Diagnostic IRM des lambeaux méniscaux médiaux déplacés le long du ligament tibial collatéral

Hir, Pierre Le; Charousset, Christophe; Duranthon, L.-D.; Grimberg, Jean; Schmider, L; Elis, J.-B.; Chassaing, V.; Laude, F.

doi:10.1016/s0035-1040(07)90277-9

Cited by 10 publications

(3 citation statements)

References 14 publications

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“…MR imaging is the most precise and least invasive diagnostic test for a MSMFT, thus avoiding unnecessary arthroscopies [10, 24]. Hir et al [16] showed that the indirect sign of a truncated free edge of the posterior and/or middle segment of the medial meniscus or a reduction in height of the posterior segment of the medial meniscus was found in 95% of these cases on MR imaging. These results support the study by Van de Berg et al [25] in which the presence of truncation of the free edge of the meniscus had a sensitivity of 64% and a specificity of 77% for the diagnosis of a displaced meniscal fragment in the meniscal recess.…”

Section: Discussionmentioning

confidence: 99%

The “sleeper’s sign” is valid and suggestive of a medial sub-meniscal flap tear

Lefèvre

Klouche²,

Sezer

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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Purpose To describe, evaluate and validate the diagnostic performance of a new clinical sign, the sleeper's sign, for the diagnosis of a medial submeniscal lap tear (MSMFT). Methods This retrospective single-center series included patients aged 18-55 years old who underwent arthroscopic treatment in 2013-2015 for a medial meniscal tear. This study was performed according to STARD (standards for reporting of diagnostic accuracy) guidelines, and the reference test was a peroperative diagnosis of a MSMFT. The preoperative consultation reports were all analyzed to search for the sleeper's sign, deined as night time medial tibiofemoral pain when the patient is in the fetal position with both knees in contact and no pain during daytime activities. Results Three-hundred and ten patients responded to the study criteria, mean age 41.7 ± 9.7 years old. The sleeper's sign was identiied in 39 (12.6%) patients and a MSMFT was conirmed during arthroscopy in 47 (15.2%) cases, with signiicant agreement between this sign, arthroscopy (kappa = 0.78, p = 10 -4 ) and MR-imaging (kappa = 0.72, p < 0.0001). The performance parameters of the sleeper's sign were: sensitivity 74.5 ± 12.5%, speciicity 98.5 ± 1.6%, Youden index 0.73 and accuracy 96.9%. MR imaging was found to be more sensitive (91.5 ± 8%). Multivariate analysis identiied the sleeper's sign as a risk factor of MSMFT during arthroscopy: OR 131.9 CI 95% [26.9-646.2], p < 0.0001 and a bone edema next to the lap tear on MR-imaging: OR 13, CI 95% [1.9-7.1], p = 0.008. ConclusionThe "sleeper's sign" is a new, valid, highly speciic clinical sign for the diagnosis of a medial submeniscal lap tear. MRI was found to be more sensitive than the sleeper's sign. Level of evidence II.

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Section: Discussionmentioning

confidence: 99%

The “sleeper’s sign” is valid and suggestive of a medial sub-meniscal flap tear

Lefèvre

Klouche²,

Sezer

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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“…The unstable flap can subsequently displace out of the compartment to the meniscal recess or intercondylar notch. Displacement of the flap inferiorly to the meniscotibial recess is more common than superior displacement to the meniscofemoral recess 15, 16. Instability and migration of the fragment results in pain and mechanical symptoms that are often recalcitrant to conservative treatment.…”

Section: Discussionmentioning

confidence: 99%

The Meniscal Grammar Signs: Comma and Apostrophe Signs for Characterization of a Displaced Fragment in the Meniscal Recess

Bassett

Hadley

Tjoumakaris

et al. 2019

Arthroscopy Techniques

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Vertical flap tears, or parrot beak flap tears, are oblique tears of the meniscus thought to originate as a central radial tear and propagate longitudinally towards the periphery, generating a partially detached unstable fragment that can subsequently displace into the meniscal recess. Although magnetic resonance imaging (MRI) is frequently used to diagnose and characterize meniscus pathology, imaging findings for displaced flap tears are not well described in the literature. The recently published meniscal comma sign describes inferior displacement of a meniscus flap tear into the meniscotibial recess that, when seen on MRI, resembles a comma. In the present article, we define the meniscal apostrophe sign, characterized by superior displacement of a meniscus flap tear into the meniscofemoral recess found on MRI. Displaced fragments in the meniscal recess are crucial to identify, as they often result in significant pain and mechanical symptoms related to tenting of the deep medial collateral ligament, which responds poorly to nonoperative treatment. Misdiagnosis of these unstable flap tears as degenerative meniscus extrusion or isolated progression of osteoarthritis can lead to a delay in treatment.

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“…Evaluation of meniscal structure, through histological analysis, allows to assess the severity of meniscal tears and the effectiveness of healing process after meniscal repair ex vivo. However, current methods for the evaluation of meniscal tears are based on macroscopic and imaging findings [4, 14, 22, 28, 30, 59, 64]. A common histological scoring system should be developed to detect in vivo and in vitro changes of meniscal fibrocartilage.…”

Section: Discussionmentioning

confidence: 99%