A Review Article on Imaging Modalities to Assess Healing Status of Repaired Menisci

Vol 4 | Issue 1 | Jan-Jun 2019 | page:6-11  | Kshitij Mody, Parag Sancheti, Kailash Patil, Madhav Borate, Ashok Shyam


Authors: Kshitij Mody [1], Parag Sancheti [1], Kailash Patil [1], Madhav Borate [1], Ashok Shyam [1]

[1] Sancheti Institute of Orthopaedics& Rehabilitation,11/12 Thube Park, Shivajinagar, Pune 411005

Address of Correspondence

Dr. Kshitij Bharat Mody
Sancheti Institute of Orthopaedics& Rehabilitation,11/12 Thube Park, Shivajinagar, Pune 411005
Email: drkshitijmody@gmail.com


Abstract

Background: Considerable developments have occurred in meniscal surgery, with increasing usage of meniscal repair as the preferred modality of treatment for meniscal tears, to preserve meniscal morphology and physiologic function and to delay osteoarthrosis. Second look arthroscopy is considered the gold standard in assessing meniscal healing. However, as arthroscopy is an invasive procedure, there is a need for developing accurate modalities for imaging of the post-repair status of the meniscus as a viable alternative to arthroscopy. Magnetic resonance imaging (MRI) is a good non-invasive imaging modality for evaluation of meniscal healing but the persistence of signals within a repaired healed meniscus on conventional MRI makes accurate interpretation difficult. MR arthrography (MRA), which involves addition of intra-articular contrast, increases the sensitivity and specificity of differentiation between healed scar and possible non-healed repair/retear. CT arthrography is another imaging technique which has been used for detection of retear; however, it is limited in the degree of information it provides as compared to MRI/MRA.
Methods: Recent articles were searched on search engines like PubMed, Google Scholar and references of different articles were checked.
Summary: There is a need for developing accurate modalities for imaging of the post-repair status of the meniscus as a viable alternative to arthroscopy. This review discusses different imaging techniques available for the evaluation of post-repair meniscus and its healing along with their advantages and disadvantages.
Keywords: ‘Meniscal repair’ ‘Post-operative radiological evaluation’ ‘MR arthrography’ ‘MR imaging’ ‘CT arthrography’.


References

1. Makris EA, Hadidi P, Athanasiou KA. The knee meniscus: structure-function, pathophysiology, current repair techniques, and prospects for regeneration. Biomaterials. 2011 Oct;32 (30):7411-7431.
2. McCauley TR. MR Imaging Evaluation of the Postoperative Knee. Radiology 2005; 234:53–61.
3. Recht MP, Kramer J. MR Imaging of the Postoperative Knee: A Pictorial Essay. RadioGraphics2002;22:765–774.
4. White LM, Schweitzer ME, Weishaupt D, Kramer J, Davis A, Marks PH. Diagnosis of Recurrent Meniscal Tears: Prospective Evaluation of Conventional MR Imaging, Indirect MR Arthrography, and Direct MR Arthrography. Radiology 2002; 222:421–429.
5. Vande Berg BC, Lecouve FE, Poilvache P, Dubuc JE, Bedat B, Maldague B, et al. Dual-Detector Spiral CT Arthrography of the Knee: Accuracy for Detection of Meniscal Abnormalities and Unstable Meniscal Tears.Radiology 2000; 216:851–857.
6. Pujol N, Panarella L, Tarik Ait Si Selmi, Neyret P, Fithian D, Beaufils P. Meniscal Healing After Meniscal Repair :A CT Arthrography Assessment. The American Journal of Sports Medicine 2008; Vol.36, No.8 :1489-1495.
7. Hantes ME, Zachosa VC, Zibisa AH, Papanagiotoub P, Karahaliosa T, Malizosa KN, Karantanasb AH. Evaluation of meniscal repair with serial magnetic resonance imaging: a comparative study between conventional MRI and indirect MR arthrography. European Journal of Radiology 50 (2004) 231–237.
8. Vance K, MeredickR , Schweitzer ME, Lubowitz JH. Magnetic Resonance Imaging of the Postoperative Meniscus. Arthroscopy 2009; 25, (5): 455-570.
9. Jones HP, Lemos MJ, Wilk RM, Smiley PM, Gutierrez R, Schepsis AA. Two-year follow-up of meniscal repair using a bioabsorbable arrow. Arthroscopy 2002; 18(1):64-69.
10. Lim PS, Schweitzer ME, Bhatia M, et al. Repeat tear of postoperative meniscus: potential MR imaging signs. Radiology 1999; 210:183–8.
11. Vives MJ, Homesley D, Ciccotti MG, Schweitzer ME. Evaluation of recurring meniscal tears with gadolinium-enhanced magnetic resonance imaging. Am J Sports Med 2003;31:868–73.
12. Arnoczky SP, Cooper TG, Stadelmaier DM, Hannafin JA. Magnetic resonance signals in healing menisci: an experimental study in dogs. Arthroscopy 1994; 10:552–7.
13. Farley TE, Howell SM, Love KF, Wolfe RD, Neumann CH. Meniscal tears: MR and arthrographic findings after arthroscopic repair. Radiology 1991; 180:517–522.
14. Bronstein R, Kirk P, Hurley J. The usefulness of MRI in evaluating menisci after meniscus repair. Orthopedics.1992 Feb;15(2):149-52.
15. Miao Y, Yu JK, Ao YF, Zheng ZZ, Gong X, Leung KK. Diagnostic values of 3 methods for evaluating meniscal healing status after meniscal repair: comparison among second-look arthroscopy, clinical assessment, and magnetic resonance imaging. Am J Sports Med. 2011 ;39(4):735-42.
16. Applegate GR, Flannigan BD, Tolin BS, Fox JM and Pizzo WD. MR diagnosis of recurrent tears in the knee: value of intraarticular contrast material. American Journal of Roentgenology. 1993;161: 821-825.
17. Lim PS, Schweitzer ME, Bhatia M, Giuliano V, Kaneriya PP, Senyk RM, et al. Repeat Tear of Postoperative Meniscus: Potential MR Imaging Signs. Radiology 1999; 210:183–188
18. Vahlensieck M, Peterfy CG, Wischer T, et al. Indirect MR arthrography: optimization and clinical applications. Radiology 1996; 200:249– 54.
19. Drape JL, Thelen P, Gay-Depassier P, Silbermann O, Benacerraf R. Intraarticular diffusion of Gd-DOTA after intravenous injection in the knee: MR imaging evaluation. Radiology 1993; 188:227–34.
20. Toms AP, White LM, Marshall TJ, Donnell ST.Imaging the post-operative meniscus. Eur J Radiol.2005 May ; 54 (2) : 189-98.
21. Pujol N, Nicolas T, Boisrenoult P, Beaufils P. Magnetic Resonance Imaging is not suitable for interpretation of meniscal status ten years after arthroscopic repair. IntOrthop. 2013 Dec; 37(12): 2371–2376.
22. Arnoczky SP, Cooper TG, Stadelmaier DM, Hannafin JA. Magnetic resonance signals in healing menisci: an experimental study in dogs. Arthroscopy 1994;10:552–7.
23. Eggli S, Wegmüller H, Kosina J, Huckell C, Jakob RP. Long term results of arthroscopic meniscal repair. Am J Sports Med 1995; 23:715– 20.
24. Muellner T, Egkher A, Nikolic A, Funovics M, Metz V. Open meniscal repair: clinical and magnetic resonance imaging findings after 12 years. Am J Sports Med 1999; 27:16–20.
25. Mustonen AO, Tielinen L, Lindahl J, Hirvensalo E, Kiuru M, Koskinen SK. MRI of menisci repaired with bioabsorbable arrows. Skeletal Radiol. 2006; 35(7):515-521.
26. Steenbrugge F, VerstraeteK ,VerdonkR.Magneticreasonance imaging of the surgically repaired meniscus A 13-year follow-up study of 13 knees. Acta OrthopScand 2004; 75 (3): 323–327 .
27. Sciulli RL, Boutin RD, Brown RR, Nguyen KD, Muhle C, LektrakulN , Resnick D et al .Evaluation of the postoperative meniscus of the knee: a study comparing conventional arthrography, conventional MR imaging, MR arthrography with iodinated contrast material, and MR arthrography with gadolinium-based contrast material. . Skeletal Radiol. 1999; 28(9):508-514.
28. Magee T, Shapiro M, Rodriguez J, Williams D. MR Arthrography of Postoperative Knee: For Which Patients Is It Useful? Radiology. 2003 Oct; 229(1):159-63.
29. Popescu D, Sastre S, Garcia AI, Tomas X, Reategui D, Caballero M. MR arthrography assessment after repair of chronic meniscal tears. Knee Surg Sports TraumatolArthrosc. 2015 Jan;23(1):171-7
30. Mutschler C, Vande Berg BC, Lecouvet FE, Poilvache P, Dubuc JE, Maldague B, Malghem J. Postoperative Meniscus: Assessment at Dual–Detector Row Spiral CT Arthrography of the Knee. Radiology 2003; 228:635–641.
31. PujolN ,Panarella L, Selmi TA, Neyret P, Fithian D, Beaufils P. Meniscal healing after meniscal repair: a CT arthrography assessment. Am J Sports Med. 2008;36(8):1489-95.
32. Henning CE. Arthroscopic repair of meniscus tears. Orthopedics 1983:6:1130-1132.
33. Henning CE, Lynch MA, Clark JR. Vascularity for healing of meniscus repairs. Arthroscopy 1987; 3 (1): 13-8.
34. Buseck MS, Noyes FR: Arthroscopic evaluation of meniscal repairs after anterior cruciate ligament reconstruction and immediate motion. Am Sports Med 1991;19:489–494.
35. C.D. Morgan, E.M. Wojtys, C.D. Casscells, S.W.CasscellsArthroscopic meniscal repair evaluated by second-look arthroscopy. Am J Sports Med, 19 (6) (1991 Nov–Dec), pp.632-637.
36. L. Deutsch, J. Rothman, H. Mink, W. Stoller, and P. Arnoczky, “Meniscal Tears : after or Arthroscoplc Repair ’,” pp. 485–488.
37. E. Farley, K. F. Love, M.Howell, and D.Wolfe, “Findings Tears : after MR and Arthroscoplc Arthrographlc,” 1991.
38. M.D.Michiel F. van Trommel, Hollis G. Potter, Lauren A. Ernberg, Peter T. Simonian, and Thomas L.Wickiewicz, “The Use of Noncontrast Magnetic Resonance Imaging Comparison With Conventional Arthrography,” Sport. Med., vol.14, no.1, pp. 2–8,1998.
39. M.E.Hantes et al., “Evaluation of meniscal repair with serial magnetic resonance imaging: A comparative study between conventional MRI and indirect MR arthrography,” Eur. J. Radiol., vol. 50,no.3,pp231–237, 2004.
40. K. V. & R. V. Franky Steenbrugge and To, “Ankle arthrodesis using dowel bone graft and cancellous-bone screws: A mechanical study in cadavers,” Acta Orthop. Scand., vol. 75,no.4,pp.471–476,2004.
41. Y. Miao et al., “MRI signal changes in completely healed meniscus confirmed by second-look arthroscopy after meniscal repair with bioabsorbable arrows,” Knee Surgery, Sport. Traumatol. Arthrosc., vol.17, no.6, pp.622–630, 2009.
42. N. Pujol, N. Tardy, P. Boisrenoult, and P. Beaufils, “Long-term outcomes of all-inside meniscal repair,” Knee Surg. Sports Traumatol. Arthrosc., vol.23, no.1, pp.219–224,2015.
43. D. Ciliz, A. Ciliz, E. Elverici, B. Sakman, E. Yüksel, and O. Akbulut, “Evaluation of postoperative menisci with MR arthrography and routine conventional MRI,” Clin. Imaging, vol. 32, no. 3, pp. 212–219,2008.
44. Tsujii A, et al., Second look arthroscopic evaluation of repaired radial/oblique tears of the midbody of the lateral meniscus in stable knees, Journal of Orthopaedic Science (2017)
45. Popescu D, Sastre S, Garcia AI, Tomas X, Reategui D, Caballero M. Knee Surg Sports TraumatolArthrosc. 2015Jan;23(1):171-7.


How to Cite this Article: Mody K, Sancheti P, Patil K, Shyam A. A Review Article on Imaging Modalities to Assess Healing Status of Repaired Menisci. Journal of Orthopaedic and Rehabilitation 2019 Jan-Jun; 4(1):6-11.

 (Abstract)      (Full Text HTML)      (Download PDF)


.