Published: 2017-12-23

MR imaging of meniscal tears

Sharad G. Gadgil, Abhay G. Kakade, Rounak R. Bagga, Mahesh H. Yadav, Zoya Mohammed Yusuf Patni


Background: Menisci transmit the forces across the joint and cushion the mechanical loading of the joint. Thus, it is important to identify meniscal tear. A thorough understanding of normal meniscal anatomy and surrounding structure is critical for diagnosis. Magnetic resonance imaging is the current modality of choice providing fine resolution and multi-planar imaging for identifying the meniscal injuries and the various pattern of tear, helping to plan the subsequent management. The purpose of the work was to study the role of MRI in classifying the meniscal injuries.

Methods: MRI Knee of 136 patients with meniscal injuries was studied. All the MR imaging scans were performed on 1.5-T MR system (Siemens magnetom Essenza).

Results: A total of 136 patients were studied in which majority of the patient’s i.e.  90.44 % had medial meniscal tear while 18.38 % patients had lateral meniscal tear. Both medial and lateral meniscal tears were found in 8.82 % patients. Among the different types of tears, horizontal tear was the most common tear in both medial and lateral meniscus comprising 52.8 % and 52 % respectively. The tears being most common in the age group 41-50years. There were associated injuries to the other ligaments of the knee joint along with meniscal tear, ACL tear being the most common and was seen in 50% of patients.

Conclusions: MRI is a good modality for classifying meniscal injury and evaluation of injuries to the associated ligaments. Secondary signs are good predictors of underlying meniscal tear in equivocal cases.


ACL (Anterior cruciate ligament), Knee joint, Medial meniscus, MRI (Magnetic Resonance Imaging), PCL (Posterior cruciate ligament), PPV (Positive predictive value)

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Oei EH, Nikken JJ, Verstijnen AC, Ginai AZ, Myriam Hunink MG. MR imaging of the menisci and cruciate ligaments: a systematic review. Radiology. 2003;226(3): 837-48.

Renstrom P, Johnson RJ. Anatomy and biomechanics of the menisci. Clin Sports Med. 1990;9:523-38.

Dehaven KE, Arnoczky SP. Meniscal repair: I. basic science, indications for repair, and open repair. J Bone Joint Surg. 1994;76:140.

David W Stoller, Arthur E. Li, Lesley J. Anderson and W. Dilworth Canon. The Knee. In: David W Stoller. Magnetic Resonance Imaging in Orthopaedics and Sports Medicine. 3rd Edition. Philadelphia: Lippincott Williams and Wilkins;2007:305-732.

Petersen W, Tillmann B. Collagenous fibril texture of the human knee joint menisci. Anat Embryol. 1998;197(4):317-324.

Arnoczky SP. Microvasculature of the human meniscus. Am J Sports Med. 1982;10:90.

Arnoczky SP. The microvasculature of the meniscus and its response to injury. Am J Sports Med. 1983;11:31.

Kaplan EB. The embryology of the menisci of the knee joint. Bull Hosp Joint Dis. 1955;16:111.

Nguyen JC1, De Smet AA, Graf BK, Rosas HG. MR imaging-based diagnosis and classification of meniscal tears. Radiographics. 2014;34(4):981-99.

Johnson DL, Swenson TM, Livesay GA, Aizawa H, Fu FH, Harner CD. Insertion-site anatomy of the human menisci: gross, arthroscopic, and topographical anatomy as a basis for meniscal transplantation. Arthroscopy: J Arthroscop Surg. 1995;11(4):386-94.

Kohn D, Moreno B. Meniscus insertion anatomy as a basis for meniscus replacement: a morphological cadaveric study. Arthroscopy. 1995;11:96.

Rath E, Richmond JC. The menisci: basic science and advances in treatment. Br J Sports Med. 2000;34:252-7.

Messner K, Gao J. The menisci of the knee joint. Anatomical and functional characteristics, and a rationale for clinical treatment. J Anat. 1998;193(Pt 2):161-78.

Reicher MA. High-resolution magnetic resonance imaging of the knee joint: normal anatomy. AJR Am J Roentgenol. 1985;145:895.

Simonian PT, Sussmann PS, van Trommel M, Wickiewicz TL, Warren RF. Popliteomeniscal fasciculi and lateral meniscal stability. Ame J Sports Medic. 1997;25(6):849-53.

Cho JM, Suh JS, Na JB, Cho JH, Kim Y, Yoo WK, et al. Variations in meniscofemoral ligaments at anatomical study and MR imaging. Skeletal Radiol. 1999;28(4):189-95.

Lee BY, Jee WH, Kim JM, Kim BS, Choi KH. Incidence and significance of demonstrating the meniscofemoral ligament on MRI. Brit J Radiol. 2000;73(867):271-4.

Crues 3rd JV, Mink J, Levy TL, Lotysch M, Stoller DW. Meniscal tears of the knee: accuracy of MR imaging. Radiol. 1987;164(2):445-8.

Rubin DA, Paletta GA Jr. Current concepts and controversies in meniscal imaging. Magn Reson Imaging Clin N Am. 2000;8:243-70.

De Smet AA, Norris MA, Yandow DR, Quintana FA, Graf BK, Keene JS. MR diagnosis of meniscal tears of the knee: importance of high signal in the meniscus that extends to the surface. AJR Am J Roentgenol. 1993;161(1):101-07.

De Smet AA, Tuite MJ. Use of the “two-slice-touch” rule for the MRI diagnosis of meniscal tears. AJR Am J Roentgenol. 2006;187(4):911-14.

Kaplan PA, Nelson NL, Garvin KL, Brown DE. MR of the knee: the significance of high signal in the meniscus that does not clearly extend to the surface. AJR Am J Roentgenol. 1991;156(2):333-6.

Crema MD, Hunter DJ, Roemer FW, Li L, Marra MD, Nogueira-Barbosa MH, et al. The relationship between prevalent medial meniscal intrasubstance signal changes and incident medial meniscal tears in women over a 1-year period assessed with 3.0 T MRI. Skeletal Radiol. 2011;40(8):1017-23.

De Smet AA. How I diagnose meniscal tears on knee MRI. AJR Am J Roentgenol. 2012;199:481-99.

Magee T, Williams D. Detection of meniscal tears and marrow lesions using coronal MRI. AJR Am J Roentgenol. 2004;183:1469-73.

Tarhan NC, Chung CB, Mohana-Borges AV, Hughes T, Resnick D. Meniscal tears: role of axial MRI alone and in combination with other imaging planes. AJR Am J Roentgenol. 2004;183(1):9-15.

De Smet AA, Graf BK. Meniscal tears missed on MR imaging: relationship to meniscal tear patterns and anterior cruciate ligament tears. AJR Am J Roentgenol. 1994;162(4):905-11.

Harper KW, Helms CA, Lambert HS 3rd, Higgins LD. Radial meniscal tears: significance, incidence, and MR appearance. AJR Am J Roentgenol. 2005;185(6):1429-34.

Fox MG. MR imaging of the meniscus: review, current trends, and clinical implications. Radiol Clin North Am. 2007;45(6):1033-53.

Ferrer-Roca O, Vilalta C. Lesions of the meniscus. II. Horizontal cleavages and lateral cysts. Clin Orthop Relat Res. 1980;(146):301-307.

De Smet AA, Graf BK, del Rio AM. Association of parameniscal cysts with underlying meniscal tears as identified on MRI and arthroscopy. AJR Am J Roentgenol. 2011;196:W180-6.

Reagan WD, McConkey JP, Loomer RL, Davidson RG. Cysts of the lateral meniscus: arthroscopy versus arthroscopy plus open cystectomy. Arthroscopy. 1989;5(4):274-81.

Rubin DA. MR imaging of the knee menisci. Radiol Clin North Am. 1997;35(1):21-44.

Vahey TN, Bennett HT, Arrington LE, Shelbourne KD, Ng J. MR imaging of the knee: pseudotear of the lateral MR Imaging of the Meniscus 515 meniscus caused by the meniscofemoral ligament. AJR Am J Roentgenol. 1990;154:1237-9.

Herman LJ, Beltran J. Pitfalls in MR imaging of the knee. Radiol. 1988;167:775-81.

Watanabe AT, Carter BC, Teitelbaum GP, Seeger LL, Bradley Jr WG. Normal variations in MR imaging of the knee: appearance and frequency. AJR Am J Roentgenol. 1989;153:341-4.

Crues JV 3rd, Ryu R, Morgan FW. Meniscal pathology: the expanding role of magnetic resonance imaging. Clin Orthop Relat Res. 1990;(252):80-87.

Costa RC, Morrison WB, Carrino JA. Medial meniscus extrusion on knee MRI: is extent associated with severity of degeneration or type of tear? AJR Am J Roentgenol. 2004;183:17-23.

Tuckman GA, Miller WJ, Remo JW, Fritts HM, Rozansky MI. Radial tears of the menisci: MR findings. AJR. Ame J Roentgenol. 1994;163(2):395-400.

Helms C. The meniscus: recent advances in MR imaging of the knee. AJR Am J Roentgenol. 2002;179:115-22.

Rosas HG. Magnetic resonance imaging of the meniscus. Magnetic resonance imaging clinics of North America. 2014;22(4):493-516.

Magee T, Shapiro M, Williams D. MR accuracy and arthroscopic incidence of meniscal radial tears. Skeletal Radiol. 2002;31(12):686-89.

Lee SY, Jee WH, Kim JM. Radial tear of the medial meniscal root: reliability and accuracy of MRI for diagnosis. AJR Am J Roentgenol. 2008;191(1):81-85.

De Smet AA, Blankenbaker DG, Kijowski R, Graf BK, Shinki K. MR diagnosis of posterior root tears of the lateral meniscus using arthroscopy as the reference standard. AJR Am J Roentgenol. 2009;192(2):480-86.

Tuckman GA, Miller WJ, Remo JW, Fritts HM, Rozansky MI. Radial tears of the menisci: MR findings. AJR. Ame J Roentgenol. 1994;163(2):395-400.

Insall JN, Scott WN. In: Surgery of the knee, vol. 1, 3rd ed. Philadelphia: Churchill Livingstone, 2001:190.

Brody JM, Lin HM, Hulstyn MJ, Tung GA. Lateral meniscus root tear and meniscus extrusion with anterior cruciate ligament tear. Radiol. 2006;239(3):805-10.

Choi CJ, Choi YJ, Lee JJ, Choi CH. Magnetic resonance imaging evidence of meniscal extrusion in medial meniscus posterior root tear. Arthroscopy. 2010;26(12):1602-06.

Lecas LK, Helms CA, Kosarek FJ, Garret WE. Inferiorly displaced flap tears of the medial meniscus: MR appearance and clinical significance. Ame J Roentgenol. 2000;174(1):161-4.

Vande Berg BC, Malghem J, Poilvache P, Maldague B, Lecouvet FE. Meniscal tears with fragments displaced in notch and recesses of knee: MR imaging with arthroscopic comparison. Radiology. 2005;234(3):842-50.

McKnight A, Southgate J, Price A, Ostlere S. Meniscal tears with displaced fragments: common patterns on magnetic resonance imaging. Skeletal Radiol. 2010;39(3):279-283.

Stoller DW. Meniscal tears: pathological correlation with MR imaging. Radiology. 1987;163:452.

Camacho MA. The double posterior cruciate ligament sign. Radiology. 2004;233:503-4.

Bui-Mansfield LT, DeWitt RM. Magnetic resonance imaging appearance of a double anterior cruciate ligament associated with a displaced tear of the lateral meniscus. J Comput Assist Tomogr. 2006;30(2):327-32.

Bergin D, Hochberg H, Zoga AC, Qazi N, Parker L, Morrison WB. Indirect soft-tissue and osseous signs on knee MRI of surgically proven meniscal tears. AJR Am J Roentgenol. 2008;191(1):86-92.