Meniscal Extrusion: A Narrative Review

Gajjar, Shreyash M.; Solanki, Ketansinh; Shanmugasundaram, Saseendar; Kambhampati, Srinivas B. S.

doi:10.1177/23259671211043797

Cited by 23 publications

(15 citation statements)

References 79 publications

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“…28 However, several problems are encountered with these modalities, including limited knee flexion angles, unreliable loading, and measurement repeatability. 15 Previous biomechanical studies had other limitations. Those that focused on meniscal dynamics and associated functions involved manual measurement of meniscal displacement and the use of pressure sensors to estimate the effect of meniscal movement.…”

Section: Discussionmentioning

confidence: 99%

Meniscal Displacement and Loss of Load-Transmission Function After Radial Tear of the Lateral Meniscus in a Porcine Model: New Insights Into the Functional Dynamics of the Injured Meniscus

et al. 2022

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Background: Meniscal extrusion/translation has been used as an index for meniscal treatment. However, the relationship between meniscal displacement and the degree of meniscal tear or load–transmission function of the lateral meniscus (LM) remains unclear. Purpose: To clarify the relationship between the width of the radial tear of the LM and (1) meniscal displacement or (2) resultant force through the meniscus under axial compressive load in the porcine model. Study Design: Controlled laboratory study. Methods: Eight intact porcine knees with or without a partial radial tear at the midbody of the LM (involving 30%, 60%, or 90% of its width) were investigated. Reflective markers were attached to the outer wall of the anterior, anteromiddle, posteromiddle, and posterior segments of the LM. A 300-N axial load was applied at 2 flexion angles (30° and 60°), and the 3–dimensional forces and trajectories of the knees were recorded. Marker movements were simultaneously tracked using a motion capture camera system. After total meniscectomy of the LM, the recorded knee trajectories were reproduced, and the resultant force through the LM was calculated (a force carried only by the meniscus in response to a load applied to the whole knee joint). Results: At both flexion angles, the change in distance (mean ± SD) between the anterior and posterior markers under load increased significantly more in the anteroposterior direction in LMs with a 90% tear than in intact LMs (30°, 0.4 ± 0.3 vs 1.4 ± 0.8 mm, P = .004; 60°, 0.1 ± 0.7 vs 1.4 ± 1.0 mm, P < .001 [intact vs 90% tear]). The change in distance between the anteromiddle and posteromiddle markers at 30° also significantly increased in LMs with a 90% tear (0.2 ± 0.2 vs 1.3 ± 1.2 mm, P = .02 [intact vs 90% tear]). The resultant force was significantly lower in LMs with a 90% tear than in intact LMs (30°, 125 ± 47 vs 48 ± 20 N, P < .001; 60°, 93 ± 46 vs 43 ± 11 N, P = .002 [intact vs 90% tear]). We found no significant differences in either meniscal displacements or resultant forces between intact LMs and those with 30% or 60% tears. Conclusion: LMs with a 90%-width midbody radial tear lost load–transmission function with their displacement relative to the tibia primarily in the anteroposterior direction in the porcine model. Clinical Relevance: Even 1 mm of displacement after meniscal injury is evidence that the load–transmission function of the meniscus is greatly impaired. When a displaced torn LM is diagnosed in preoperative imaging, meniscal repair surgery should be considered.

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Section: Discussionmentioning

confidence: 99%

Meniscal Displacement and Loss of Load-Transmission Function After Radial Tear of the Lateral Meniscus in a Porcine Model: New Insights Into the Functional Dynamics of the Injured Meniscus

et al. 2022

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“…Meniscal extrusion may be underestimated on supine MRI scans, instead, ultrasound is a dynamic study and can detect the knee joint line, the presence of extrusion and is able to a better quantification of the condition compared with MRI [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

MRI evaluation of meniscal anatomy: which parameters reach the best inter-observer concordance?

et al. 2022

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Purpose The aim of the study is to evaluate which MRI parameters achieve the best degree of inter-individual concordance in the description of meniscal fibrocartilage, regarding its morphology, signal and position. Materials and methods Eighty-nine knee MRIs were included in the study, retrospectively re-evaluated by three radiologists who completed a binary report (normal/abnormal) describing the meniscus signal, position relative to the tibial plateau margin and morphology. The inter-individual concordance value was calculated using Cohen's test. Results We obtained different inter-individual concordance values according to the parameters considered. The concordance was poor in the description of the meniscal position relative to the tibial plateau margin (average k = 0.6); the result was comparable in the description of the meniscal morphology (average k = 0.56). The best results were obtained with the meniscal signal analysis (average k = 0.8). Conclusion To the best of our knowledge, there are no studies in the literature assessing the concordance between multiple readers in the description of the parameters we studied. The results we obtained suggest that the most reliable parameter for describing meniscal fibrocartilage is its signal intensity, whereas morphology and position may lead to different interpretations that are not always unequivocal.

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“…While weight-bearing radiographs can highlight important findings such as JSN and subchondral sclerosis 63 , quantification of extrusion is not feasible with radiographs since soft-tissue structures cannot be visualized. Meanwhile, computed tomography (CT) arthrography does allow for visualization of the menisci and thus can detect the presence of extrusion.…”

Section: Diagnosismentioning

confidence: 99%