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Sex Difference in Contusion of the Medial Femoral Condyle Rim-Association with MRI Occult Meniscal Tears in the ACL
Nicholas P Fleege1, D Lee Bennett2, Howard J O'Rourke2
1Department of Student Affairs, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa, USA.
Background:
Meniscal tears, specifically lateral meniscal tears, have a larger than expected un-derdiagnosis rate in the presence of an ACL tear. The purpose of our study was to search for an MRI bone contusion pattern associated with MRI occult meniscal tears in patients with an ACL tear, specifically a contusion of the rim of the medial femoral condyle (RMFC). Our hypothesis was that there would be a significant association between RMFC contusions and MRI occult meniscal tears in patients with an ACL tear. We also searched for a difference between sexes with respect to the presence of the RMFC contusion in the setting of an occult meniscal tear. We also categorized the type, size, and location of these occult meniscal tears in the setting of an ACL tear.
Methods:
This was a retrospective study that examined characteristics of occult meniscal tears and their association with a RMFC bone contusion. IRB approval was obtained. The date range of the study was June 2009 through December 2015. 6392 consecutive knee MRI reports in patients with an ACL deficient knee were reviewed. The study group included 22 patients with MRI occult meniscal tears, the control group included 110 patients. Relevant statistical values were calculated.
Results:
The most common type of occult meniscal tears were small radial and small longitudinal tears of the lateral meniscus. Occult meniscal tears were associated with an RMFC contusion in the study group (p=0.0457), particularly in males (p = 0.0003). In males with a torn ACL, the sensitivity of an RMFC contusion for an occult meniscal tear was 80%.
Conclusion:
In males with an ACL tear, there was a significant association between a contusion of the RMFC and an occult meniscal tear (commonly small radial or small peripheral partial-thickness longitudinal tears). RMFC contusions were reliably identified by radiologists in this study.Level of Evidence: II.
Insights
A bone contusion on the medial femoral condyle rim is a significant indicator of an occult lateral meniscal tear in patients with an anterior cruciate ligament (ACL) tear, especially in males.
Area of Science:
- Orthopedic imaging
- Sports medicine
- Knee injuries
Background:
- Lateral meniscal tears are frequently underdiagnosed in patients with anterior cruciate ligament (ACL) tears.
- Identifying occult meniscal tears is crucial for effective treatment and patient outcomes.
- Bone contusions on MRI may serve as a predictive marker for associated meniscal pathology.
Purpose of the Study:
- To investigate the association between a specific MRI bone contusion pattern, the rim of the medial femoral condyle (RMFC), and MRI-occult meniscal tears in patients with ACL tears.
- To determine if RMFC contusions can predict occult meniscal tears in the setting of an ACL tear.
- To explore sex-based differences in the presence of RMFC contusions and occult meniscal tears.
Main Methods:
- Retrospective review of 6392 knee MRI reports in patients with ACL deficiency (June 2009 - December 2015).
- Identified a study group of 22 patients with MRI-occult meniscal tears and a control group of 110 patients.
- Analyzed MRI findings for RMFC contusions and characterized occult meniscal tears (type, size, location).
Main Results:
- Occult meniscal tears were significantly associated with RMFC contusions (p=0.0457), particularly in males (p=0.0003).
- The most common occult tears were small radial and small longitudinal tears of the lateral meniscus.
- In males with an ACL tear, RMFC contusion demonstrated 80% sensitivity for detecting occult meniscal tears.
Conclusions:
- A significant association exists between RMFC contusions and occult meniscal tears in males with ACL tears.
- RMFC contusions are reliable indicators, often associated with small radial or peripheral partial-thickness longitudinal tears.
- Radiologists can reliably identify RMFC contusions, aiding in the diagnosis of occult lateral meniscal tears.
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