Meniscus preservation surgery is increasingly vital, especially for root and peripheral injuries.
Root tears and ramp tears have significant clinical repercussions if left untreated, emphasizing the importance of MRI diagnosis and surgical repair.
Deep dives
Historical Shift to Meniscus Preservation Surgery
The article discusses the historical shift from complete and partial meniscectomies to meniscus preservation surgery, emphasizing the increasing importance of meniscus research in knee joint health. Around one third of meniscus injuries are now deemed fixable, rising to over 55% with concurrent ACL injuries, underscoring the significance of preservation. Focus has shifted to root and peripheral meniscus injuries, highlighting the crucial role of understanding meniscus anatomy and the implications of not addressing root tears.
Importance of Meniscus Roots and Ramp Tears
Meniscus roots play a crucial biomechanical role in anchoring the meniscus to the tibial plateau, and injuries to these roots, like root tears, can lead to significant clinical repercussions if left untreated. Root tears, equivalent in impact to total meniscectomies, are associated with heightened tibiofemoral contact pressures and accelerated cartilage degeneration. Ramp tears, often linked to ACL ruptures, accentuate sagittal and rotational knee laxity, with MRI serving as a vital tool for their detection. Surgical repair of root tears has shown improved outcomes in symptom management and osteoarthritis progression.
Diagnosis and Classification of Root and Ramp Tears
MRI plays a critical role in diagnosing root and ramp tears, detecting characteristic signs like the ghost sign, radial defect sign, and clef sign associated with these injuries. Root tears are classified into five types based on the LaPrade system, varying from stable partial tears to avulsion fractures at the root attachment. Ramp lesions are categorized into five types based on the location and extent of the tear at the meniscocapsular junction, often linked to ACL injuries. Special attention is needed to identify these peripheral meniscus injuries, sometimes challenging to diagnose, especially in association with other knee pathologies.
Dr. Jennifer Weaver summarizes the article "Knee MRI: Meniscus Roots, Ramps, Repairs, and Repercussions" published online June 29, 2023 in the RadioGraphics journal.