.
- Magnetic resonance imaging (MRI) is commonly used to evaluate DLM, but its accuracy in detecting tears can be limited.
Purpose of the Study:
- To determine if meniscal deformation and displacement on MRI are associated with tears in children with DLM.
- To assess the predictive value of MRI signal changes for DLM tears.
Main Methods:
- Retrospective review of MRI scans and arthroscopic findings in 69 patients (79 knees) with suspected DLM tears.
- Grading of DLM signal and morphologic changes (deformation/displacement) by two independent observers.
- Correlation of MRI findings with arthroscopic tear assessment.
Main Results:
- Menisci with morphologic changes on MRI were significantly more likely to have tears (P = .001).
- Grade 3 signal changes on MRI were highly predictive of tears (24/25 cases).
- Morphologic changes on MRI increased the likelihood of tears, even with non-grade 3 signal changes (85% vs. 56% tear rate).
Conclusions:
- Preoperative MRI signal intensities alone are not accurate for predicting DLM tears in children, except for grade 3 changes.
- Meniscal deformation or displacement on MRI indicates an increased risk of tears in DLM, even with other signal abnormalities.
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