MR Imaging of the Postoperative Meniscus: Repair, Resection, and Replacement

ABSTRACT

Meniscal surgery is one of the most common orthopedic procedures performed in clinical practice today. Increasing awareness of the importance of the meniscus in knee function and stability has resulted in abandonment of the once common complete meniscectomy in favor of meniscus-preserving surgeries and, in some circumstances, meniscal replacement. Although the accuracy of magnetic resonance imaging in the diagnosis of meniscal tears is well established, imaging of the postoperative meniscus has proved more challenging, with debate about the optimal imaging technique. This article discusses normal meniscal anatomy and biomechanics to serve as the background for understanding meniscal pathology and treatment. This is followed by a review of meniscal surgery, with emphasis placed on meniscal repair, partial meniscectomy, and meniscal transplantation. Finally, imaging modalities utilized in the assessment of the postoperative meniscus are reviewed, including their advantages and disadvantages.

KEYWORDS

Postoperative menisus - partial meniscectomy - meniscal repair - meniscal transplantation - MR arthrography - CT arthrography

REFERENCES

• 1 Arnoczky S P, Warren R F. Microvasculature of the human meniscus.  Am J Sports Med. 1982;  10 90-95
• 2 Greis P E, Bardana D D, Holmstrom M C, Burks R T. Meniscal injury: 1. Basic science and evaluation.  J Am Acad Orthop Surg. 2002;  10 168-176
• 3 Rijk P C. Meniscal allograft transplantation-part I: background, results, graft selection and preservation, and surgical considerations.  Arthroscopy. 2004;  20 728-743
• 4 Beaupre A, Choukroun R, Guidouin R, Garneau R, Gerardin H, Cardou A. Knee menisci: correlation between microstructure and biomechanics.  Clin Orthop Relat Res. 1986;  208 72-75
• 5 Renstrom P, Johnson R J. Anatomy and biomechanics of the menisci.  Clin Sports Med. 1990;  9 523-538
• 6 Levy I M, Torzilli P A, Warren R F. The effect of medial meniscectomy on anterior posterior motion of the knee.  J Bone Joint Surg Am. 1982;  64 883-887
• 7 Fairbank T J. Knee joint changes after meniscectomy.  J Bone Joint Surg Br. 1948;  30 664-670
• 8 Davis K W, Tuite M J. MR imaging of the postoperative meniscus of the knee.  Semin Musculoskelet Radiol. 2002;  6 35-45
• 9 Shiozaki Y, Horibe S, Mitsuoka T, Nakamura N, Toritsula Y, Shino K. Prediction of reparability of isolated semilunar lateral meniscus tears by magnetic resonance imaging.  Knee Surg Sports Traumatol Arthrosc. 2002;  10 213-217
• 10 DeHaven K E. Meniscus repair.  Am J Sports Med. 1999;  27 242-250
• 11 Matava M J, Eck K, Totty W, Wright R W, Shively R A. Magnetic resonance imaging as a tool to predict meniscal reparability.  Am J Sports Med. 1999;  27 436-443
• 12 Johnson M J, Kucas G L, Dusek J K, Henning C E. Isolated arthroscopic meniscal repair: a long-term outcome study (more than 10 years).  Am J Sports Med. 1999;  27 44-49
• 13 Rubman M H, Noyes F R, Barber-Westin S D. Arthroscopic repair of meniscal tears that extend into the avascular zone.  Am J Sports Med. 1998;  26 87-95
• 14 Harper K W, Helms C A, Lambert H S, Higgins L D. Radial meniscal tears: significance, incidence, and MR appearance.  AJR Am J Roentgenol. 2005;  185 1429-1434
• 15 Baratz M E, Fu F H, Mengato R. Meniscal tears: the effect of meniscectomy and of repair on intraarticular contact areas and stress in the human knee. A preliminary report.  Am J Sports Med. 1986;  14 270-275
• 16 Spahn G. Arthroscopic revisions in failed meniscal surgery.  Int Orthop. 2003;  27 378-381
• 17 Greis P E, Holmstrom M C, Bardana D D, Burks R T. Meniscal injury: II. Management.  J Am Acad Orthop Surg. 2002;  10 177-187
• 18 Rangger C, Klestil T, Gloetzer W, Kemmler G, Benedetto K P. Osteoarthritis after arthroscopic partial meniscectomy.  Am J Sports Med. 1995;  23 240-244
• 19 Sekiya J K, Ellingson C I. Meniscal allograft transplantation.  J Am Acad Orthop Surg. 2006;  14 164-174
• 20 Graf K W, Sekiya J K, Wojtys E M. Long-term results after combined medial meniscal allograft transplantation and anterior cruciate ligament reconstruction: minimum 8.5 year follow-up study.  Arthroscopy. 2004;  20 129-140
• 21 Verdonk P CM, Demurie A, Almqvist K F, Veys E M, Verbruggen G, Verdonk R. Transplantation of viable meniscal allograft.  J Bone Joint Surg Am. 2006;  88 109-118
• 22 Alhalki M M, Howell S M, Hull M L. How three methods for fixing a medial meniscal autograft affect tibial contact mechanics.  Am J Sports Med. 1999;  27 320-328
• 23 Farr J, Meneghini R M, Cole B J. Allograft interference screw fixation in meniscus transplantation.  Arthroscopy. 2004;  20 322-327
• 24 Rodeo S A. Meniscal allografts-where do we stand?.  Am J Sports Med. 2001;  29 246-261
• 25 Peters G, Wirth C J. The current state of meniscal allograft transplantation and replacement.  Knee. 2003;  10 19-31
• 26 Rubin D A, Paletta Jr G A. Current concepts and controversies in meniscal imaging.  Magn Reson Imaging Clin N Am. 2000;  8 243-270
• 27 Muellner T, Egkher A, Nikolic A, Funovics M, Metz V. Open meniscal repair: clinical and magnetic resonance imaging findings after twelve years.  Am J Sports Med. 1999;  27 16-20
• 28 Sciulli R L, Boutin R D, Brown R R et al.. Evaluation of the post-operative meniscus of the knee: a study comparing conventional arthrography, conventional MR imaging, MR arthropathy with iodated contrast material, and MR arthrography with gadolinium-based contrast material.  Skeletal Radiol. 1999;  28 508-514
• 29 White L M, Schweitzer M E, Weishaupt D, Kramer J, Davis A, Marks P H. Diagnosis of recurrent meniscal tears: prospective evaluation of conventional MR imaging, indirect MR arthrography, and direct MR arthrography.  Radiology. 2002;  222 421-429
• 30 Toms A P, White L M, Marchall T J, Donell S T. Imaging the post-operative meniscus.  Eur J Radiol. 2005;  54 189-198
• 31 De Smet A A. Imaging and MR arthrography for diagnosis of recurrent tears in the postoperative meniscus.  Semin Musculoskelet Radiol. 2005;  9 116-124
• 32 Recht M P, Kramer J. MR imaging of the postoperative knee: a pictorial essay.  Radiographics. 2002;  22 765-774
• 33 Mutschler C, Vande Berg B C, Lecouvet F E et al.. Post-operative meniscus: assessment at dual-detector row spiral CT arthrography of the knee.  Radiology. 2003;  228 635-641
• 34 Noyes F R, Barber-Westin S D, Butler D L, Wilkins R M. The role of allografts in repair and reconstruction of the knee joint ligaments and menisci.  Instr Course Lect. 1998;  47 379-396
• 35 Verstraete K L, Verdonk R, Verstraete P, De Rooy J, Kunnen M. Current status and imaging of allograft meniscal transplantation.  Eur J Radiol. 1997;  26 16-22
• 36 Potter H G, Rodeo S A, Wickiewicz T L, Warren R F. MR imaging of meniscal allografts: correlation with clinical and arthroscopic outcomes.  Radiology. 1996;  198 509-514
• 37 Verdonk P, Depaepe Y, Desmyter S et al.. Normal and transplanted lateral knee menisci: evaluation of extrusion using magnetic resonance imaging and ultrasound.  Knee Surg Sports Traumatol Arthrosc. 2004;  12 411-419