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Medial meniscus posterior root tear causes swelling of the medial meniscus and expansion of the extruded meniscus: a comparative analysis between 2D and 3D MRI

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

This study aimed to clarify the advantages of three-dimensional (3D) magnetic resonance imaging (MRI) over two-dimensional (2D) MRI in measuring the size of the medial meniscus (MM) and to analyse the volumes of MM and the extruded meniscus in patients with MM posterior root tear (MMPRT), at 10° and 90° knee flexion.

Methods

This study included 17 patients with MMPRTs and 15 volunteers with uninjured knees. The MMs were manually segmented for 3D reconstruction; thereafter, the extruded part separated from the tibial edge was determined. The length, width, height, and extrusion of MM were measured by the 2D and 3D methods, and compared. The MM volume, extruded meniscus volume, and their ratio were also calculated using 3D analysis software in the two groups.

Results

The estimated length and posterior height of MM were larger with 3D MRI than with 2D MRI measurements. The MM volume was significantly greater in MMPRT knees than in normal knees, with increasing MM height. In MMPRT knees, the mean volume of the extruded meniscus and its ratio significantly increased by 304 mm3 (p = 0.02) and 9.1% (p < 0.01), respectively, during knee flexion.

Conclusions

This study demonstrated that 3D MRI could estimate the precise MM size and that MMPRT caused swelling of the meniscus due to the increased thickness in the posteromedial part. The clinical significance of this study lies in its 3D evaluation of MM volume, which should help the surgeon understand the biomechanical failure of MM function and improve MMPRT repair technique.

Level of evidence

III.

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Abbreviations

2D:

Two-dimensional

3D:

Three-dimensional

CI:

Confidence interval

ICC:

Intra-class correlation coefficient

Iso FSE:

Isotropic resolution fast spin-echo

LM:

Lateral meniscus

MM:

Medial meniscus

MMBW:

Medial meniscus body width

MMEV:

Medial meniscus extrusion volume

MML:

Medial meniscus length

MMME:

Medial meniscus medial extrusion

MMPE:

Medial meniscus posterior extrusion

MMPH:

Medial meniscus posterior height

MMPRT:

Medial meniscus posterior root tear

MMRV:

Medial meniscus remaining volume

MMV:

Medial meniscus volume

MPL:

Medial plateau width

MRI:

Magnetic resonance imaging

OA:

Osteoarthritis

TPW:

Total plateau width

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Acknowledgements

This study was supported by Takatsugu Yamauchi and Hiroki Ichikawa, who are radiologic technologists, and who took accurate MRI measurements and reviewed the 3D MRI protocol. We are grateful to Dr. Shinichi Miyazawa for the validation analysis.

Funding

No funding was received.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Okayama University Graduate School, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan

    Yoshiki Okazaki, Takayuki Furumatsu, Yusuke Kamatsuki, Shin Masuda, Yuki Okazaki, Takaaki Hiranaka, Ximing Zhang & Toshifumi Ozaki

  2. Division of Radiology, Medical Technology Department, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan

    Takuya Yamaguchi

  3. Department of Orthopaedic Surgery, Iwakuni Medical Center, 1-1-1 Atago-machi, Iwakuni, Yamaguchi, 740-8510, Japan

    Yuya Kodama

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  1. Yoshiki Okazaki
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Correspondence to Takayuki Furumatsu.

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Okazaki, Y., Furumatsu, T., Yamaguchi, T. et al. Medial meniscus posterior root tear causes swelling of the medial meniscus and expansion of the extruded meniscus: a comparative analysis between 2D and 3D MRI. Knee Surg Sports Traumatol Arthrosc 28, 3405–3415 (2020). https://doi.org/10.1007/s00167-019-05580-6

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