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The flipped meniscus sign

N Haramati1, R B Staron, S Rubin

  • 1Department of Radiology, Columbia-Presbyterian Medical Center, New York, New York.

Skeletal Radiology
|January 1, 1993
PubMed
Summary
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An enlarged anterior meniscal horn on MRI may indicate a hidden meniscal fragment or bucket-handle tear. This finding, often associated with posterior horn tears, requires careful evaluation for accurate diagnosis.

Area of Science:

  • Orthopedics
  • Radiology
  • Sports Medicine

Background:

  • Meniscal fragments are clinically significant but challenging to detect using magnetic resonance (MR) imaging.
  • Early and accurate diagnosis of meniscal tears is crucial for effective patient management.

Purpose of the Study:

  • To describe and illustrate the MR imaging appearance of a specific, easily overlooked meniscal fragment.
  • To correlate MR findings with surgical outcomes in cases of suspected meniscal tears.

Main Methods:

  • Prospective identification of ten knees with abnormally large anterior meniscal horns (≥8 mm height) on MR images.
  • Analysis of associated tears, particularly in the ipsilateral posterior horns of the same meniscus.
  • Review of surgical findings in patients with confirmed bucket-handle meniscal tears and anterior horn fragments.

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Main Results:

  • Abnormally enlarged anterior meniscal horns were consistently associated with large tears of the ipsilateral posterior horns.
  • The lateral meniscus was involved in nine out of ten cases.
  • Two patients had surgically confirmed bucket-handle tears with meniscal fragments overlying the anterior horn; one case showed a change from previous normal MR imaging.

Conclusions:

  • An enlarged anterior meniscal horn on MR imaging, especially with an ipsilateral posterior horn tear, strongly suggests a meniscal fragment.
  • This MR appearance may also indicate a posteriorly detached bucket-handle tear of the meniscus.
  • Radiologists should consider these possibilities when encountering this specific MR finding to avoid diagnostic delays.