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The "Floating" Meniscus: MRI in Knee Trauma and Implications for Surgery

Ravi S. Bikkina1, Charles A. Tujo2, Albert B. Schraner2 and Nancy M. Major1

1 Department of Radiology, Duke University Medical Center, Erwin Rd., PO Box 3808, Durham, NC 27710.
2 Department of Diagnostic Imaging, David Grant Medical Center, 101 Bodin Cir., Travis Air Force Base, CA 94535.



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  		Fig. 1A. —28-year-old man after motor vehicle crash with associated knee dislocation. Coronal fast spin-echo fat-saturated T2-weighted image shows large quantity of fluid extending between lateral meniscus and tibial plateau (arrow), representing "floating" meniscus, which was confirmed surgically. Note high signal within anterior cruciate ligament representing tear and contusion of medial femoral condyle. Also note high signal in chondral defect.

 


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  		Fig. 1B. —28-year-old man after motor vehicle crash with associated knee dislocation. Sagittal fast spin-echo fat-saturated T2-weighted image shows large quantity of fluid surrounding lateral meniscus representing meniscal avulsion from tibial plateau. Note associated elevation of floating anterior horn of meniscus.

 


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  		Fig. 1C. —28-year-old man after motor vehicle crash with associated knee dislocation. Intraoperative photograph shows forceps grasping floating lateral meniscus that has been avulsed from tibial plateau (arrow). Note gap between meniscus and tibia.

 


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  		Fig. 2A. —29-year-old man after acute knee dislocation. Coronal fast spin-echo fat-saturated T2-weighted image shows relatively small quantity of fluid extending between tibial plateau and lateral meniscus (arrow) suggestive of "floating" meniscus. Note absence of fluid beneath normal medial meniscus and contusions of lateral femoral condyle and lateral tibial plateau.

 


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  		Fig. 2B. —29-year-old man after acute knee dislocation. Sagittal fast spin-echo fat-saturated T2-weighted image confirms meniscal avulsion, with fluid completely surrounding anterior horn of lateral meniscus and extending beneath posterior horn. This floating meniscus was repaired surgically.

 


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  		Fig. 3. —Schematic diagram shows attachment of medial meniscus to adjacent tibial plateau by normal meniscotibial ligament and relationship of meniscotibial ligament to adjacent medial collateral ligament (MCL).

 


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  		Fig. 4A. —29-year-old man after clipping injury without dislocation sustained while playing football. On coronal fast spin-echo fat-saturated T2-weighted image, far posterior aspect has large quantity of fluid extending between tibial plateau and medial meniscus. No other injuries were identified on MRI or at surgery.

 


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  		Fig. 4B. —29-year-old man after clipping injury without dislocation sustained while playing football. Sagittal fast spin-echo non-fat-saturated T2-weighted image shows subtle small quantity of fluid extending beneath posterior horn and body of medial meniscus.

 


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  		Fig. 5A. —51-year-old man after motorcycle crash with associated knee dislocation. Coronal fast spin-echo fat-saturated T2-weighted image shows significant quantity of fluid extending between tibial plateau and "floating" lateral meniscus. Note complete lateral and medial collateral ligament tears and marked widening of lateral joint space.

 


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  		Fig. 5B. —51-year-old man after motorcycle crash with associated knee dislocation. Sagittal fast spin-echo non-fat-saturated T2-weighted image shows large quantity of fluid extending beneath avulsed lateral meniscus and tibial plateau, with associated superior migration of floating anterior horn.

 

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