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Amiri S, Mirahmadi A, Parvandi A, Moshfegh MZ, Hashemi Abatari SP, Farrokhi M, Hoseini SM, Kazemi SM, Momenzadeh K, Wu JS, Nazarian A. Excellent accuracy of magnetic resonance imaging for diagnosis of discoid meniscus tears: A systematic review and meta-analysis. J Exp Orthop 2024; 11:e12051. [PMID: 38899047 PMCID: PMC11185948 DOI: 10.1002/jeo2.12051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 06/21/2024] Open
Abstract
Purpose The discoid meniscus (DM) is distinguished by its thickened, disc-shaped formation, which extends over the tibial plateau. The likelihood of developing osteoarthritis escalates if a DM tear remains undiagnosed and untreated. While DM tears can be diagnosed through arthroscopy, the high cost, invasive nature and limited availability of this procedure highlight the need for a better diagnostic modality. This study aims to determine the accuracy of magnetic resonance imaging (MRI) in diagnosing DM tears. Methods A systematic review was conducted to gather articles with at least 10 cases on the comparison of MRI and arthroscopy as the gold standard for DM tear diagnosis. Stata and MetaDisc were used to conduct the statistical analysis. The quality of the included studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Results Five diagnostic performance studies, derived from four original research papers involving 305 patients, were evaluated. Based on the pooled data, the sensitivity, specificity, diagnostic odds ratio, positive limit of detection and negative limit of detection were found to be 0.87 (95% confidence interval [CI], 0.82-0.91) and 0.84 (95% CI, 0.75-0.90), 32.88 (95% CI, 5.81-186.02), 5.22 (95% CI, 1.71-15.92) and 0.18 (95% CI, 0.09-0.38), respectively. A hierarchical summary receiver operating characteristic curve with an area under the curve of 0.92 was generated. Conclusion This meta-analysis demonstrates that MRI has excellent sensitivity and specificity for diagnosing DM tears. Despite its lower accuracy compared to arthroscopy, MRI can be used in symptomatic patients as a viable alternative to arthroscopy due to its inherent advantages. Level of Evidence Level IV.
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Affiliation(s)
- Shayan Amiri
- Shohadaye Haftom‐e‐Tir Hospital, Department of Orthopedic, School of MedicineIran University of Medical SciencesTehranIran
| | - Alireza Mirahmadi
- Bone, Joint and Related Tissue Research Center, Akhtar Orthopedic HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Ava Parvandi
- Bone, Joint and Related Tissue Research Center, Akhtar Orthopedic HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Mana Zaker Moshfegh
- Bone, Joint and Related Tissue Research Center, Akhtar Orthopedic HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Seyedeh Pardis Hashemi Abatari
- Bone, Joint and Related Tissue Research Center, Akhtar Orthopedic HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Mehrdad Farrokhi
- Student Research Committee, Department of Epidemiology, School of Public Health and SafetyShahid Beheshti University of Medical SciencesTehranIran
| | - Seyyed Mehdi Hoseini
- Bone, Joint and Related Tissue Research Center, Akhtar Orthopedic HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Seyed Morteza Kazemi
- Bone, Joint and Related Tissue Research Center, Akhtar Orthopedic HospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Kaveh Momenzadeh
- Department of Orthopaedic Surgery, Boston Children's Hospital and Harvard Medical School, Bostonthe Musculoskeletal Translational Innovation InitiativeBostonMassachusettsUSA
| | - Jim S. Wu
- Department of Radiology, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMassachusettsUSA
| | - Ara Nazarian
- Department of Orthopaedic Surgery, Boston Children's Hospital and Harvard Medical School, Bostonthe Musculoskeletal Translational Innovation InitiativeBostonMassachusettsUSA
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Tyler PA, Jain V, Ashraf T, Saifuddin A. Update on imaging of the discoid meniscus. Skeletal Radiol 2022; 51:935-956. [PMID: 34546382 DOI: 10.1007/s00256-021-03910-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/14/2021] [Accepted: 09/14/2021] [Indexed: 02/02/2023]
Abstract
Discoid menisci represent a range of morphological meniscal variants, most commonly involving the lateral meniscus. Clinical presentation ranges from an asymptomatic incidental finding to snapping, pain, swelling and reduced range of knee movement. Symptomatic presentation of discoid menisci is usually due to meniscal tears and instability resulting from abnormal meniscal morphology and ultrastructure, with absent peri-meniscal ligamentous and meniscocapsular attachments characteristic of the Wrisberg sub-type. This article reviews the current classification systems of discoid menisci, gross morphological characteristics of each sub-type and ultrastructure. Clinical presentation, arthroscopic findings and indirect radiological diagnostic criteria are described, as are the MRI findings of normal and pathological discoid menisci. Current concepts of surgical management and outcomes of the discoid meniscus are also briefly discussed.
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Affiliation(s)
- P A Tyler
- Royal National Orthopaedic Hospital, Brockley Hill Stanmore, London, HA7 4LP, UK
| | - V Jain
- Royal National Orthopaedic Hospital, Brockley Hill Stanmore, London, HA7 4LP, UK.
| | - T Ashraf
- The Royal Orthopaedic Hospital & Queen Elizabeth University Hospital, Birmingham, UK
| | - A Saifuddin
- Royal National Orthopaedic Hospital, Brockley Hill Stanmore, London, HA7 4LP, UK
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Schachne JM, Heath MR, Yen YM, Shea KG, Green DW, Fabricant PD. The Safe Distance to the Popliteal Neurovascular Bundle in Pediatric Knee Arthroscopic Surgery: An Age-Based Magnetic Resonance Imaging Anatomic Study. Orthop J Sports Med 2019; 7:2325967119855027. [PMID: 31321247 PMCID: PMC6624919 DOI: 10.1177/2325967119855027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: The close proximity of the popliteal neurovascular bundle to the posterior
horn of the lateral meniscus puts it at risk of compromise during lateral
meniscal repair. This is particularly important in smaller pediatric
patients, who are commonly treated for lateral meniscal abnormalities in
isolation (discoid meniscus) or concomitantly with anterior cruciate
ligament reconstruction. Purpose: To quantify the distance between the posterior horn of the lateral meniscus
and the popliteal neurovascular bundle along the path of meniscal repair and
to investigate for associations with age, sex, height, weight, body mass
index (BMI), and skeletal maturity. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 144 magnetic resonance imaging scans were evaluated in a cohort of
patients aged 10 to 18 years without meniscal or ligament abnormalities.
Measurements were made along a line from the anterolateral portal between
the popliteal neurovascular bundle and the free edge, midpoint, and
meniscocapsular junctions of the posterior horn of the lateral meniscus. In
addition to descriptive statistics of these distances by age and sex,
analyses of variance and linear regression analyses were performed to
investigate for associations with age, sex, height, weight, BMI, and
skeletal maturity. Results: Male participants had a significantly larger mean free edge distance (14.4 ±
2.5 vs 13.1 ± 2.5 mm, respectively; P = .005) and midpoint
distance (9.6 ± 2.2 vs 8.9 ± 1.8 mm, respectively; P =
.011) than female participants but not a significantly larger
meniscocapsular distance (5.2 ± 1.6 vs 4.6 ± 1.4 mm, respectively;
P = .096). Linear regression analyses revealed
significant associations between these distances and age, height, weight,
and BMI (P < .001 for all). There were statistically
significant pairwise differences for free edge and midpoint distances to the
neurovascular bundle between patients with open and closed physes. Conclusion: The distance between the posterior horn of the lateral meniscus and the
popliteal vasculature along a trajectory from the standard anterolateral
arthroscopic portal increases linearly throughout development between the
ages of 10 and 18 years. There were also significant associations between
height, weight, BMI, and skeletal maturity and these anatomic distances.
Knowing the safe distance to the popliteal vasculature will increase the
safety of arthroscopic lateral meniscal repair in children, especially with
all-inside devices that require setting the penetration depth for the
advancement of a sharp delivery device beyond the posterior capsule.
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Affiliation(s)
- Jonathan M Schachne
- Division of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Madison R Heath
- Division of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Yi-Meng Yen
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kevin G Shea
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Daniel W Green
- Division of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Peter D Fabricant
- Division of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
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Shimozaki K, Nakase J, Takata Y, Asai K, Toyooka K, Kitaoka K, Tsuchiya H. The characteristic findings of an inverted-type discoid lateral meniscus tear: a hidden tear pattern. BMC Musculoskelet Disord 2019; 20:223. [PMID: 31096968 PMCID: PMC6524316 DOI: 10.1186/s12891-019-2618-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 05/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to reveal the clinical history and physical and magnetic resonance imaging (MRI) findings of patients with an inverted-type discoid lateral meniscus (DLM) tear compared with those with a symptomatic and torn discoid meniscus without inverted tear patterns. MATERIALS AND METHODS Between 2014 and 2016, 12 patients underwent arthroscopic partial meniscectomy for an inverted-type DLM tear (inverted group). We age-matched these patients with 12 controls who were extracted from many normal DLM tear cases in the same period (non-inverted group). The assessment items were traumatic history with the onset of pain, the mean duration between the appearance of symptoms and surgery, preoperative knee range of motion (ROM), positive findings on the McMurray test, knee locking or catching, and characteristic MRI findings. These items were compared between the two groups using χ2 and Student's t-tests. RESULT All patients in the inverted group had clear trauma with the onset of pain during sports or daily life activities, and 7 of the 12 patients with a non-inverted type of DLM tear had clear trauma. There was a significantly higher rate of traumatic history in the inverted group than in the non-inverted group (P = 0.03). The mean duration between the appearance of symptoms and surgery, preoperative knee ROM, positive findings on the McMurray test, and knee locking or catching were not significantly different between the inverted and non-inverted groups. On MRI, the diagnosis ratio of DLM was significantly higher in the non-inverted group (9/12 cases) than in the inverted group (3/12 cases, P = 0.04). Nine of the 12 inverted-type patients had the characteristic findings of an inverted-type DLM tear, including a duplicated or enlarged posterior horn and blunting of the inner rim, on the sagittal plane of an MRI. CONCLUSION Patients with inverted-type DLM tears had clear trauma and infrequently had the characteristic MRI findings that are observed in patients with normal DLM tears. Physicians should suspect that an inverted-type DLM tear is present during diagnosis and focus on the posterior horn to find the inverted sign on the MRI sagittal plane. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Kengo Shimozaki
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa-shi, Ishikawa-ken, 920-8641, Japan
| | - Junsuke Nakase
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa-shi, Ishikawa-ken, 920-8641, Japan.
| | - Yasushi Takata
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa-shi, Ishikawa-ken, 920-8641, Japan
| | - Kazuki Asai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa-shi, Ishikawa-ken, 920-8641, Japan
| | - Kazu Toyooka
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa-shi, Ishikawa-ken, 920-8641, Japan
| | | | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa-shi, Ishikawa-ken, 920-8641, Japan
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Discoid lateral meniscus can be overlooked by magnetic resonance imaging in patients with meniscal tears. Knee Surg Sports Traumatol Arthrosc 2018; 26:2317-2323. [PMID: 28894908 DOI: 10.1007/s00167-017-4704-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 08/30/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE MRI evaluation of torn lateral meniscus was compared with arthroscopy. This study calculates the sensitivity, specificity, and accuracy of MRI in determining the presence or absence of discoid lateral meniscus (DLM) for different tear types. METHODS MR imaging of 156 knees with arthroscopically confirmed lateral meniscus tears was analysed. There were 78 knees (70 patients) in non-DLM group and 78 knees (74 patients) in DLM group on arthroscopy as the reference standard. The presence of DLM on MRI was determined by an orthopaedic surgeon and a radiologist, who were blinded to the arthroscopic findings. The presence of discoid meniscus on MRI was determined by coronal and sagittal measurements, considering the tear pattern of lateral meniscus. The tear pattern was categorized into six types based on arthroscopic findings: horizontal, longitudinal, radial, combined radial, degenerative, and complex tear. The sensitivity, specificity, and accuracy of MRI were calculated for each type of lateral meniscus tear. In addition, we analysed the reason for non-detection of discoid meniscus on preoperative MRI. RESULT The sensitivity for determining the presence of discoid meniscus was 58% for radial tear, 57% for combined radial tear, and 65% for longitudinal tear, whereas the specificity was 100% for all tear groups. In the presence of radial or longitudinal tear, the accuracy of MRI was significantly lower than having no radial and longitudinal tear (p < 0.001). The presence of discoid meniscus was not recognized on MRI because of large radial tear (12 knees), deformed bucket-handle tear (6 knees), and inverted flap tear (3 knees). CONCLUSIONS MRI was not successful in determining the presence or absence of DLM in radial tear, combined radial tear, and longitudinal tear. When there are large radial tear, deformed bucket-handle tear, and inverted flap tear in lateral meniscus, it is recommended to consider the possibility of DLM. This information can help to make accurate diagnosis of DLM, which allows appropriate surgical planning and facilitates patient's information on poor prognosis of DLM. LEVEL OF EVIDENCE Level I.
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