Case 41 - 30 year old male with sudden onset right knee pain while weight-lifting (squats)
30 year old male with sudden onset right knee pain while weight-lifting (squatting)
- The coronal proton density images are the key to the diagnosis in this case. The body of the medial meniscus appears truncated and diminutive compared to the contralateral side. We can also see an extra structure sitting in the intercondylar notch in addition to the ACL and PCL. If we follow this extra structure we can see that it attaches to the lateral meniscus both anteriorly and posteriorly.
- On sagittal proton density images we can again see the double PCL sign, with an extra hypointense band sitting anterior to the actual PCL.
- These findings are compatible with a large bucket handle tear of the medial meniscus.
- The patient also has a moderate joint effusion.
- It is important to attempt to identify the affected zone of the meniscus: the peripheral vascular zone versus the nonvascular free edge. Tears through the peripheral vascular zone may be repaired, but tears of in the nonvascular free edge are typically resected. In this case the vertical longitudinal tear has occurred through the peripheral vascular zone of the medial meniscus resulting in a large mesially displaced flap and a small peripheral remnant.
- It is also important to attempt to identify whether the displaced fragment maintains its anterior and posterior attachments to the peripheral remnant.
Accession: CL0053
Study description: MR JOINT LOWER KNEE-RT
Case discussion: