Abstract
Objective
To determine the association of meniscal flounce with the pattern and location of the meniscal tear, concomitant ligamentous injury, amount of knee joint effusion, and flexion and rotation angles.
Materials and methods
A total of 283 knees of 280 patients were retrospectively reviewed over a 9-month period. Thirty-one magnetic resonance images of patients with meniscal flounce were compared with those of age- and sex-matched control group (n = 62) without meniscal flounce. The presence of meniscal tear was evaluated and, if present, its location and pattern were recorded. The amount of joint effusion was graded, and the joint angle was measured. The Fisher’s exact, Cochran-Armitage trend, and t tests were performed to compare the findings between the two groups. The decision tree analysis was employed to determine the most significant factor of meniscal flounce.
Results
Meniscal flounce was present in 11.0% (31/283) of the adult population. Approximately 80.6% of meniscal flounce occurred in the torn medial menisci. The presence of meniscal flounce was significantly associated with tears at the body (p = 0.007), posterior horn (p = 0.001), and meniscocapsular junction (p = 0.002) of the medial meniscus. The decision tree analysis revealed that the posterior horn tear of the medial meniscus was the most significant predictor of meniscal flounce.
Conclusion
The most significant factor associated with meniscal flounce is tear at the posterior horn of the medial meniscus, followed by tear at the meniscocapsular junction.
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References
Zarins B, McInerney V. Lesions of the meniscus. In: Casscells S, editor. Arthroscopy: diagnostic and surgical practice. Philadelphia: Lea & Febiger; 1984. p. 37–51.
Gillquist J, Hagberg G. A new modification of the technique of arthroscopy of the knee joint. Acta Chir Scand. 1976;142(2):123–30.
Chew FS. Medial meniscal flounce: demonstration on MR imaging of the knee. AJR Am J Roentgenol. 1990;155(1):199.
Yu JS, Cosgarea AJ, Kaeding CC, Wilson D. Meniscal flounce MR imaging. Radiology. 1997;203(2):513–5.
Kim BH, Seol HY, Jung HS, Cha SH, Park CM, Lim HC. Meniscal flounce on MR: correlation with arthroscopic or surgical findings. Yonsei Med J. 2000;41(4):507–11.
Park JS, Ryu KN, Yoon KH. Meniscal flounce on knee MRI: correlation with meniscal locations after positional changes. AJR Am J Roentgenol. 2006;187(2):364–70.
Wright RW, Boyer DS. Significance of the arthroscopic meniscal flounce sign: a prospective study. Am J Sports Med. 2007;35(2):242–4.
Wadhwa V, Omar H, Coyner K, Khazzam M, Robertson W, Chhabra A. ISAKOS classification of meniscal tears-illustration on 2D and 3D isotropic spin echo MR imaging. Eur J Radiol. 2016;85(1):15–24.
Kolman BH, Daffner RH, Sciulli RL, Soehnlen MW. Correlation of joint fluid and internal derangement on knee MRI. Skelet Radiol. 2004;33(2):91–5.
Dornacher D, Trubrich A, Guelke J, Reichel H, Kappe T. Evaluation of a modified knee rotation angle in MRI scans with and without trochlear dysplasia: a parameter independent of knee size and trochlear morphology. Knee Surg Sports Traumatol Arthrosc. 2017;25(8):2447–52.
Kim E, Kim YJ, Cha JG, Kim MY, Lee DH, Cho SG, et al. Kinematic change of the meniscus and the tibiofemoral joint space in asymptomatic volunteers using a wide bore 3T closed MRI system. Skelet Radiol. 2015;44(10):1441–51.
Rubin DA, Palmer WE. Imaging of the knee. In: Hodler J, von Schulthess G, Zollikofer CL, editors. Diagnostic Imaging and Interventional Techniques. Verlag: Springer; 2005. p. 26–38.
Rath E, Richmond JC. The menisci: basic science and advances in treatment. Br J Sports Med. 2000;34(4):252–7.
Gupte CM, Bull AM, Thomas RD, Amis AA. A review of the function and biomechanics of the meniscofemoral ligaments. Arthroscopy. 2003;19(2):161–71.
Jee W-H, McCauley TR, Kim J-M, Jun D-J, Lee Y-J, Choi B-G, et al. Meniscal tear configurations: categorization with MR imaging. Am J Roentgenol. 2003;180(1):93–7.
Barile A, Conti L, Lanni G, Calvisi V, Masciocchi C. Evaluation of medial meniscus tears and meniscal stability: weight-bearing MRI vs arthroscopy. Eur J Radiol. 2013;82(4):633–9.
Villegas DF, Hansen TA, Liu DF, Donahue TLH. A quantitative study of the microstructure and biochemistry of the medial meniscal horn attachments. Ann Biomed Eng. 2008;36(1):123–31.
Stephen JM, Halewood C, Kittl C, Bollen SR, Williams A, Amis AA. Posteromedial meniscocapsular lesions increase tibiofemoral joint laxity with anterior cruciate ligament deficiency, and their repair reduces laxity. Am J Sports Med. 2016;44(2):400–8.
DePhillipo NN, Moatshe G, Brady A, Chahla J, Aman ZS, Dornan GJ, et al. Effect of meniscocapsular and meniscotibial lesions in ACL-deficient and ACL-reconstructed knees: a biomechanical study. Am J Sports Med. 2018;46(10):2422–31.
Watanabe Y, Van Scyoc A, Tsuda E, Debski RE, Woo SL. Biomechanical function of the posterior horn of the medial meniscus: a human cadaveric study. J Orthop Sci. 2004;9(3):280–4.
Crawford R, Walley G, Bridgman S, Maffulli N. Magnetic resonance imaging versus arthroscopy in the diagnosis of knee pathology, concentrating on meniscal lesions and ACL tears: a systematic review. Br Med Bull. 2007;84:5–23.
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Kim, H.J., Ahn, J.M., Kim, Y. 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, 1277–1284 (2020). https://doi.org/10.1007/s00256-020-03416-w
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DOI: https://doi.org/10.1007/s00256-020-03416-w