Isolated meniscus extrusion associated with meniscotibial ligament abnormality
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Isolated meniscus extrusion associated with meniscotibial ligament abnormality Aaron J. Krych1 · Christopher D. Bernard1 · Devin P. Leland1 · Christopher L. Camp1 · Adam C. Johnson2 · Jonathan T. Finnoff3 · Michael J. Stuart1 Received: 30 January 2019 / Accepted: 1 July 2019 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019
Abstract Purpose The purpose of this study was to describe meniscus extrusion, present imaging characteristics, and provide clinical correlations for patients with isolated meniscus extrusion. Methods Of the 3244 MRI reports identified as having meniscus extrusion, 20 patients were identified to have isolated meniscus extrusion (0.62%). Patients with moderate to severe chondromalacia, meniscus tears, intra-articular fractures, tumours, and ligament tears were excluded. Radiographs were reviewed and graded using Kellgren–Lawrence (K–L) scores. MRI’s were reviewed for the extent of extrusion and whether or not the meniscotibial ligament was intact. Clinical presentation and management were recorded. Results The study population consisted of 12 females and 8 males with a mean age of 40.5, diagnosed with meniscus extrusion and minimal concomitant knee pathology. 68% of patients were considered symptomatic as their knee pain correlated with the side of their meniscus extrusion and no other reason for pain was identified. The mean amount of meniscus extrusion was 2.5 mm (SD ± 1.1 mm) with 45% (9 of 20) having 3 + mm of extrusion. Meniscotibial ligament abnormality was identified in 65% of cases (13 of 20). Patients with 3 + mm of meniscus extrusion were much more likely to have associated meniscotibial ligament abnormality (100%, 9 of 9) compared to those with 3 mm) meniscus extrusion. Meniscus root attachments and the meniscotibial ligaments are essential anatomic structures of the knee [26]. Meniscotibial ligaments play an important role in stabilising the meniscus on the tibial plateau (Fig. 1). The meniscus may become avulsed from the tibial plateau when the meniscotibial ligaments are disrupted; however, the meniscus typically remains intact without evidence of an intrasubstance tear [5]. Meniscus extrusion may result from this type of injury due to the lack of stabilising attachment sites. More commonly, meniscus extrusion has been associated with a meniscus root tear or degeneration [7, 8, 21, 27], but oblique, radial, and complex meniscus tears have been implicated as well [8]. Additionally, meniscus extrusion may occur in the presence of knee OA, limb malalignment or joint effusion [14, 15, 24, 25]. Meniscus extrusion in the presence of meniscus tears or OA has been well studied, but the knowledge regarding extrusion in patients without substantial knee pathology is limited. For example, some authors [2, 11] have found a significant association between body mass index (BMI) or age and extrusion while other studies did not demonstrate this association [9, 14]. Fig. 1 Superior view of the medial and lateral meniscus depicting the meniscotibial liga
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