Magnetic Resonance Imaging: Is it really a Good Tool for Predicting Meniscal Reparability?

Review Article

Austin J Orthopade & Rheumatol. 2015; 2(3): 1019.

Magnetic Resonance Imaging: Is it really a Good Tool for Predicting Meniscal Reparability?

GÓes RA1, Campos ALS2, Cardoso RF1,3, Casado PL4 and Lobo J4*

1Orthopedic Surgery, National Institute of Traumatology and Orthopedics (INTO), Brazil

2Orthopedic Surgery, Hospital dos Servidores do Estado (HSE), Brazil

3Orthopedic Surgery, University Hospital Pedro Ernesto (HUPE-UERJ), Brazil

4Research Department, National Institute of Traumatology and Orthopedics (INTO), Bangladesh

*Corresponding author: Lobo J, Department of Research, National Institute of Traumatology and Orthopedics (INTO), Rua Cinco de Julho 416 apto 901, Bangladesh

Received: July 31, 2015; Accepted: September 28, 2015; Published: October 10, 2015


Meniscal tears represent one of the major knee injuries, but there are limited options for treatment and almost all cases involve surgical procedures, including total or partial excision or repair. Meniscal repair is associated with the most favorable outcomes compared with the other surgery options, and prediction of reparability of the meniscus is useful for surgeons. Conventional Magnetic Resonance Imaging (MRI) remains the method of choice and widely used for the noninvasive evaluation of the knee joint. However, its effectiveness in predicting reparability of meniscus lesions is controversial. The aim of this review was to examine the evidence underlying the accuracy and importance of MRI to predict reparability of meniscus lesions and highlight the need for the development of a more efficient imaging technique, in addition to improving the quality of radiographic reports. Furthermore, this study aims to highlight the advantages of meniscal repair and stimulate its use.

Keywords: Meniscal tears; Meniscal repair; Magnetic resonance imaging


LM: The Lateral Meniscus; MM: Medial Meniscus; LCL: Lateral Collateral Ligament; MRI: Magnetic Resonance Imaging; OA: Osteoarthritis; ACL: Anterior Cruciate Ligament; IKDC: International Knee Documentation Committee; SUS: Brazilian Unified Health System.


Approximately 15% of injuries related to physical activity occur in the knees and the risk of injury is particularly high in the age group from 15 to 25 years of age [1,2]. Among all knee injuries, meniscal lesions represent approximately 15% of all injuries and almost 25% of these involve surgical procedures [3,4].

The menisci of the knee are fibro cartilaginous structures that increase cartilage contact area and decrease contact stress in the femur-tibial joint [5]. They are essential for load transmission, shock absorption, shock stability, and lubricating the knee joint [6,7].

In each knee there are two menisci, one medial and one lateral, both located above the tibia, but there are anatomical and functional differences between them. The Lateral Meniscus (LM) is circular while the Medial Meniscus (MM) is C-shaped. The MM is attached to the tibia at its most posterior portion, but its anterior portion is not as stable. Another difference is that the body of the MM is attached to the joint capsule of the knee, while the ML is not due to the presence of the popliteal hiatus and Lateral Collateral Ligament (LCL). When analyzing the mobility of menisci, the MM is able to move up to 5 mm and the ML up to 10 mm. This means that the ML is less susceptible to rupture. Regarding the biomechanics, the medial meniscus may be susceptible in anterior cruciate ligament-deficient knees that undergo recurrent instability because it is a secondary stabilizer to anterior translation [7,8].

Furthermore, the menisci, as well as the cartilage, have fewer blood vessels, which make regeneration more difficult in case of injuries. When they are injured, they hardly ever recover spontaneously because knee biomechanics and the functional capacity of the meniscus are changed, which damages the joint, causing pain and discomfort to patients and early arthrosis [9,10].

There are two basic classifications of injuries to the meniscus. The first depends on the location of the lesion and they are classified by their proximity to the meniscus blood supply, namely whether they are located in the “red-red,” “red-white,” or “white-white” zones (Figure 1). The second type depends on the pattern and configuration of the tear (longitudinal, oblique, horizontal, radial, “bucket-handle, or complex tear) [6,7,11] (Figure 2).