Degenerative Medial Meniscus Tear With a Displaced Flap Into the Meniscotibial Recess and Tibial Peripheral Reactive Bone Edema Presents Good Results With Arthroscopic Surgical Treatment

Helito, Camilo Partezani; Helito, Paulo Victor Partezani; Sobrado, Marcel Faraco; Giglio, Pedro Nogueira; Guimarães, Tales Mollica; Pécora, José Ricardo; Gobbi, Riccardo Gomes; Rodrigues, Marcelo Bordalo; Berg, Bruno

doi:10.1016/j.arthro.2021.04.033

Cited by 7 publications

(6 citation statements)

References 29 publications

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“…There is a broad spectrum of pathologies that can lead to signal changes around the knee joint (22) . As mentioned in previous studies on this topic (6)(7)(8)10) , a displaced meniscal flap is often mistaken for a simple meniscus extrusion; it is therefore important to characterize the resulting edema in order to distinguish between the two.…”

Section: Discussionmentioning

confidence: 99%

“…Degenerative lesions with flaps displaced into the meniscotibial recess may also benefit from surgical treatment. Helito et al ( 8 ) showed that only approximately 20% of patients with such lesions improved with conservative treatment, the remaining patients being submitted to surgical treatment. The challenge in this type of lesion is to determine whether the edema is due to the displacement of the meniscal flap or to a more global overload in the compartment, which might not improve with surgical treatment ( 21 ) .…”

Section: Discussionmentioning

confidence: 99%

“…The characterization of tibial edema related to cases of inferior displacement of a meniscal flap tear is another practical tool for the correct diagnosis of this pathology and the possible indication of surgical treatment for flap resection and pain reduction. Helito et al ( 8 ) showed that the postoperative evolution after flap resection was unsatisfactory only in smokers and patients with varus alignment. It is still unknown whether flap resection leads to the reduction or resolution of tibial edema.…”

Section: Discussionmentioning

confidence: 99%

“…The terms “osteomeniscal impingement”, “osteomeniscal impact”, “osteomeniscal impact edema”, and “meniscal comma sign” have all been used to characterize this pathology. Helito et al ( 8 ) , Herschmiller et al ( 9 ) , Krych et al ( 7 ) , Lecas et al ( 10 ) , and Jung et al ( 11 ) have suggested that surgical treatment produces good results for this type of lesion. To date, the associated edema has been characterized and localized only in a subjective manner, the observations having included only whether the edema is focal on the tibial periphery or diffuse throughout the tibial plateau, without objective parameters that could provide a more precise characterization.…”

Section: Introductionmentioning

confidence: 99%

“…However, those authors did not determine the exact location of the edema. In the preoperative evaluation, it is important to describe the location and extent of such edema because lesions associated with greater overload and degeneration tend to show less improvement after surgical treatment, although surgery can be successful if the edema is caused by a flap tear displaced into the meniscotibial recess ( 8 ) .…”

Section: Introductionmentioning

confidence: 99%

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Where is tibial edema located in cases of osteomeniscal impingement?

et al. 2023

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Objective: To characterize the location of tibial edema related to meniscal degeneration with a flap displaced into the meniscotibial recess (osteomeniscal impingement) on magnetic resonance imaging (MRI). Materials and Methods: We evaluated 40 MRI examinations of patients submitted to surgery due to inferior displacement of a meniscal flap tear into the meniscotibial recess and peripheral bone edema. Tibial edema was quantified in the coronal and axial planes. Results: On coronal MRI sequences, edema started in the tibial periphery and extended for a mean of 5.6 ± 1.4 mm, or 7.4 ± 2.1% of the tibial plateau. In the craniocaudal direction, the mean extension was 8.8 ± 2.9 mm. The mean ratio between the extent of craniocaudal and mediolateral edema was 1.6 ± 0.6. In the axial plane, the edema started in the medial periphery and extended for a mean of 6.2 ± 2.0 mm, or 8.2 ± 2.9% of the tibial plateau. In the anteroposterior measurement, the mean start and end of the edema was 21.4 ± 5.4 mm and 35.7 ± 5.7 mm, respectively, or 43.4 ± 10.2% and 72.8 ± 11.1% of the tibial plateau. Conclusion: Apparently, tibial edema resulting from osteomeniscal impingement always starts in the periphery of the meniscus. In the coronal plane, it appears to be more extensive in the craniocaudal direction than in the mediolateral direction. In the axial plane, we found it to extend, on average, approximately 6.2 mm in the mediolateral direction and to be most commonly located from the center to the posterior region of the medial tibial plateau.

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