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Musculoskeletal
Diagnosis
Trauma
Knee
Menisci
Meniscus Pitfalls and Variations
Meniscus Pitfalls and Variations
Donna G. Blankenbaker, MD, FACR; Andrew Sonin, MD, FACR
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KEY FACTS

  • Imaging

    TERMINOLOGY

    • Abbreviations

      • Medial meniscus (MM)
      • Lateral meniscus (LM)

    • Definitions

      • Variety of anatomic conditions and variations of menisci and their attachments that may be mistaken for pathology on MR

    IMAGING

    • MR Findings

      • Imaging Recommendations

        DIFFERENTIAL DIAGNOSIS

          CLINICAL ISSUES

          • Demographics

            DIAGNOSTIC CHECKLIST

            • Consider

              Selected References

              1. Iqbal A et al: The ring-shaped meniscus: a case series demonstrating the variation of imaging appearances on MRI. Skeletal Radiol. 49(2):281-9, 2020
              2. Kim HJ et al: Association of meniscal flounce in the knee with the pattern and location of meniscal tear, concomitant ligamentous injury, amount of knee joint effusion, and flexion and rotation angles: a magnetic resonance evaluation. Skeletal Radiol. 49(8):1277-84, 2020
              3. Lee SK et al: Ring-shaped lateral meniscus combined with an accessory meniscus: a rare anatomical variant. J Orthop Surg (Hong Kong). 28(1):2309499019893059, 2020
              4. Kim YM et al: Anteromedial meniscofemoral ligament of the anterior horn of the medial meniscus: clinical, magnetic resonance imaging, and arthroscopic features. Arthroscopy. 34(5):1590-600, 2018
              5. Kocher MS et al: Discoid lateral meniscus in children: diagnosis, management, and outcomes. J Am Acad Orthop Surg. 25(11):736-43, 2017
              6. Sharma A et al: Medial oblique meniscomeniscal ligament of knee. Am J Orthop (Belle Mead NJ). 46(5):E276-9, 2017
              7. Bolog NV et al: Reporting knee meniscal tears: technical aspects, typical pitfalls and how to avoid them. Insights Imaging. 7(3):385-98, 2016
              8. Ellis HB Jr et al: Prevalence of discoid meniscus during arthroscopy for isolated lateral meniscal pathology in the pediatric population. J Pediatr Orthop. 37(4):285-92, 2015
              9. Esteves C et al: Ring-shaped lateral meniscus with hypoplasic anterior cruciate ligament. Skeletal Radiol. 44(12): 1813-8, 2015
              10. Jose J et al: Wrisberg-variant discoid lateral meniscus: current concepts, treatment options, and imaging features with emphasis on dynamic ultrasonography. Am J Orthop (Belle Mead NJ). 44(3):135-9, 2015
              11. Kamimura M et al: Medial meniscus tear morphology and related clinical symptoms in patients with medial knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 23(1):158-63, 2015
              12. LaPrade CM et al: Meniscal root tears: a classification system based on tear morphology. Am J Sports Med. 43(2):363-9, 2015
              13. Boutin RD et al: Magnetic resonance imaging of the postoperative meniscus: resection, repair, and replacement. Magn Reson Imaging Clin N Am. 22(4):517-55, 2014
              14. James EW et al: Radiographic identification of the anterior and posterior root attachments of the medial and lateral menisci. Am J Sports Med. 42(11):2707-14, 2014
              15. Mohankumar R et al: Pitfalls and pearls in MRI of the knee. AJR Am J Roentgenol. 203(3):516-30, 2014
              16. Rosas HG: Magnetic resonance imaging of the meniscus. Magn Reson Imaging Clin N Am. 22(4):493-516, 2014
              17. Van Steyn MO et al: The hypermobile lateral meniscus: a retrospective review of presentation, imaging, treatment, and results. Knee Surg Sports Traumatol Arthrosc. 24(5):1555-9, 2014
              18. Murlimanju BV et al: Morphological variants of lateral meniscus of the knee: a cadaveric study in South Indian human fetuses. Anat Sci Int. 86(2):63-8, 2011
              19. Yue BW et al: Wrisberg variant of the discoid lateral meniscus with flipped meniscal fragments simulating bucket-handle tear: MRI and arthroscopic correlation. Skeletal Radiol. 40(8):1089-94, 2011
              20. Kim JE et al: Is the location of the Wrisberg ligament related to frequent complete discoid lateral meniscus tear? Acta Radiol. 51(10):1120-5, 2010
              21. Kim HK et al: Oblique meniscomeniscal ligament: a normal variant. Pediatr Radiol. 39(6):634, 2009
              22. Laundre BJ et al: MRI accuracy for tears of the posterior horn of the lateral meniscus in patients with acute anterior cruciate ligament injury and the clinical relevance of missed tears. AJR Am J Roentgenol. 193(2):515-23, 2009
              23. Mustonen AO et al: MRI of acute meniscal injury associated with tibial plateau fractures: prevalence, type, and location. AJR Am J Roentgenol. 191(4):1002-9, 2008
              24. Peduto AJ et al: Popliteomeniscal fascicles: anatomic considerations using MR arthrography in cadavers. AJR Am J Roentgenol. 190(2):442-8, 2008
              25. de Abreu MR et al: Meniscofemoral ligaments: patterns of tears and pseudotears of the menisci using cadaveric and clinical material. Skeletal Radiol. 36(8):729-35, 2007
              26. Fox MG: MR imaging of the meniscus: review, current trends, and clinical implications. Radiol Clin North Am. 45(6):1033-53, vii, 2007
              27. Park LS et al: Posterior horn lateral meniscal tears simulating meniscofemoral ligament attachment in the setting of ACL tear: MRI findings. Skeletal Radiol. 36(5):399-403, 2007
              28. Kim YG et al: An arthroscopic analysis of lateral meniscal variants and a comparison with MRI findings. Knee Surg Sports Traumatol Arthrosc. 14(1):20-6, 2006
              29. 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
              30. Sonin A et al: Intra-articular ganglion arising from the meniscofemoral ligament of Humphrey. Skeletal Radiol. 32(5):295-7, 2003
              31. Aydingöz U et al: MR imaging of the anterior intermeniscal ligament: classification according to insertion sites. Eur Radiol. 12(4):824-9, 2002
              32. Erbagci H et al: An MRI study of the meniscofemoral and transverse ligaments of the knee. Surg Radiol Anat. 24(2):120-4, 2002
              33. Gupte CM et al: Meniscofemoral ligaments revisited. Anatomical study, age correlation and clinical implications. J Bone Joint Surg Br. 84(6):846-51, 2002
              34. Cothran RL Jr et al: MR imaging of meniscal contusion in the knee. AJR Am J Roentgenol. 177(5):1189-92, 2001
              35. Lee BY et al: Incidence and significance of demonstrating the meniscofemoral ligament on MRI. Br J Radiol. 73(867):271-4, 2000
              36. Thornton DD et al: Magnetic resonance imaging of the knee menisci. Semin Roentgenol. 35(3):217-30, 2000
              37. Cho JM et al: Variations in meniscofemoral ligaments at anatomical study and MR imaging. Skeletal Radiol. 28(4):189-95, 1999
              38. Sanders TG et al: Oblique meniscomeniscal ligament: another potential pitfall for a meniscal tear--anatomic description and appearance at MR imaging in three cases. Radiology. 213(1):213-6, 1999
              39. De Maeseneer M et al: Normal and abnormal medial meniscocapsular structures: MR imaging and sonography in cadavers. AJR Am J Roentgenol. 171(4):969-76, 1998
              40. Miller TT et al: Relationship of the meniscofemoral ligaments of the knee to lateral meniscus tears: magnetic resonance imaging evaluation. Am J Orthop (Belle Mead NJ). 27(11):729-32, 1998
              41. Poynton AR et al: The meniscofemoral ligaments of the knee. J Bone Joint Surg Br. 79(2):327-30, 1997
              42. Jordan MR: Lateral Meniscal Variants: Evaluation and Treatment. J Am Acad Orthop Surg. 4(4):191-200, 1996
              43. De Smet AA et al: MR diagnosis of meniscal tears: analysis of causes of errors. AJR Am J Roentgenol. 163(6):1419-23, 1994
              44. Mesgarzadeh M et al: MR imaging of the knee: expanded classification and pitfalls to interpretation of meniscal tears. Radiographics. 13(3):489-500, 1993
              45. Hassine D et al: The meniscofemoral ligaments: magnetic resonance imaging and anatomic correlations. Surg Radiol Anat. 14(1):59-63, 1992
              46. 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
              47. Carpenter WA: Meniscofemoral ligament simulating tear of the lateral meniscus: MR features. J Comput Assist Tomogr. 14(6):1033-4, 1990
              48. Vahey TN et al: MR imaging of the knee: pseudotear of the lateral meniscus caused by the meniscofemoral ligament. AJR Am J Roentgenol. 154(6):1237-9, 1990
              49. Watanabe AT et al: Common pitfalls in magnetic resonance imaging of the knee. J Bone Joint Surg Am. 71(6):857-62, 1989
              Related Anatomy
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              Related Differential Diagnoses
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              References
              Tables

              Tables

              KEY FACTS

              • Imaging

                TERMINOLOGY

                • Abbreviations

                  • Medial meniscus (MM)
                  • Lateral meniscus (LM)

                • Definitions

                  • Variety of anatomic conditions and variations of menisci and their attachments that may be mistaken for pathology on MR

                IMAGING

                • MR Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      CLINICAL ISSUES

                      • Demographics

                        DIAGNOSTIC CHECKLIST

                        • Consider

                          Selected References

                          1. Iqbal A et al: The ring-shaped meniscus: a case series demonstrating the variation of imaging appearances on MRI. Skeletal Radiol. 49(2):281-9, 2020
                          2. Kim HJ et al: Association of meniscal flounce in the knee with the pattern and location of meniscal tear, concomitant ligamentous injury, amount of knee joint effusion, and flexion and rotation angles: a magnetic resonance evaluation. Skeletal Radiol. 49(8):1277-84, 2020
                          3. Lee SK et al: Ring-shaped lateral meniscus combined with an accessory meniscus: a rare anatomical variant. J Orthop Surg (Hong Kong). 28(1):2309499019893059, 2020
                          4. Kim YM et al: Anteromedial meniscofemoral ligament of the anterior horn of the medial meniscus: clinical, magnetic resonance imaging, and arthroscopic features. Arthroscopy. 34(5):1590-600, 2018
                          5. Kocher MS et al: Discoid lateral meniscus in children: diagnosis, management, and outcomes. J Am Acad Orthop Surg. 25(11):736-43, 2017
                          6. Sharma A et al: Medial oblique meniscomeniscal ligament of knee. Am J Orthop (Belle Mead NJ). 46(5):E276-9, 2017
                          7. Bolog NV et al: Reporting knee meniscal tears: technical aspects, typical pitfalls and how to avoid them. Insights Imaging. 7(3):385-98, 2016
                          8. Ellis HB Jr et al: Prevalence of discoid meniscus during arthroscopy for isolated lateral meniscal pathology in the pediatric population. J Pediatr Orthop. 37(4):285-92, 2015
                          9. Esteves C et al: Ring-shaped lateral meniscus with hypoplasic anterior cruciate ligament. Skeletal Radiol. 44(12): 1813-8, 2015
                          10. Jose J et al: Wrisberg-variant discoid lateral meniscus: current concepts, treatment options, and imaging features with emphasis on dynamic ultrasonography. Am J Orthop (Belle Mead NJ). 44(3):135-9, 2015
                          11. Kamimura M et al: Medial meniscus tear morphology and related clinical symptoms in patients with medial knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 23(1):158-63, 2015
                          12. LaPrade CM et al: Meniscal root tears: a classification system based on tear morphology. Am J Sports Med. 43(2):363-9, 2015
                          13. Boutin RD et al: Magnetic resonance imaging of the postoperative meniscus: resection, repair, and replacement. Magn Reson Imaging Clin N Am. 22(4):517-55, 2014
                          14. James EW et al: Radiographic identification of the anterior and posterior root attachments of the medial and lateral menisci. Am J Sports Med. 42(11):2707-14, 2014
                          15. Mohankumar R et al: Pitfalls and pearls in MRI of the knee. AJR Am J Roentgenol. 203(3):516-30, 2014
                          16. Rosas HG: Magnetic resonance imaging of the meniscus. Magn Reson Imaging Clin N Am. 22(4):493-516, 2014
                          17. Van Steyn MO et al: The hypermobile lateral meniscus: a retrospective review of presentation, imaging, treatment, and results. Knee Surg Sports Traumatol Arthrosc. 24(5):1555-9, 2014
                          18. Murlimanju BV et al: Morphological variants of lateral meniscus of the knee: a cadaveric study in South Indian human fetuses. Anat Sci Int. 86(2):63-8, 2011
                          19. Yue BW et al: Wrisberg variant of the discoid lateral meniscus with flipped meniscal fragments simulating bucket-handle tear: MRI and arthroscopic correlation. Skeletal Radiol. 40(8):1089-94, 2011
                          20. Kim JE et al: Is the location of the Wrisberg ligament related to frequent complete discoid lateral meniscus tear? Acta Radiol. 51(10):1120-5, 2010
                          21. Kim HK et al: Oblique meniscomeniscal ligament: a normal variant. Pediatr Radiol. 39(6):634, 2009
                          22. Laundre BJ et al: MRI accuracy for tears of the posterior horn of the lateral meniscus in patients with acute anterior cruciate ligament injury and the clinical relevance of missed tears. AJR Am J Roentgenol. 193(2):515-23, 2009
                          23. Mustonen AO et al: MRI of acute meniscal injury associated with tibial plateau fractures: prevalence, type, and location. AJR Am J Roentgenol. 191(4):1002-9, 2008
                          24. Peduto AJ et al: Popliteomeniscal fascicles: anatomic considerations using MR arthrography in cadavers. AJR Am J Roentgenol. 190(2):442-8, 2008
                          25. de Abreu MR et al: Meniscofemoral ligaments: patterns of tears and pseudotears of the menisci using cadaveric and clinical material. Skeletal Radiol. 36(8):729-35, 2007
                          26. Fox MG: MR imaging of the meniscus: review, current trends, and clinical implications. Radiol Clin North Am. 45(6):1033-53, vii, 2007
                          27. Park LS et al: Posterior horn lateral meniscal tears simulating meniscofemoral ligament attachment in the setting of ACL tear: MRI findings. Skeletal Radiol. 36(5):399-403, 2007
                          28. Kim YG et al: An arthroscopic analysis of lateral meniscal variants and a comparison with MRI findings. Knee Surg Sports Traumatol Arthrosc. 14(1):20-6, 2006
                          29. 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
                          30. Sonin A et al: Intra-articular ganglion arising from the meniscofemoral ligament of Humphrey. Skeletal Radiol. 32(5):295-7, 2003
                          31. Aydingöz U et al: MR imaging of the anterior intermeniscal ligament: classification according to insertion sites. Eur Radiol. 12(4):824-9, 2002
                          32. Erbagci H et al: An MRI study of the meniscofemoral and transverse ligaments of the knee. Surg Radiol Anat. 24(2):120-4, 2002
                          33. Gupte CM et al: Meniscofemoral ligaments revisited. Anatomical study, age correlation and clinical implications. J Bone Joint Surg Br. 84(6):846-51, 2002
                          34. Cothran RL Jr et al: MR imaging of meniscal contusion in the knee. AJR Am J Roentgenol. 177(5):1189-92, 2001
                          35. Lee BY et al: Incidence and significance of demonstrating the meniscofemoral ligament on MRI. Br J Radiol. 73(867):271-4, 2000
                          36. Thornton DD et al: Magnetic resonance imaging of the knee menisci. Semin Roentgenol. 35(3):217-30, 2000
                          37. Cho JM et al: Variations in meniscofemoral ligaments at anatomical study and MR imaging. Skeletal Radiol. 28(4):189-95, 1999
                          38. Sanders TG et al: Oblique meniscomeniscal ligament: another potential pitfall for a meniscal tear--anatomic description and appearance at MR imaging in three cases. Radiology. 213(1):213-6, 1999
                          39. De Maeseneer M et al: Normal and abnormal medial meniscocapsular structures: MR imaging and sonography in cadavers. AJR Am J Roentgenol. 171(4):969-76, 1998
                          40. Miller TT et al: Relationship of the meniscofemoral ligaments of the knee to lateral meniscus tears: magnetic resonance imaging evaluation. Am J Orthop (Belle Mead NJ). 27(11):729-32, 1998
                          41. Poynton AR et al: The meniscofemoral ligaments of the knee. J Bone Joint Surg Br. 79(2):327-30, 1997
                          42. Jordan MR: Lateral Meniscal Variants: Evaluation and Treatment. J Am Acad Orthop Surg. 4(4):191-200, 1996
                          43. De Smet AA et al: MR diagnosis of meniscal tears: analysis of causes of errors. AJR Am J Roentgenol. 163(6):1419-23, 1994
                          44. Mesgarzadeh M et al: MR imaging of the knee: expanded classification and pitfalls to interpretation of meniscal tears. Radiographics. 13(3):489-500, 1993
                          45. Hassine D et al: The meniscofemoral ligaments: magnetic resonance imaging and anatomic correlations. Surg Radiol Anat. 14(1):59-63, 1992
                          46. 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
                          47. Carpenter WA: Meniscofemoral ligament simulating tear of the lateral meniscus: MR features. J Comput Assist Tomogr. 14(6):1033-4, 1990
                          48. Vahey TN et al: MR imaging of the knee: pseudotear of the lateral meniscus caused by the meniscofemoral ligament. AJR Am J Roentgenol. 154(6):1237-9, 1990
                          49. Watanabe AT et al: Common pitfalls in magnetic resonance imaging of the knee. J Bone Joint Surg Am. 71(6):857-62, 1989