Semin Musculoskelet Radiol 2008; 12(4): 318-333
DOI: 10.1055/s-0028-1100639
© Thieme Medical Publishers

Meniscus Imaging

Wouter C. J Huysse1 , Koenraad L. Verstraete1 , Peter C. Verdonk2 , René Verdonk2
  • 1Department of Radiology, Ghent University Hospital, Gent, Belgium
  • 2Department of Orthopedic Surgery, Physical Medicine, and Rehabilitation, Ghent University Hospital, Gent, Belgium
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Publikationsverlauf

Publikationsdatum:
18. November 2008 (online)

ABSTRACT

As the therapeutic options for the treatment of meniscal lesions evolve, so do the challenges in both preoperative and postoperative imaging of the meniscus. Ideally, an imaging modality should accurately depict the meniscus and any meniscal lesions in such a way that the best treatment option can be chosen. It should also be able to depict the treated area, accurately assess the follow-up of treatment, and differentiate the findings associated with the treatment from recurrent lesions.

At this moment magnetic resonance (MR) is the imaging modality of choice for the virgin meniscus, the operated meniscus, and the transplanted meniscus. In all these situations, unenhanced MR imaging accurately displays the meniscus and the possible lesions. Only in patients with sutured menisci can the performance of MR be improved by intra-articular contrast administration.

Computed tomographic arthrography has a similar accuracy as MR imaging for the detection of meniscal lesion, and it is especially valuable for the evaluation of menisci in the presence of orthopaedic hardware. It remains, however, an invasive technique that requires ionizing radiation.

REFERENCES

  • 1 Bylski-Austrow D I, Ciarelli M J, Kayner D C, Matthews L S, Goldstein S A. Displacements of the menisci under joint load: an in vitro study in human knees.  J Biomech. 1994;  27(4) 421-431
  • 2 Herwig J, Egner E, Buddecke E. Chemical changes of human knee joint menisci in various stages of degeneration.  Ann Rheum Dis. 1984;  43(4) 635-640
  • 3 Bullough P G, Munuera L, Murphy J, Weinstein A M. The strength of the menisci of the knee as it relates to their fine structure.  J Bone Joint Surg Br. 1970;  52(3) 564-567
  • 4 Ingman A M, Ghosh P, Taylor T K. Variation of collagenous and non-collagenous proteins of human knee joint menisci with age and degeneration.  Gerontologia. 1974;  20(4) 212-223
  • 5 Beaupre A, Choukroun R, Guidouin R, Garneau R, Gerardin H, Cardou A. Knee menisci. Correlation between microstructure and biomechanics.  Clin Orthop Relat Res. 1986;  (208) 72-75
  • 6 McDevitt C A, Webber R J. The ultrastructure and biochemistry of meniscal cartilage.  Clin Orthop Relat Res. 1990;  (252) 8-18
  • 7 Cheung H S. Distribution of type I, II, III and V in the pepsin solubilized collagens in bovine menisci.  Connect Tissue Res. 1987;  16(4) 343-356
  • 8 Thompson W O, Thaete F L, Fu F H, Dye S F. Tibial meniscal dynamics using three-dimensional reconstruction of magnetic resonance images.  Am J Sports Med. 1991;  19(3) 210-215
  • 9 Ghadially F N, Lalonde J M, Wedge J H. Ultrastructure of normal and torn menisci of the human knee joint.  J Anat. 1983;  136(Pt 4) 773-791
  • 10 Hellio Le Graverand M P, Ou Y, Schield-Yee T et al.. The cells of the rabbit meniscus: their arrangement, interrelationship, morphological variations and cytoarchitecture.  J Anat. 2001;  198(Pt 5) 525-535
  • 11 Kambic H E, Futani H, McDevitt C A. Cell, matrix changes and alpha-smooth muscle actin expression in repair of the canine meniscus.  Wound Repair Regen. 2000;  8(6) 554-561
  • 12 Arnoczky S P, Warren R F. Microvasculature of the human meniscus.  Am J Sports Med. 1982;  10(2) 90-95
  • 13 Benedetto K P, Glotzer W, Kunzel K H, Gaber O. Vascularization of the menisci—morphological basis for meniscus repair.  Acta Anat (Basel). 1985;  124(1–2) 88-92
  • 14 Stone K R. Meniscus replacement.  Clin Sports Med. 1996;  15(3) 557-571
  • 15 van Arkel E R, de Boer H H. Human meniscal transplantation. Preliminary results at 2- to 5-year follow-up.  J Bone Joint Surg Br. 1995;  77(4) 589-595
  • 16 Selesnick F H, Noble H B, Bachman D C, Steinberg F L. Internal derangement of the knee: diagnosis by arthrography, arthroscopy, and arthrotomy.  Clin Orthop Relat Res. 1985;  (198) 26-30
  • 17 Vande Berg B C, Lecouvet F E, Poilvache P, Maldague B, Malghem J. Spiral CT arthrography of the knee: technique and value in the assessment of internal derangement of the knee.  Eur Radiol. 2002;  12(7) 1800-1810
  • 18 Coulier B. Direct 3D imaging of the knee menisci during 16-row multislice CT arthrography.  JBR-BTR. 2006;  89(6) 291-297
  • 19 Manco L G, Kavanaugh J H, Fay J J, Bilfield B S. Meniscus tears of the knee: prospective evaluation with CT.  Radiology. 1986;  159(1) 147-151
  • 20 Manco L G, Berlow M E. Meniscal tears—comparison of arthrography, CT, and MRI.  Crit Rev Diagn Imaging. 1989;  29(2) 151-179
  • 21 Vande Berg B C, Lecouvet F E, Poilvache P et al.. Assessment of knee cartilage in cadavers with dual-detector spiral CT arthrography and MR imaging.  Radiology. 2002;  222(2) 430-436
  • 22 De Filippo M, Pogliacomi F, Bertellini A, Averna R, Onniboni M, Zompatori M. Multidetector computed tomography arthrography of the knee: diagnostic accuracy and indications.  Eur J Radiol. 2008 Mar 6;  , [Epub ahead of print]
  • 23 Dupas B, Frampas E, Leaute F, Bertrand-Vasseur A, Lerat F. Complications of fluoroscopy-, ultrasound-, and CT-guided percutaneous interventional procedures.  J Radiol. 2005;  86(5) 586-598
  • 24 White L M, Schweitzer M E, Weishaupt D, Kramer J, Davis A, Marks P H. Diagnosis of recurrent meniscal tears: prospective evaluation of conventional MR imaging, indirect MR arthrography, and direct MR arthrography.  Radiology. 2002;  222(2) 421-429
  • 25 Magee T, Shapiro M, Rodriguez J, Williams D. MR arthrography of postoperative knee: for which patients is it useful?.  Radiology. 2003;  229(1) 159-163
  • 26 Walker P S, Erkman M J. The role of the menisci in force transmission across the knee.  Clin Orthop Relat Res. 1975;  (109) 184-192
  • 27 Lubowitz J H, Verdonk P C, Reid III J B, Verdonk R. Meniscus allograft transplantation: a current concepts review.  Knee Surg Sports Traumatol Arthrosc. 2007;  15(5) 476-492
  • 28 Wojtys E M, Chan D B. Meniscus structure and function.  Instr Course Lect. 2005;  54 323-330
  • 29 Jackson J P. Degenerative changes in the knee after meniscectomy.  BMJ. 1968;  2(5604) 525-527
  • 30 Cox J S, Nye C E, Schaefer W W, Woodstein I J. The degenerative effects of partial and total resection of the medial meniscus in dogs' knees.  Clin Orthop Relat Res. 1975;  (109) 178-183
  • 31 Dandy D J, Jackson R W. Meniscectomy and chondromalacia of the femoral condyle.  J Bone Joint Surg Am. 1975;  57(8) 1116-1119
  • 32 Lutfi A M. Morphological changes in the articular cartilage after meniscectomy. An experimental study in the monkey.  J Bone Joint Surg Br. 1975;  57(4) 525-528
  • 33 Lemaire R. Osteoarthrosis of the knee joint, a predictable consequence of meniscectomy in patients with angular deformity of the knee [author's translation].  Acta Chir Belg. 1977;  76(3) 355-360
  • 34 Gotzen L. Meniscus and cartilage damage [in German].  Langenbecks Arch Chir. 1987;  372 255-257
  • 35 Gear M W. The late results of meniscectomy.  Br J Surg. 1967;  54(4) 270-272
  • 36 Bassett F H, Harrelson J M. Meniscectomy in osteoarthritis.  Clin Orthop Relat Res. 1974;  (101) 53-60
  • 37 Benninghoff A. Form und Bau der Gelenkknorpel in ihren Beziehungen zur Funktion.  Z Zellforsch Mikrosk Anat. 1925;  2 783-862
  • 38 Crues III J V, Mink J, Levy T L, Lotysch M, Stoller D W. Meniscal tears of the knee: accuracy of MR imaging.  Radiology. 1987;  164(2) 445-448
  • 39 Sproule J A, Khan F, Rice J J, Nicholson P, McElwain J P. Altered signal intensity in the posterior horn of the medial meniscus: an MR finding of questionable significance.  Arch Orthop Trauma Surg. 2005;  125(4) 267-271
  • 40 De Smet A A, Norris M A, Yandow D R, Quintana F A, Graf B K, Keene J S. MR diagnosis of meniscal tears of the knee: importance of high signal in the meniscus that extends to the surface.  AJR Am J Roentgenol. 1993;  161(1) 101-107
  • 41 Rubin D A, Harner C D, Costello J M. Treatable chondral injuries in the knee: frequency of associated focal subchondral edema.  AJR Am J Roentgenol. 2000;  174(4) 1099-1106
  • 42 Helms C A. The meniscus: recent advances in MR imaging of the knee.  AJR Am J Roentgenol. 2002;  179(5) 1115-1122
  • 43 Rubin D A, Kneeland J B. MR imaging of the musculoskeletal system: technical considerations for enhancing image quality and diagnostic yield.  AJR Am J Roentgenol. 1994;  163(5) 1155-1163
  • 44 Escobedo E M, Hunter J C, Zink-Brody G C, Wilson A J, Harrison S D, Fisher D J. Usefulness of turbo spin-echo MR imaging in the evaluation of meniscal tears: comparison with a conventional spin-echo sequence.  AJR Am J Roentgenol. 1996;  167(5) 1223-1227
  • 45 Peterfy C G, Janzen D L, Tirman P F, van Dijke C F, Pollack M, Genant H K. “Magic-angle” phenomenon: a cause of increased signal in the normal lateral meniscus on short-TE MR images of the knee.  AJR Am J Roentgenol. 1994;  163(1) 149-154
  • 46 Farley T E, Howell S M, Love K F, Wolfe R D, Neumann C H. Meniscal tears: MR and arthrographic findings after arthroscopic repair.  Radiology. 1991;  180(2) 517-522
  • 47 Burke B J, Escobedo E M, Wilson A J, Hunter J C. Chondrocalcinosis mimicking a meniscal tear on MR imaging.  AJR Am J Roentgenol. 1998;  170(1) 69-70
  • 48 Justice W W, Quinn S F. Error patterns in the MR imaging evaluation of menisci of the knee.  Radiology. 1995;  196(3) 617-621
  • 49 Burk Jr D L, Dalinka M K, Kanal E et al.. Meniscal and ganglion cysts of the knee: MR evaluation.  AJR Am J Roentgenol. 1988;  150(2) 331-336
  • 50 Tuckman G A, Miller W J, Remo J W, Fritts H M, Rozansky M I. Radial tears of the menisci: MR findings.  AJR Am J Roentgenol. 1994;  163(2) 395-400
  • 51 Wright D H, De Smet A A, Norris M. Bucket-handle tears of the medial and lateral menisci of the knee: value of MR imaging in detecting displaced fragments.  AJR Am J Roentgenol. 1995;  165(3) 621-625
  • 52 Helms C A, Laorr A, Cannon Jr W D. The absent bow tie sign in bucket-handle tears of the menisci in the knee.  AJR Am J Roentgenol. 1998;  170(1) 57-61
  • 53 Campbell S E, Sanders T G, Morrison W B. MR imaging of meniscal cysts: incidence, location, and clinical significance.  AJR Am J Roentgenol. 2001;  177(2) 409-413
  • 54 Cothran Jr R L, Major N M, Helms C A, Higgins L D. MR imaging of meniscal contusion in the knee.  AJR Am J Roentgenol. 2001;  177(5) 1189-1192
  • 55 Stoller D W, Martin C, Crues III J V, Kaplan L, Mink J H. Meniscal tears: pathologic correlation with MR imaging.  Radiology. 1987;  163(3) 731-735
  • 56 Kaplan P A, Nelson N L, Garvin K L, Brown D E. MR of the knee: the significance of high signal in the meniscus that does not clearly extend to the surface.  AJR Am J Roentgenol. 1991;  156(2) 333-336
  • 57 LaPrade R F, Burnett Q M, Veenstra M A, Hodgman C G. The prevalence of abnormal magnetic resonance imaging findings in asymptomatic knees. With correlation of magnetic resonance imaging to arthroscopic findings in symptomatic knees.  Am J Sports Med. 1994;  22(6) 739-745
  • 58 Mink J H, Levy T, Crues III J V. Tears of the anterior cruciate ligament and menisci of the knee: MR imaging evaluation.  Radiology. 1988;  167(3) 769-774
  • 59 Rubin D A, Paletta Jr G A. Current concepts and controversies in meniscal imaging.  Magn Reson Imaging Clin N Am. 2000;  8(2) 243-270
  • 60 Matava M J, Eck K, Totty W, Wright R W, Shively R A. Magnetic resonance imaging as a tool to predict meniscal reparability.  Am J Sports Med. 1999;  27(4) 436-443
  • 61 DeHaven K E. Meniscus repair.  Am J Sports Med. 1999;  27(2) 242-250
  • 62 Clark C R, Ogden J A. Development of the menisci of the human knee joint. Morphological changes and their potential role in childhood meniscal injury.  J Bone Joint Surg Am. 1983;  65(4) 538-547
  • 63 Lento P H, Akuthota V. Meniscal injuries: a critical review.  J Back Musculoskeletal Rehabil. 2000;  15(2–3) 55-62
  • 64 Biedert R M. Treatment of intrasubstance meniscal lesions: a randomized prospective study of four different methods.  Knee Surg Sports Traumatol Arthrosc. 2000;  8(2) 104-108
  • 65 Fox M G. MR imaging of the meniscus: review, current trends, and clinical implications.  Magn Reson Imaging Clin N Am. 2007;  15(1) 103-123
  • 66 Henning C E, Lynch M A, Clark J R. Vascularity for healing of meniscus repairs.  Arthroscopy. 1987;  3(1) 13-18
  • 67 Verdonk R. Meniscal transplantation.  Acta Orthop Belg. 2002;  68(2) 118-127
  • 68 Verdonk R, Almqvist K F, Huysse W, Verdonk P C. Meniscal allografts: indications and outcomes.  Sports Med Arthrosc. 2007;  15(3) 121-125
  • 69 Nawata M, Wakitani S, Nakaya H et al.. Use of bone morphogenetic protein 2 and diffusion chambers to engineer cartilage tissue for the repair of defects in articular cartilage.  Arthritis Rheum. 2005;  52(1) 155-163
  • 70 Verdonk P C, Verstraete K L, Almqvist K F et al.. Meniscal allograft transplantation: long-term clinical results with radiological and magnetic resonance imaging correlations.  Knee Surg Sports Traumatol Arthrosc. 2006;  14(8) 694-706
  • 71 Kelly B T, Robertson W, Potter H G et al.. Hydrogel meniscal replacement in the sheep knee—preliminary evaluation of chondroprotective effects.  Am J Sports Med. 2007;  35(1) 43-52
  • 72 de Boer H H, Koudstaal J. The fate of meniscus cartilage after transplantation of cryopreserved nontissue-antigen-matched allograft. A case report.  Clin Orthop Relat Res. 1991;  (266) 145-151
  • 73 Garrett J C, Steensen R N. Meniscal transplantation in the human knee: a preliminary report.  Arthroscopy. 1991;  7(1) 57-62
  • 74 Verstraete K L, Verdonk R, Lootens T, Verstraete P, De R J, Kunnen M. Current status and imaging of allograft meniscal transplantation.  Eur J Radiol. 1997;  26(1) 16-22
  • 75 Cole B J, Carter T R, Rodeo S A. Allograft meniscal transplantation: background, techniques, and results.  Instr Course Lect. 2003;  52 383-396
  • 76 Peters G, Wirth C J. The current state of meniscal allograft transplantation and replacement.  Knee. 2003;  10(1) 19-31
  • 77 Kuhn J E, Wojtys E M. Allograft meniscus transplantation.  Clin Sports Med. 1996;  15(3) 537-556
  • 78 Arnoczky S P, DiCarlo E F, O'Brien S J, Warren R F. Cellular repopulation of deep-frozen meniscal autografts: an experimental study in the dog.  Arthroscopy. 1992;  8(4) 428-436
  • 79 Jackson D W, Whelan J, Simon T M. Cell survival after transplantation of fresh meniscal allografts. DNA probe analysis in a goat model.  Am J Sports Med. 1993;  21(4) 540-550
  • 80 Fabbriciani C, Lucania L, Milano G, Schiavone P A, Evangelisti M. Meniscal allografts: cryopreservation vs deep-frozen technique. An experimental study in goats.  Knee Surg Sports Traumatol Arthrosc. 1997;  5(2) 124-134
  • 81 Pollard M E, Kang Q, Berg E E. Radiographic sizing for meniscal transplantation.  Arthroscopy. 1995;  11(6) 684-687
  • 82 Verdonk P CM, Demurie A, Almqvist F, Veys E M, Verbruggen G, Verdonk R. Transplantation of viable meniscal allograft. Survivorship analysis and clinical outcome of one hundred cases.  J Bone Joint Surg Am. 2005;  87(4) 715-724
  • 83 Alford W, Cole B J. The indications and technique for meniscal transplant.  Orthop Clin North Am. 2005;  36(4) 469
  • 84 Kohn D. Autograft meniscus replacement: experimental and clinical results.  Knee Surg Sports Traumatol Arthrosc. 1993;  1(2) 123-125
  • 85 Kohn D, Verdonk R, Aagaard H, Seil R, Dienst M. Meniscal substitutes—animal experience.  Scand J Med Sci Sports. 1999;  9(3) 141-145
  • 86 Kohn D, Aagaard H, Verdonk R, Dienst M, Seil R. Postoperative follow-up and rehabilitation after meniscus replacement.  Scand J Med Sci Sports. 1999;  9(3) 177-180
  • 87 Stone K R, Steadman J R, Rodkey W G, Li S T. Regeneration of meniscal cartilage with use of a collagen scaffold. Analysis of preliminary data.  J Bone Joint Surg Am. 1997;  79(12) 1770-1777
  • 88 Kon E, Chiari C, Marcacci M et al.. Tissue engineering for total meniscal substitution: animal study in sheep model.  Tissue Eng Part A. 2008;  14(6) 1067-1080
  • 89 de Groot J H. Polyurethane scaffolds for meniscal tissue regeneration.  Med Device Technol. 2005;  16(7) 18-20
  • 90 Buma P, van Tienen T, Veth R. The collagen meniscus implant.  Expert Rev Med Devices. 2007;  4(4) 507-516
  • 91 Recht M P, Kramer J. MR imaging of the postoperative knee: a pictorial essay.  Radiographics. 2002;  22(4) 765-774
  • 92 Deutsch A L, Mink J H, Fox J M et al.. Peripheral meniscal tears: MR findings after conservative treatment or arthroscopic repair.  Radiology. 1990;  176(2) 485-488
  • 93 Smith D K, Totty W G. The knee after partial meniscectomy: MR imaging features.  Radiology. 1990;  176(1) 141-144
  • 94 Totty W G, Matava M J. Imaging the postoperative meniscus.  Magn Reson Imaging Clin N Am. 2000;  8(2) 271-283
  • 95 Verstraete K L, Vanderwoude H J, Hogendoorn P CW, Dedeene Y, Kunnen M, Bloem J L. Dynamic contrast-enhanced MR imaging of musculoskeletal tumors: basic principles and clinical applications.  J Magn Reson Imaging. 1996;  6(2) 311-321
  • 96 Verstraete K L, Verstraete P, Lootens T, De Rooy J W, Kunnen M, Verdonk R. Spectrum of MR imaging findings of meniscal allografts: clinical and arthroscopic correlation.  Radiology. 1996;  201(P) 432 , Abstract
  • 97 Potter H G, Rodeo S A, Wickiewicz T L, Warren R F. MR imaging of meniscal allografts: correlation with clinical and arthroscopic outcomes.  Radiology. 1996;  198(2) 509-514
  • 98 Patten R M, Rolfe B A. MRI of meniscal allografts.  J Comput Assist Tomogr. 1995;  19(2) 243-246
  • 99 Verdonk P, Depaepe Y, Desmyter S et al.. Normal and transplanted lateral knee menisci: evaluation of extrusion using magnetic resonance imaging and ultrasound.  Knee Surg Sports Traumatol Arthrosc. 2004;  12(5) 411-419
  • 100 van Arkel E RA, Goei R, de Ploeg I, de Boer H H. Meniscal allografts: evaluation with magnetic resonance imaging and correlation with arthroscopy.  Arthroscopy. 2000;  16(5) 517-521
  • 101 Costa C R, Morrison W B, Carrino J A. Medial meniscus extrusion on knee MRI: is extent associated with severity of degeneration or type of tear?.  AJR Am J Roentgenol. 2004;  183(1) 17-23
  • 102 Gale D R, Chaisson C E, Totterman S M, Schwartz R K, Gale M E, Felson D. Meniscal subluxation: association with osteoarthritis and joint space narrowing.  Osteoarthritis Cartilage. 1999;  7(6) 526-532
  • 103 Thornton D D, Rubin D A. Magnetic resonance imaging of the knee menisci.  Semin Roentgenol. 2000;  35(3) 217-230
  • 104 Verstraete K L, Verstraete P, Lootens T, De Rooy J W, Kunnen M, Verdonk R. Spectrum of MR imaging findings of meniscal allografts, with clinical and arthroscopic correlation.  Radiology. 1996;  201(P) 537 , Abstract
  • 105 Hoben G M, Athanasiou K A. Meniscal repair with fibrocartilage engineering.  Sports Med Arthrosc. 2006;  14(3) 129-137
  • 106 Buma P, Ramrattan N N, van Tienen T G, Veth R P. Tissue engineering of the meniscus.  Biomaterials. 2004;  25(9) 1523-1532
  • 107 Buma P, van T T, Veth R. The collagen meniscus implant.  Expert Rev Med Devices. 2007;  4(4) 507-516
  • 108 Stone K R, Steadman J R, Rodkey W G, Li S T. Regeneration of meniscal cartilage with use of a collagen scaffold. Analysis of preliminary data.  J Bone Joint Surg Am. 1997;  79(12) 1770-1777
  • 109 Rodkey W G, DeHaven K E, Montgomery III W H et al.. Comparison of the collagen meniscus implant with partial meniscectomy. A prospective randomized trial.  J Bone Joint Surg Am. 2008;  90(7) 1413-1426
  • 110 Zaffagnini S, Giordano G, Vascellari A et al.. Arthroscopic collagen meniscus implant results at 6 to 8 years follow up.  Knee Surg Sports Traumatol Arthrosc. 2007;  15(2) 175-183
  • 111 Huysse W CJ, Verdonk R, Verdonk P, Verstraete K. Imaging findings after meniscal repair with degradable polyurethane scaffold: preliminary results.  Skeletal Radiol. 2008;  37 593

Wouter C. J HuysseM.D. 

Department of Radiology, Ghent University Hospital

De Pintelaan 185, -1K12 IB, 9000 Gent, Belgium

eMail: Wouter.huysse@ugent.be

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