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Meniscal Degeneration
Andrew Sonin, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Synonyms

              • Intrasubstance degeneration, myxoid degeneration, mucoid degeneration, mucinous degeneration; fraying
            • Definitions

              • Internal disruption of normal meniscal architecture ± mucinous degeneration without extension to articular surface = degeneration
              • Irregularity of meniscal free edge without linear tear; or amorphous increased signal at free edge = fraying

            IMAGING

            • General Features

              • MR Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • Staging, Grading, & Classification

                      • Gross Pathologic & Surgical Features

                        • Microscopic Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Consider

                                    • Image Interpretation Pearls

                                      Selected References

                                      1. Ahn JH et al: Comparison between conservative treatment and arthroscopic pull-out repair of the medial meniscus root tear and analysis of prognostic factors for the determination of repair indication. Arch Orthop Trauma Surg. 135(9):1265-76, 2015
                                      2. Fischenich KM et al: Effects of degeneration on the compressive and tensile properties of human meniscus. J Biomech. 48(8):1407-11, 2015
                                      3. McNulty AL et al: Mechanobiology of the meniscus. J Biomech. 48(8):1469-78, 2015
                                      4. Takahashi K et al: Medial meniscal posterior root/horn radial tears correlate with cartilage degeneration detected by T1ρ relaxation mapping. Eur J Radiol. 84(6):1098-104, 2015
                                      5. Wang L et al: T1rho MRI at 3T of menisci in patients with acute anterior cruciate ligament (ACL) injury. J Magn Reson Imaging. 41(2):544-9, 2015
                                      6. Choi JY et al: Posterior medial meniscus root ligament lesions: MRI classification and associated findings. AJR Am J Roentgenol. 203(6):1286-92, 2014
                                      7. Howell R et al: Degenerative meniscus: Pathogenesis, diagnosis, and treatment options. World J Orthop. 5(5):597-602, 2014
                                      8. van Tiel J et al: Delayed gadolinium-enhanced MRI of the meniscus (dGEMRIM) in patients with knee osteoarthritis: relation with meniscal degeneration on conventional MRI, reproducibility, and correlation with dGEMRIC. Eur Radiol. 24(9):2261-70, 2014
                                      9. Li CA et al: Correlation of histological examination of meniscus with MR images: focused on high signal intensity of the meniscus not caused by definite meniscal tear and impact on mr diagnosis of tears. Korean J Radiol. 14(6):935-45, 2013
                                      10. Hunter D: Degeneration of the meniscus and progression of osteoarthritis. HSS J. 8(1):13-4, 2012
                                      11. Joseph GB et al: Baseline mean and heterogeneity of MR cartilage T2 are associated with morphologic degeneration of cartilage, meniscus, and bone marrow over 3 years--data from the Osteoarthritis Initiative. Osteoarthritis Cartilage. 20(7):727-35, 2012
                                      12. McWalter EJ et al: UTE T2∗ mapping detects sub-clinical meniscus degeneration. Osteoarthritis Cartilage. 20(6):471-2, 2012
                                      13. Subhas N et al: Accuracy of MRI in the diagnosis of meniscal tears in older patients. AJR Am J Roentgenol. 198(6):W575-80, 2012
                                      14. Sun Y et al: Meniscal calcification, pathogenesis and implications. Curr Opin Rheumatol. 24(2):152-7, 2012
                                      15. Lee DH et al: Predictors of degenerative medial meniscus extrusion: radial component and knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 19(2):222-9, 2011
                                      16. Zarins ZA et al: Cartilage and meniscus assessment using T1rho and T2 measurements in healthy subjects and patients with osteoarthritis. Osteoarthritis Cartilage. 18(11):1408-16, 2010
                                      17. Galea A et al: The accuracy of magnetic resonance imaging scanning and its influence on management decisions in knee surgery. Arthroscopy. 25(5):473-80, 2009
                                      18. Low AK et al: Clinical significance of intrasubstance meniscal lesions on MRI. J Med Imaging Radiat Oncol. 52(3):227-30, 2008
                                      19. Mesiha M et al: Pathologic characteristics of the torn human meniscus. Am J Sports Med. 35(1):103-12, 2007
                                      20. Jones AO et al: Medial meniscus posterior root attachment injury and degeneration: MRI findings. Australas Radiol. 50(4):306-13, 2006
                                      21. Sproule JA et al: Altered signal intensity in the posterior horn of the medial meniscus: an MR finding of questionable significance. Arch Orthop Trauma Surg. 125(4):267-71, 2005
                                      22. Boya H et al: Clinical and arthroscopic features of meniscal tears and a search for the role of infection in histologically confirmed meniscal mucoid degeneration. Knee Surg Sports Traumatol Arthrosc. 12(4):294-9, 2004
                                      23. Fukuta S et al: Prevalence of abnormal findings in magnetic resonance images of asymptomatic knees. J Orthop Sci. 7(3):287-91, 2002
                                      24. Cothran RL Jr et al: MR imaging of meniscal contusion in the knee. AJR Am J Roentgenol. 177(5):1189-92, 2001
                                      25. Jerosch J et al: Age-related magnetic resonance imaging morphology of the menisci in asymptomatic individuals. Arch Orthop Trauma Surg. 115(3-4):199-202, 1996
                                      26. Peterfy CG et al: "Magic-angle" phenomenon: a cause of increased signal in the normal lateral meniscus on short-TE MR images of the knee. AJR Am J Roentgenol. 163(1):149-54, 1994
                                      27. Raunest J et al: Magnetic resonance imaging (MRI) and arthroscopy in the detection of meniscal degenerations: correlation of arthroscopy and MRI with histology findings. Arthroscopy. 10(6):634-40, 1994
                                      28. Hodler J et al: Degenerative changes of the menisci of the knee. Value of different MR pulse sequences. Acta Radiol. 34(4):404-7, 1993
                                      29. Kaplan PA et al: MR of the knee: the significance of high signal in the meniscus that does not clearly extend to the surface. AJR Am J Roentgenol. 156(2):333-6, 1991
                                      30. Hajek PC et al: The high signal intensity meniscus of the knee. Magnetic resonance evaluation and in vivo correlation. Invest Radiol. 22(11):883-90, 1987
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Top Differential Diagnoses

                                            • Pathology

                                              • Clinical Issues

                                                TERMINOLOGY

                                                • Synonyms

                                                  • Intrasubstance degeneration, myxoid degeneration, mucoid degeneration, mucinous degeneration; fraying
                                                • Definitions

                                                  • Internal disruption of normal meniscal architecture ± mucinous degeneration without extension to articular surface = degeneration
                                                  • Irregularity of meniscal free edge without linear tear; or amorphous increased signal at free edge = fraying

                                                IMAGING

                                                • General Features

                                                  • MR Findings

                                                    • Imaging Recommendations

                                                      DIFFERENTIAL DIAGNOSIS

                                                        PATHOLOGY

                                                        • Staging, Grading, & Classification

                                                          • Gross Pathologic & Surgical Features

                                                            • Microscopic Features

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Demographics

                                                                  • Natural History & Prognosis

                                                                    • Treatment

                                                                      DIAGNOSTIC CHECKLIST

                                                                      • Consider

                                                                        • Image Interpretation Pearls

                                                                          Selected References

                                                                          1. Ahn JH et al: Comparison between conservative treatment and arthroscopic pull-out repair of the medial meniscus root tear and analysis of prognostic factors for the determination of repair indication. Arch Orthop Trauma Surg. 135(9):1265-76, 2015
                                                                          2. Fischenich KM et al: Effects of degeneration on the compressive and tensile properties of human meniscus. J Biomech. 48(8):1407-11, 2015
                                                                          3. McNulty AL et al: Mechanobiology of the meniscus. J Biomech. 48(8):1469-78, 2015
                                                                          4. Takahashi K et al: Medial meniscal posterior root/horn radial tears correlate with cartilage degeneration detected by T1ρ relaxation mapping. Eur J Radiol. 84(6):1098-104, 2015
                                                                          5. Wang L et al: T1rho MRI at 3T of menisci in patients with acute anterior cruciate ligament (ACL) injury. J Magn Reson Imaging. 41(2):544-9, 2015
                                                                          6. Choi JY et al: Posterior medial meniscus root ligament lesions: MRI classification and associated findings. AJR Am J Roentgenol. 203(6):1286-92, 2014
                                                                          7. Howell R et al: Degenerative meniscus: Pathogenesis, diagnosis, and treatment options. World J Orthop. 5(5):597-602, 2014
                                                                          8. van Tiel J et al: Delayed gadolinium-enhanced MRI of the meniscus (dGEMRIM) in patients with knee osteoarthritis: relation with meniscal degeneration on conventional MRI, reproducibility, and correlation with dGEMRIC. Eur Radiol. 24(9):2261-70, 2014
                                                                          9. Li CA et al: Correlation of histological examination of meniscus with MR images: focused on high signal intensity of the meniscus not caused by definite meniscal tear and impact on mr diagnosis of tears. Korean J Radiol. 14(6):935-45, 2013
                                                                          10. Hunter D: Degeneration of the meniscus and progression of osteoarthritis. HSS J. 8(1):13-4, 2012
                                                                          11. Joseph GB et al: Baseline mean and heterogeneity of MR cartilage T2 are associated with morphologic degeneration of cartilage, meniscus, and bone marrow over 3 years--data from the Osteoarthritis Initiative. Osteoarthritis Cartilage. 20(7):727-35, 2012
                                                                          12. McWalter EJ et al: UTE T2∗ mapping detects sub-clinical meniscus degeneration. Osteoarthritis Cartilage. 20(6):471-2, 2012
                                                                          13. Subhas N et al: Accuracy of MRI in the diagnosis of meniscal tears in older patients. AJR Am J Roentgenol. 198(6):W575-80, 2012
                                                                          14. Sun Y et al: Meniscal calcification, pathogenesis and implications. Curr Opin Rheumatol. 24(2):152-7, 2012
                                                                          15. Lee DH et al: Predictors of degenerative medial meniscus extrusion: radial component and knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 19(2):222-9, 2011
                                                                          16. Zarins ZA et al: Cartilage and meniscus assessment using T1rho and T2 measurements in healthy subjects and patients with osteoarthritis. Osteoarthritis Cartilage. 18(11):1408-16, 2010
                                                                          17. Galea A et al: The accuracy of magnetic resonance imaging scanning and its influence on management decisions in knee surgery. Arthroscopy. 25(5):473-80, 2009
                                                                          18. Low AK et al: Clinical significance of intrasubstance meniscal lesions on MRI. J Med Imaging Radiat Oncol. 52(3):227-30, 2008
                                                                          19. Mesiha M et al: Pathologic characteristics of the torn human meniscus. Am J Sports Med. 35(1):103-12, 2007
                                                                          20. Jones AO et al: Medial meniscus posterior root attachment injury and degeneration: MRI findings. Australas Radiol. 50(4):306-13, 2006
                                                                          21. Sproule JA et al: Altered signal intensity in the posterior horn of the medial meniscus: an MR finding of questionable significance. Arch Orthop Trauma Surg. 125(4):267-71, 2005
                                                                          22. Boya H et al: Clinical and arthroscopic features of meniscal tears and a search for the role of infection in histologically confirmed meniscal mucoid degeneration. Knee Surg Sports Traumatol Arthrosc. 12(4):294-9, 2004
                                                                          23. Fukuta S et al: Prevalence of abnormal findings in magnetic resonance images of asymptomatic knees. J Orthop Sci. 7(3):287-91, 2002
                                                                          24. Cothran RL Jr et al: MR imaging of meniscal contusion in the knee. AJR Am J Roentgenol. 177(5):1189-92, 2001
                                                                          25. Jerosch J et al: Age-related magnetic resonance imaging morphology of the menisci in asymptomatic individuals. Arch Orthop Trauma Surg. 115(3-4):199-202, 1996
                                                                          26. Peterfy CG et al: "Magic-angle" phenomenon: a cause of increased signal in the normal lateral meniscus on short-TE MR images of the knee. AJR Am J Roentgenol. 163(1):149-54, 1994
                                                                          27. Raunest J et al: Magnetic resonance imaging (MRI) and arthroscopy in the detection of meniscal degenerations: correlation of arthroscopy and MRI with histology findings. Arthroscopy. 10(6):634-40, 1994
                                                                          28. Hodler J et al: Degenerative changes of the menisci of the knee. Value of different MR pulse sequences. Acta Radiol. 34(4):404-7, 1993
                                                                          29. Kaplan PA et al: MR of the knee: the significance of high signal in the meniscus that does not clearly extend to the surface. AJR Am J Roentgenol. 156(2):333-6, 1991
                                                                          30. Hajek PC et al: The high signal intensity meniscus of the knee. Magnetic resonance evaluation and in vivo correlation. Invest Radiol. 22(11):883-90, 1987