Abstract
Background
Medial posterior horn meniscal tear is difficult to visualise during arthroscopy and is occasionally undetected by preoperative magnetic resonance imaging (MRI). Consequently, attention should be paid to performing a thorough examination and to some characteristic signs that indicate occult meniscal tear. The purpose of this study was to assess an indicative correlation between arthroscopic features of cartilage injury and a concomitant occult meniscal tear.
Methods
We performed a retrospective clinical and radiographic study of a consecutive series of patients between January 2013 and December 2014. Of 1,596 patients, all 78 with wave-like chondral injury of the medial femoral condyle diagnosed at arthroscopy were included in the study. The occurrence, pattern, location and concomitant pathology of medial meniscal injury were analysed.
Results
The characteristic wave sign associated with chondral injury in the medial femoral condyle was detected by MRI preoperatively in two cases only; all others were discovered intraoperatively at arthroscopy. Cartilage injury was rated as Outerbridge type II in 53 patients, type III in 24, and type IV in one. Wave sign defects were all characterised by their transverse orientation in the load-bearing femoral condyle. The occult longitudinal peripheral meniscus tear of the posterior horn was seen in all patients with a positive wave sign visualised under arthroscopy. The wave sign was positively correlated with medial peripheral meniscal injury of the posterior horn (P < 0.01).
Conclusion
Wave sign chondral injury in the medial femoral condyle seen at arthroscopy is a characteristic indicator for concomitant occult medial longitudinal peripheral meniscus tears of the posterior horn.
Level of evidence
Case series, Level IV.
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References
Ahn JH, Bae TS, Kang KS, Kang SY, Lee SH (2011) Longitudinal tear of the medial meniscus posterior horn in the anterior cruciate ligament-deficient knee significantly influences anterior stability. Am J Sports Med 39(10):2187–2193
Chambers S, Cooney A, Caplan N, Dowen D, Kader D (2014) The accuracy of magnetic resonance imaging (MRI) in detecting meniscal pathology. J R Nav Med Serv 100(2):157–160
Lubowitz JH, Rossi MJ, Baker BS, Guttmann D (2004) Arthroscopic visualization of the posterior compartments of the knee. Arthroscopy 20(7):675–680
Yan R, Wang H, Yang Z, Ji ZH, Guo YM (2011) Predicted probability of meniscus tears: comparing history and physical examination with MRI. Swiss Med Wkly 141:w13314
Hirtler L, Unger J, Weninger P (2015) Acute and chronic menisco-capsular separation in the young athlete: diagnosis, treatment and results in thirty seven consecutive patients. Int Orthop. [Epub ahead of print]
Yoo JC, Ahn JH SH, Yoon YC (2009) Increasing incidence of medial meniscal tears in nonoperatively treated anterior cruciate ligament insufficiency patients documented by serial magnetic resonance imaging studies. Am J Sports Med 37(8):1478–1483
De Maeseneer M, Shahabpour M, Vanderdood K, Van Roy F, Osteaux M (2002) Medial meniscocapsular separation: MR imaging criteria and diagnostic pitfalls. Eur J Radiol 41(3):242–252
Amin KB, Cosgarea AJ, Kaeding CC (1999) The value of intercondylar notch visualization of the posteromedial and posterolateral compartments during knee arthroscopy. Arthroscopy 15(8):813–817
Levy AS, Meier SW (2003) Approach to cartilage injury in the anterior cruciate ligament-deficient knee. Orthop Clin N Am 34:149–167
Smith JP 3rd, Barrett GR (2001) Medial and lateral meniscal tear patterns in anterior cruciate ligament-deficient knees: a prospective analysis of 575 tears. Am J Sports Med 29:415–419
Plymale M, Fleisig GS, Kocaj SM, Cooney WP, Evans TJ, Cain EL, Dugas JR (2014) Visualization and reduction of a mensical capsular junction tear in the knee: an arthroscopic surgical technique. Am J Orthop (Belle Mead NJ) 43(11):498–500
Kim YM, Joo YB, Cha SM, Hwang JM (2012) Role of the mechanical axis of lower limb and body weight in the horizontal tear and root ligament tear of the posterior horn of the medial meniscus. Int Orthop 36(9):1849–1855
Choi YR, Kim JH, Chung JH, Lee DH, Ryu KJ, Ha DH, Dan J, Lee SM (2014) The association between meniscal subluxation and cartilage degeneration. Eur J Orthop Surg Traumatol 24(1):79–84
Allen CR, Wong EK, Livesay GA, Sakane M, Fu FH, Woo SL (2000) Importance of the medial meniscus in the anterior cruciate ligament–deficient knee. J Orthop Res 18:109–115
Lewandrowski KU, Müller J, Schollmeier G (1997) Concomitant meniscal and articular cartilage lesions in the femorotibial joint. Am J Sports Med 25(4):486–494
Feucht MJ, Bigdon S, Mehl J, Bode G, Müller-Lantzsch C, Südkamp NP, Niemeyer P (2015) Risk factors for posterior lateral meniscus root tears in anterior cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc 23(1):140–145
Austin B, Montgomery RD, Wright J, Bellah JR, Tonks C (2007) Evaluation of three approaches to meniscal release. Vet Comp Orthop Traumatol 20(2):92–97
Vega J, Golanó P, Peña F (2014) Iatrogenic articular cartilage injuries during ankle arthroscopy. Knee Surg Sports Traumatol Arthrosc. [Epub ahead of print]
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Zhang, X., You, T., Jiang, X. et al. Characteristic arthroscopic signs of cartilage injuries indicating concomitant occult medial meniscal peripheral tears of posterior horn. International Orthopaedics (SICOT) 40, 191–195 (2016). https://doi.org/10.1007/s00264-015-2759-x
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DOI: https://doi.org/10.1007/s00264-015-2759-x