Findings and procedure details

The menisci are structures with intrinsic low signal intensity on all MRI sequences.

半月板在所有MRI序列上呈固有的低信號結(jié)構(gòu)。

Therefore, the MRI criteria for diagnosing meniscal tears in the absence of previous surgery is either an increased intrasubstance signal unequivocally contacting the articular surface on at least two consecutive slices, “the 2-touch slice rule”, or at least in one coronal and in one orthogonal sagittal plane.

因此，在沒有既往手術(shù)史的情況下診斷半月板撕裂的MRI標(biāo)準(zhǔn)是在至少兩個(gè)連續(xù)層面上可見明確接觸關(guān)節(jié)面的內(nèi)部高信號影，“2個(gè)連續(xù)層面規(guī)則”，或者至少在一個(gè)冠狀面和一個(gè)正交的矢狀面。

Considering the anatomy of the meniscus, the posterior horn of the medial meniscus is the most commonly involved. Anterior horn tears are rare and should be carefully diagnosed as they are only reported with a prevalence of 2% of all medial meniscal tears and 16% of all lateral meniscal tears.

考慮到半月板的解剖結(jié)構(gòu)，內(nèi)側(cè)半月板后角撕裂是最常見的。 前角撕裂是罕見的，診斷應(yīng)慎重，因?yàn)榍敖撬毫言谒袃?nèi)側(cè)半月板撕裂中占2%的比例、在所有外側(cè)半月板撕裂占16%的比例。

以下為病例圖片：

Fig. 1: Posterior horn medial meniscal tear

內(nèi)側(cè)半月板后角撕裂

Fig. 2: Lateral meniscus anterior horn tear

外側(cè)半月板前角撕裂

Fig. 3: Traumatic tear – young patient with a vertical tear of the posterior horn of the medial meniscus

創(chuàng)傷性撕裂 - 年輕患者內(nèi)側(cè)半月板后角垂直撕裂

Fig. 4: Degenerative tear – older patient with horizontal tear

退行性撕裂 - 老年患者水平撕裂

Fig. 5: Longitudinal-vertical tear with associated ACL tear

圖5：縱向垂直撕裂伴有前交叉韌帶撕裂

Fig. 6: Bucket handle tear showing the typical double PCL sign on sagittal image

桶柄樣撕裂，矢狀位圖像顯示典型的“雙后交叉韌帶”征象

Fig. 7: Horizontal tear of the lateral meniscus with an associated parameniscal cyst (secondary sign of meniscal tear presence)

外側(cè)半月板水平撕裂伴半月板囊腫（半月板撕裂的間接征象）

Fig. 8: Radial tear

放射狀撕裂

Fig. 9: Vertical flap tear

垂直瓣?duì)钏毫?/span>

Fig. 10: Complex tear

復(fù)雜撕裂

Fig. 11: Radial posterior root tear of the medial meniscus

內(nèi)側(cè)半月板后根的放射狀撕裂

Fig. 12: Radial posterior root tear associated with a subchondral insufficiency fracture

后根的放射狀撕裂般軟骨下不全性骨折

Fig. 13: Particular Meniscal Tears Illustration

半月板部分撕裂的示意圖

Fig. 14: Wrisberg Rip

Wrisberg rips are longitudinal vertical meniscal tears. They occur at the at the junction of the ligament of Wrisberg and the posterior horn of the lateral meniscus, and are commonly associated with anterior cruciate ligament tears

Wrisberg撕裂是縱向垂直半月板撕裂。 它們發(fā)生在Wrisberg韌帶和外側(cè)半月板后角的交界處，通常與前交叉韌帶撕裂相關(guān)

Fig. 15: Ramp lesion

Ramp lesion特指內(nèi)側(cè)半月板后角滑膜緣的撕裂傷,是半月板損傷少見的一種,一般是陳舊性前交叉韌帶斷裂導(dǎo)致的繼發(fā)性損傷

Fig. 16: Discoid meniscus

盤狀半月板

Fig. 17: Degenerated discoid meniscus in a young patient

一名年輕患者的退變性盤狀半月板

Fig. 18: Meniscal flounce

裙邊樣半月板（變異）

Secondary signs – tips to diagnose a meniscal tear

• Injuries of the popliteomeniscal fascicles

• Meniscal extrusion

• Parameniscal cysts

• Linear subchondral bone marrow edema adjacent to the meniscal posterior roots attachment sites

• Bone contusions

診斷半月板撕裂的間接征象：

• 腘肌半月板纖維束的損傷
  

• 半月板外突
  

• 半月板旁囊腫
  

• 鄰近半月板后根附著部位的軟骨下線性骨髓水腫
  

• 骨挫傷

Conclusion

Radiology has a major role in depicting meniscal tears mainly those that occur at “blind spots” for the arthroscopist (flap and mainly posterior root longitudinal tears).

放射學(xué)在診斷半月板撕裂中起主要作用，主要是針對關(guān)節(jié)鏡手術(shù)的“盲點(diǎn)”（瓣?duì)詈秃蟾鶠橹鞯目v向撕裂）。

Although meniscus repair and transplantation are becoming more common, the majority of meniscal surgeries are still partial or subtotal meniscectomies.

盡管半月板修補(bǔ)和移植變得越來越普遍，但大多數(shù)半月板手術(shù)仍然是部分或次全切除術(shù)。

As treatment options for meniscal injuries continue to evolve an accurate interpretation of imaging studies becomes more complex but also necessary. 

隨著半月板損傷的治療選擇不斷發(fā)展，對影像學(xué)的準(zhǔn)確解讀變得更加復(fù)雜，但也是必要的。

A detailed knowledge of technical factors, normal anatomy, pitfalls, subtypes of meniscal tears, surgical techniques, as well as adhering rigorously to established imaging criteria (ISAKOS classification) for the diagnosis of meniscal tear are required not only for high diagnostic accuracies but also because it has implications on patient management. 

詳細(xì)了解技術(shù)因素、正常解剖、診斷陷阱、半月板撕裂的亞型、手術(shù)方式，以及嚴(yán)格遵守既定影像標(biāo)準(zhǔn)（ISAKOS分類）是診斷半月板撕裂必要條件，不僅可以提高診斷的準(zhǔn)確性，而且對患者的管理也有影響。

 Classification of meniscal tears as developed by ISAKOS.

 A: Types of tears. B: Location.