Magnetic resonance imaging of the meniscal roots
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REVIEW ARTICLE
Magnetic resonance imaging of the meniscal roots Ban Sharif 1 & Tanweer Ashraf 2 & Asif Saifuddin 3,4 Received: 14 November 2019 / Revised: 30 December 2019 / Accepted: 2 January 2020 # ISS 2020
Abstract The meniscal roots and supporting structures anchor the menisci to the tibial plateau and resist hoop stress, thereby preventing radial displacement of the menisci and secondary degenerative tibiofemoral compartment changes that may occur if this is compromised. The anatomy of the four meniscal roots and their supporting structures on magnetic resonance imaging (MRI) will be outlined in this review article, as well as the imaging appearances of meniscal root–related pathology, namely meniscal root degeneration and tears, meniscal extrusion and tibial plateau cystic lesions. Keywords Magnetic resonance imaging . Meniscal roots . Meniscal root tear . Meniscal root degeneration
Introduction The menisci are crescent-shaped wedges of fibrocartilage, which enable articulation between the concave femoral condyles and the flat tibial plateau [1]. The main body of the menisci is composed of circumferentially oriented collagen fibre bundles and radially oriented collagen tie-fibre sheets [2]. The peripheral borders of the menisci are attached to the fibrous joint capsule. The medial meniscus has a firm attachment to the deep medial collateral ligament and is fixed to the inferior margin of the tibial plateau by the coronary ligament [3]. The meniscofemoral ligaments (MFL), popliteal fascia and arcuate complex attach the lateral meniscus directly to the femur [4], while part of the popliteus tendon is attached to the lateral meniscus. The anterior inter-meniscal ligament (AIML) attaches the menisci to each other [5]. The meniscal roots originate from the anterior and posterior horns of the menisci and firmly attach the menisci to the central tibial plateau (Fig. 1). They have structural similarities with the main body of the meniscus and transition into it through continuous
collagen organisation from the roots into the meniscal body [6]. Andrews et al. identified small tie-fibres in the meniscal roots, with large tie-fibre bundles at the meniscus transition [6]. There may also be continuity between the meniscal root and outer portion of the meniscus, which then blends with the fibrocartilage-like inner portion of the meniscus [6]. The meniscal roots resist hoop stress thereby preventing radial displacement of the menisci and have a protective effect on the articular cartilage of the medial and lateral joint compartments [5]. Degenerative or traumatic disruption of the meniscal roots and their supporting structures can lead to pain, meniscal extrusion and secondary tibiofemoral osteoarthritis [7]. Therefore, particular attention should be paid to the status of the meniscal roots when assessing the knee on magnetic resonance imaging (MRI). The current article describes in detail the anatomy and pathology of the meniscal roots.
Anatomy of the meniscal roots and related structures Anterior root medial meniscu
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