A spreading roots sign: Characteristic sign of the preliminary stage of medial meniscus posterior root tear on magnetic resonance imaging

Nakamura, Ryuichi; Okano, Akira; Yoshida, Ippei; Shimakawa, Tomoyuki

doi:10.1016/j.jos.2021.07.005

Cited by 13 publications

(13 citation statements)

References 21 publications

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“…Nakamura et al. found that the appearance of SRS was consistent with a set of precursory symptoms and recommended SRS as a precursory sign of MMPRTs [ 14 ]. Similar to SRS, a posterior shiny-corner lesion (PSCL) was reported to be one of the helpful MRI findings after MMPRTs [ 36 , 37 ].…”

Section: Discussionmentioning

confidence: 99%

“…In addition to the WORMS evaluation, SRS was diagnosed as a BML spreading out like roots from the attachment of the medial meniscus posterior root on the coronal plane of the MRI images [ 14 ] (Fig. 3 ).…”

Section: Methodsmentioning

confidence: 99%

“…The posterior tibial slope (PTS) is a potential risk factor for medial meniscus posterior root tears (MMPRTs) [ 8 – 10 ] and is reportedly associated with the development and progression of knee OA via joint overloading [ 11 – 13 ]. Recently, the spreading root sign (SRS), a type of BML spreading out like roots from the attachment of the medial meniscus posterior root, has been reported to be an important MRI finding in the preliminary stage of MMPRT development [ 14 ]. Although this lesion may be affected by intrinsic tibial morphology, its association has not been revealed.…”

Section: Introductionmentioning

confidence: 99%

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Greater medial proximal tibial slope is associated with bone marrow lesions in middle-aged women with early knee osteoarthritis

Ishibashi,

Sasaki,

Ishibashi

et al. 2023

J Orthop Traumatol

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Background Bone marrow lesion (BML) is an important magnetic resonance finding (MRI) finding that predicts knee osteoarthritis. The purpose of this study was to investigate the influence of proximal tibial morphology on BML, including the spreading root sign (SRS), in women without radiographic knee osteoarthritis (OA). It was hypothesized that varus alignment and a greater posterior tibial slopes (PTS) are associated with BML. Materials and methods A total of 359 female volunteers without knee OA who were participants in the Iwaki Health Promotion Project in 2017 or 2019 were enrolled. Participants were divided into the non-OA and early knee OA (EKOA) groups based on the Luyten’s classification criteria. The presence of pathological cartilage lesions, BMLs, attritions, meniscal lesions and effusions was scored on T2-weighted fat-suppressed magnetic resonance imaging (MRI) according to the Whole-Organ MRI Scoring system. The medial proximal tibial angle (MPTA) and medial and lateral PTS (MPTS and LPTS, respectively) were measured. Regression and receiver operating characteristic (ROC) analyses were performed to reveal the relationship between BMLs and proximal tibial morphological parameters. Results Of the 359 participants, 54 (15%) were classified as having EKOA. The prevalence of cartilage lesions, BMLs, attritions, meniscal lesions and effusions was higher in the EKOA group than in the non-OA group. The two groups had no significant difference in the proximal tibial parameters. Regression analysis revealed that age and a smaller MPTA were associated with BML in both groups. Attrition (p = 0.029) and the MPTS (p = 0.025) were positively associated with BML in the EKOA group. Conclusion The prevalence of BMLs was higher in women with EKOA and correlated with the varus and greater posterior slopes in those without radiographic knee OA. Level of evidence Level III, retrospective case–control study.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Greater medial proximal tibial slope is associated with bone marrow lesions in middle-aged women with early knee osteoarthritis

Ishibashi,

Sasaki,

Ishibashi

et al. 2023

J Orthop Traumatol

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“…The most important finding of this study was that the cleft width significantly increased during knee flexion, which would help diagnose MMPRT. Several characteristic MRI signs detect MMPRT, which have high diagnostic sensitivity [8, 18, 21, 24]. Despite several characteristic signs of MMPRT, the diagnosis of MMPRT remains difficult for clinicians or radiologists who are unfamiliar with this pathology.…”

Section: Discussionmentioning

confidence: 99%

Increased cleft width during knee flexion is useful for the diagnosis of medial meniscus posterior root tears

Hiranaka

Kamatsuki

Miyazawa

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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PurposeThis study aimed to evaluate changes in the cleft width, defined as the distance between the lateral edge of the medial tibial plateau and that of the medial meniscus (MM) posterior root, using open magnetic resonance imaging (MRI) in patients with MM posterior root tear (MMPRT). MethodsThis study included 25 patients (20 women and 5 men; mean age: 65.2 years) who were diagnosed with MMPRT and underwent pullout repair. Upon coronal imaging, the cleft width was evaluated at the 10° and 90° flexed knee positions. The difference in the cleft width (defined as the cleft width at 90° minus the cleft width at 10°) was also calculated. Upon sagittal imaging, the MM posterior extrusion (MMPE) at 90° was also evaluated. Separate univariate linear regression models were used to determine the association between the time from injury to MRI and radiographic measurements. ResultsThe mean cleft width at 10° and 90° was 4.9 ± 2.6 mm and 7.4 ± 3.7 mm, respectively; the mean difference in cleft width was 2.5 ± 1.5 mm, and the mean MMPE at 90° was 3.7 ± 1.3 mm. There was a significant difference in cleft width at 10° and 90° (p < 0.001). The time from injury to MRI was significantly associated with the cleft width at 10° (R = 0.42; p = 0.023), cleft width at 90° (R = 0.59; p = 0.002), the difference in the cleft width (R = 0.62; p = 0.008), and MMPE at 90° (R = 0.53; p = 0.008). ConclusionThis study demonstrates that the cleft width is significantly larger during knee flexion than during knee extension. Increased cleft width during knee flexion (“graben” sign) may help diagnose MMPRT, especially in cases where the cleft sign is unclear during knee extension. Level of evidenceIII.

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“…However, MMPRT repair alone does not guarantee an optimal result 4 , 5 owing to meniscal extrusion, 6 varus alignment, 2 and medial/posterior tibial slope. 7 , 8 To address this issue, we began performing MMPRT repair combined with meniscal centralization and high tibial osteotomy (HTO) 8 , 9 to reduce meniscal extrusion and to eliminate malalignments, respectively. However, contrary to our expectations, some second-look arthroscopies showed a stretched root with scar healing.…”

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confidence: 99%

Double-Row Root Repair with Bridging Centralization Using Double Nonsliding Anchors for Medial Meniscus Posterior Root Tear

Nakamura,

Kawashima,

Amemiya

et al. 2023

Arthroscopy Techniques

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A spreading roots sign: Characteristic sign of the preliminary stage of medial meniscus posterior root tear on magnetic resonance imaging

Cited by 13 publications

References 21 publications

Greater medial proximal tibial slope is associated with bone marrow lesions in middle-aged women with early knee osteoarthritis

Greater medial proximal tibial slope is associated with bone marrow lesions in middle-aged women with early knee osteoarthritis

Increased cleft width during knee flexion is useful for the diagnosis of medial meniscus posterior root tears

Double-Row Root Repair with Bridging Centralization Using Double Nonsliding Anchors for Medial Meniscus Posterior Root Tear

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