대한근골격영상의학회

Title : Case 516

Age / Sex : 22 / M Chief complaint: Right knee pain after soccer What is your impression? Two weeks later, you can see the final diagnosis with a brief discussion of this case. (Please submit only one answer) Courtesy: Dong Hyun Kim, SMG-SNU Boramae medical center Diagnosis: meniscocapsular injury/tear of lateral meniscus Discussion Op finding: Lateral meniscocapsular junction tear, 2cm Discussion: Meniscocapsular separation Meniscocapsular separation refers to detachment of the meniscus from its capsular attachments. It is an uncommon injury. Clinical presentation Clinical findings are nonspecific and can include pain, instability, and joint effusion. Pathology Location it is more common in the medial (more frequently posterior horn region) than in the lateral compartment of the knee meniscofemoral detachment is more common than meniscotibial detachment Associations While it can uncommonly occur in isolation, it is more often associated with other ligamentous injuries. Radiographic features MRI Meniscocapsular separation is usually diagnosed arthroscopically and the positive predictive value (PPV) of MRI has been traditionally described as being low (as low as 9% medially and 13% laterally). Low predictive value MRI findings that have been correlated with meniscocapsular separation include -interposition of fluid between the meniscus and the medial collateral ligament -meniscal corner tears: according to one study had a PPV of 0% medially and 50% laterally -perimeniscal fluid -meniscofemoral and meniscotibial extension tears -irregular meniscal outline -increased distance between the meniscus and the medial collateral ligament -visualisation of fluid from the superior all the way to the inferior end of the meniscus has been described as a more suggestive feature (PPV unknown) Treatment and prognosis It may heal after conservative treatment or after re-suturing the meniscus into the capsule. Complications Potential complications include: increased meniscal mobility and resultant meniscal tears Differential diagnosis On MRI consider a normal menisco-synovial recess / perimeniscal recess.

Title : Case 516

Age / Sex : 22 / M

Chief complaint: Right knee pain after soccer

What is your impression?
Two weeks later, you can see the final diagnosis with a brief discussion of this case. (Please submit only one answer)

Courtesy: Dong Hyun Kim, SMG-SNU Boramae medical center

Diagnosis:

meniscocapsular injury/tear of lateral meniscus

Discussion

Op finding: Lateral meniscocapsular junction tear, 2cm

Discussion:

Meniscocapsular separation

Meniscocapsular separation refers to detachment of the meniscus from its capsular attachments. It is an uncommon injury.

Clinical presentation

Clinical findings are nonspecific and can include pain, instability, and joint effusion.

Pathology

Location

it is more common in the medial (more frequently posterior horn region) than in the lateral compartment of the knee

meniscofemoral detachment is more common than meniscotibial detachment

Associations

While it can uncommonly occur in isolation, it is more often associated with other ligamentous injuries.

Radiographic features

MRI

Meniscocapsular separation is usually diagnosed arthroscopically and the positive predictive value (PPV) of MRI has been traditionally described as being low (as low as 9% medially and 13% laterally).

Low predictive value MRI findings that have been correlated with meniscocapsular separation include

-interposition of fluid between the meniscus and the medial collateral ligament

-meniscal corner tears: according to one study had a PPV of 0% medially and 50% laterally

-perimeniscal fluid

-meniscofemoral and meniscotibial extension tears

-irregular meniscal outline

-increased distance between the meniscus and the medial collateral ligament

-visualisation of fluid from the superior all the way to the inferior end of the meniscus has been described as a more suggestive feature (PPV unknown)

Treatment and prognosis

It may heal after conservative treatment or after re-suturing the meniscus into the capsule.

Complications

Potential complications include:

increased meniscal mobility and resultant meniscal tears

Differential diagnosis

On MRI consider a normal menisco-synovial recess / perimeniscal recess.