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Inferiorly Displaced Flap Tears of the Medial Meniscus

MR Appearance and Clinical Significance

Lynn K. Lecas1, Clyde A. Helms1, Frank J. Kosarek1 and William E. Garret2

1 Department of Radiology, Duke University Medical Center, Erwin Rd., Box 3808, Durham, NC 27710.
2 Department of Orthopedic Surgery, University of North Carolina, Manning Dr. Chapel Hill, NC 27514.



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  		Fig. 1. —Drawing shows inferior flap tear. Horizontal tear runs through undersurface of medial meniscus with displacement of flap (arrow) inferomedially in medial gutter.

 


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  		Fig. 2. —44-year-old man with inferior flap tear of medial meniscus. Coronal fast spin-echo T2-weighted MR image (3283/76 [TR/TE]) with fat saturation shows inferomedial displacement of medial meniscus fragment (arrow) deep in relation to medial collateral ligament and adjacent to tibial plateau.

 


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  		Fig. 3. —65-year-old man with inferior flap tear of medial meniscus.

A, Coronal fast spin-echo T2-weighted MR image (3816/70 [TR/TE]) with fat saturation shows inferomedial displacement of medial meniscal fragment (arrow) deep in relation to medial collateral ligament and adjacent to tibial plateau.

 


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  		Fig. 3. —65-year-old man with inferior flap tear of medial meniscus.

B, MR image (3816/70) obtained posterior to A shows displaced fragment (short arrow) in gutter. Note abnormal signal extending horizontally through parent meniscus to involve superior and inferior surfaces, representing flap tear (long, thin arrow).

 


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  		Fig. 3. —65-year-old man with inferior flap tear of medial meniscus.

C, Sagittal proton density-weighted MR image (2000/20) with fat saturation obtained through most medial aspect of knee reveals large fragment (arrow) of meniscus in medial gutter.

 


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  		Fig. 4. —44-year-old man with inferior flap tear of medial meniscus.

A Sagittal proton density-weighted image (2000/20 [TR/TE]) with fat saturation through most medial aspect of knee. Large fragment (arrow) of meniscus is in medial gutter.

 


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  		Fig. 4. —44-year-old man with inferior flap tear of medial meniscus.

B, MR image obtained more toward intercondylar notch than A shows abnormally shaped body segment with flap (arrows) of meniscus beneath inferior surface of parent meniscus.

 


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  		Fig. 5. —60-year-old man with inferior flap tear of medial meniscus with MR image depicting semimembranous tendon as separate structure from displaced meniscal fragment. Axial fast spin-echo T2-weighted MR image (4666/75 [TR/TE]) with fat saturation through tibial plateau. In medial joint is large displaced fragment (M) of meniscus. Semimembranous tendon (arrow) is seen separate from fragment. Between two structures is joint fluid extending in popliteal cyst (P).

 


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  		Fig. 6. —66-year-old man with inferior flap tear of medial meniscus with MR image depicting semimembranous tendon as separate structure from displaced meniscal fragment. Coronal fast spin-echo T2-weighted MR image (3283/76 [TR/TE]) with fat saturation. Inferomedially displaced fragment (straight arrow) is clearly seen as separate from semimembranous tendon (curved arrow).

 

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