Discoid lateral meniscus (DLM) is a common anatomic variant in the knee typically presented in young populations, with a greater incidence in the Asian population than in other populations. At the posterolateral attachment of the lateral meniscus, the popliteomeniscal fascicles, specifically the posterosuperior and anteroinferior fascicles, connect the posterior horn of the lateral meniscus to the popliteal tendon, forming the popliteal hiatus instead of the meniscocapsular tissue. The medial meniscus is sandwiched between the tibia and femur in this joint with attachments to all margins except for the lateral margin. A compressive axial load and forward thrust load were . Most of the weight is borne on the posterior portion of the meniscus. The lateral meniscus is attached to the shin and is located on the outer side of the knee. horn of the lateral meniscus [ 1] (Figs. Click here to Login. The lateral meniscus does not cover the lateral and caudal parts of the tibial condyle. The patient is positioned with the knee flexed at 90° on the operating table. The lateral. Hypothesis: The anterior medial (AM) and anterior lateral (AL) meniscal roots could be quantitatively defined relative to open and arthroscopic surgical landmarks. The inner edge is similar to the medial meniscus. apart from the broad attachments of the anterior and posterior horn of the lateral meniscus to the tibia, additional attachments include the meniscofemoral ligaments of humphry and wrisberg at the posterior horn [ 11, 12 ], the transverse ligament of winslow, which interconnects the anterior horns of the medial and lateral menisci, and the … The lateral meniscus is also attached to the fibula by the meniscofibular ligament and to the tibia by a coronary ligament. The repair methods included total meniscectomy of the lateral meniscus, for which 3-matic software was used to reconstruct the posterior root of the lateral meniscus attachment point with the single-stitch technique and double-stitch technique through the tibial tunnel (Figs. The peripheral attachments are more rigid than the lateral meniscus. The lateral collateral ligament lies over the popliteal tendon and inserts distally on the head of the fibula. Defining the quantitative anatomy of the anterior meniscal root attachments is essential for developing improved diagnostic and surgical techniques. Less common than meniscal body tears and frequently unrecognized. Early-stage lateral meniscus tear strengthening exercises Static Quadriceps Contractions. The band goes around the knee joint in a crescent-shaped path and is located between the . The lateral meniscus posterior root attachment center was located 4.3 (±0.5) mm medial from the nearest articular cartilage margin and directly 12.7 (±1.1) mm from the nearest margin of the . Long-term follow-up after excision. The lateral meniscus has a loose posterior peripheral attachment where it is separated from the capsule . Its usually the posterior root of the meniscus that is torn and medial more than lateral meniscus. (A) Superior view and (B) posterior view. The outer edges of each meniscus attach to the tibia by the short coronary ligaments. Descriptions include attachment to the lateral meniscus [2, 5, 11, 12, 20, 21, Meniscal and tibiofemoral cartilage lesions 22, 23, 28], the fibular head [2, 5, 9, 12, 13, 20, 21, 23, 25, 27, 32], the posterior cruciate ligament [30] and posterior Meniscal lesions were observed in 45% of the specimens; joint capsule [17, 20]. Similar to the medial meniscus, variations in sizing is largely correlated with gender, height, and weight. The lateral meniscus is more mobile than the medial meniscus as there is no attachment to the lateral collateral ligament or joint capsule. In contrast, this relative lack of mobility of the medial meniscus contributes to restricted motion and more prone to injury. The lateral meniscus is attached to the lateral tibial condyle at the following locations 4-6: posterior horn via the posterior meniscotibial ligament 4 midportion or corpus via the lateral meniscotibial ligament, which courses obliquely immediately beneath the fibular collateral ligament 5,6 Description. Debridement of the meniscal remnant is carried out to the peripheral capsule and a tuft of capsular attachment of meniscus is left to serve as a reference The lateral meniscus (external semilunar fibrocartilage) is a fibrocartilaginous band that spans the lateral side of the interior of the knee joint. The meniscus is a C-shaped cartilage disk that is found in the knee. By Boris Poberaj 4 Videos. 1 and 2). Tears in the menisci are categorized according to their shape, their location, how complete they are and whether or not they are stable, according to The Steadman Clinic. Medial and lateral meniscal posterior root attachments and relevant arthroscopic bony landmarks. The medial meniscus is the central band of cartilage attached to the tibia, or shinbone. This technique achieves lateral meniscus root fixation, reducing the risk of subluxation of the meniscus and subsequent osteoarthritis. Primarily, it connects to the intercondyloid eminence of the tibia. In the central third, there is no menisco-capsular junction, and when we lift up the meniscus, the popliteal tendon is visible in the popliteal aperture ( Figure 16 ). However . The lateral meniscus is more mobile than the medial meniscus as there is no attachment to the lateral collateral ligament or joint capsule. The discoid lateral meniscus has been well described. The ring-shaped lateral meniscus was not originally included in the classification systems but has been reported in the literature several times. The average width is 9 to 10 mm , and the average thickness . The lateral meniscus is consistent in width throughout its course. Its anterior end is attached in front of the intercondyloid eminence of the tibia, lateral to, and . attachment of the lateral meniscus, closely approximating the lateral edge of the patella tendon. In addition, the popliteomeniscal fascicles are fibrous bands located lateral and posterior to the transition of the horn into the root that help form the popliteal hiatus ( 2 , 23 ). We have the medial meniscus on the inner side of the knee and the lateral meniscus on the outer side of the knee. The arthrotomy will incorporate this portal in the later stages of the procedure. The posterior root of the lateral meniscus lies anterior to the attachment of the posterior horn of the medial meniscus, medial to the articular margin of the lateral tibial plateau. A thorough understanding of the imaging protocols, normal meniscal anatomy, surrounding anatomic structures, and anatomic variants and pitfalls is critical to ensure diagnostic accuracy and prevent unnecessary surgery. There is a relative lack of mobility of the medial meniscus compared to the lateral meniscus due to its hard attachments to the medial collateral ligament and the knee joint capsule. Posterior Root of Lateral Meniscus. Anteriorly, it is also attached to lateral menisci by transverse ligament and patella either directly or by patellomeniscal ligaments which are anterior capsular thickenings[1]. In 76 % of cases, the posterior root of lateral meniscus reveals two attachment . Discoid lateral meniscus: prevalence of peripheral rim instability. The medial Meniscus of the knee is a C-shaped structure larger in radius than the lateral meniscus. The discoid lateral-meniscus syndrome. Lateral meniscus posterior root attachment (LPRA) The LPRA is 1.5 mm posterior and 4.2 mm medial to the lateral tibial eminence (LTE) ( 17 ). We have two menisci in either knee. ACL, anterior cruciate ligament; LPRA, lateral meniscus . OBJECTIVE. The lateral meniscus (meniscus lateralis; external semilunar fibrocartilage) is nearly circular and covers a larger portion of the articular surface than the medial one.It is grooved laterally for the tendon of the Popliteus, which separates it from the fibular collateral ligament. 2 Comments. Type 1 is most common, and type 3 is least common. Its other attachments are extensions of itself that form or meld with ligaments. It has been calculated that the lateral meniscus absorbs about 70% . The 30° scope is introduced through the anterolateral portal, and a complete arthroscopic examination of the knee is performed. It is nearly circular and covers a larger portion of the articular surface than the medial. 23-14 ). The lateral meniscus becomes less 'mobile' during flexing, extension and rotation movements of the knee. An actual tear of the meniscus is distinguished from degenerative changes on a magnetic resonance imaging scan by communication of the intra-substance signal with the edge of the meniscus. Its anterior end, thin and pointed, is attached to the anterior intercondyloid fossa of the tibia, in front of the anterior cruciate ligament; The greatest displacement of the meniscus is caused by external rotation, while internal rotation relaxes it. mensicus.11 The medial meniscus is less mobile than the lateral meniscus secondary to its attachments to the MCL, allowing 2 to 5 mm of translation; this attachment to the MCL may be a contributor to the increased incidence of medial meniscal tearing.14 In comparison, the lateral meniscus translates 9 to 11mm in the anterioposterior plane.14 Type 3: The Wrisberg variant, where the meniscus may have a normal morphology but lacks its posterior attachments; ie, the meniscotibial ligament and meniscal fascicles. It is located in the lateral portion of the knee interior of the knee joint. The posterior lateral root also has supplemental medial fibers, which account for 30.7% of the native root attachment area (83.1 mm 2) and 17.6% of the native root strength. Acute tear of lateral meniscus of right knee; Current right knee lateral meniscus tear; Current tear of lateral meniscus of right knee; ICD-10-CM S83.281A is grouped within Diagnostic Related Group(s) (MS-DRG v 39.0): 562 Fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh with mcc This article describes a unique variation of the ring lateral meniscus in which the anterior root attachment was to the anterior cruciate ligament . The lateral meniscus is on the outside of the knee. Additionally, the center point of the LPRA is 4.3 mm medial to the lateral cartilage inflection point and 12.7 mm directly anterior to the most proximal aspect of the PCL tibial attachment ( 17 ). A meniscus root tear is defined as either an avulsion of the meniscal root from its attachment point or a radial root tear within 1cm of the root attachment. It is somewhat more in C shape as compared to lateral menisci as it is medial meniscus are clear of the plateau anteriorly and posteriorly. 2. the meniscus with direct attachment to bone; the rest is attached to the joint capsule and collateral liga- ments.1-5The fibers that attach the roots to the tibia are the main restrictors against meniscal extrusion and are vital for the functional integrity of the menisci.6-8 Lateral meniscal root tears are often concomitant with The medial meniscus is on the inner side of the knee joint. The meniscus attaches to the tibia via coronary ligaments. However, the . Subsequently, the posterior horn of the lateral meniscus becomes hypermobile, and is able to sublux into the knee joint. Relative to the medial meniscus, the posterior root attachment of the lateral meniscus has been described as more diverse and complex (9,18,20). The anterior transverse ligament, also known as the geniculate ligament, connects the anterior horns of the medial and lateral meniscus.Medially the transverse ligament blends with the posterior attachment of the anterior medial root ligament. It is one of two menisci of the knee, the other being the medial meniscus. It is also anterolateral to the medial meniscus posterior root attachment, in keeping with the more circular shape of the lateral meniscus. The anchoring of the medial meniscus is consistent, whereas the attachment of the lateral meniscus is variable. Medial and lateral meniscal posterior root attachments and relevant arthroscopic bony landmarks. From Guermazi et al, freely available here.. During weight-bearing, axial loading of the tibiofemoral joint imparts a radial force on the menisci (figure 2), which is resisted by the circumferential meniscal fibres. 5 The lateral meniscus is more loosely attached than the medial meniscus and can translate approximately 11mm with normal knee motion. The coronary ligaments (meniscotibial ligaments) provide an attachment from the posterior horn of the lateral meniscus to the tibia, and are thought to assist in keeping the lateral meniscus adherent to the tibial plateau 3. These are semi circular discs found in the joint. The lateral meniscus is even more important than the medial meniscus for shock absorption. The posterior horn of the lateral meniscus includes the main body of the lateral meniscus, posterior to the popliteus tendon, and its root attachment on the posterior aspect of the tibia. Again, the lateral meniscus has a third attachment by an oblique band that passes from the caudal end to the caudal part of the intercondyloid fossa of the femur. T he anterior and posterior roots are the only parts of the meniscus with direct attachment to bone; the - lateral meniscus is 4-5 mm thick, and has a width of 10-12 mm; - the lateral meniscus bears upto 70% of medial compartment contact pressures; - Soft Tissue Attachments: - unlike medial meniscus there is no attachment to its adjacent collateral ligament ; 72,118,221 The medial meniscus is firmly attached to the medial collateral ligament and the joint capsule via the coronary ligament, but the lateral meniscus lacks these attachments. Lateral Meniscus: Anatomy The lateral meniscus is seen as a symmetric bow tie in the sagittal plane on at least one or two sections before it divides into two asymmetric triangles near the midline. Lateral Meniscal Variants: Evaluation and Treatment. Consequently, at the inner aspect of the lateral compartment, the anterior and posterior horn tibial root attachments are in close proximity to each other. 4 . Magnetic resonance (MR) imaging is currently the modality of choice for detecting meniscal injuries and planning subsequent treatment. The lateral collateral ligament lies over the popliteal tendon and inserts distally on the head of the fibula. The lateral meniscus ( external semilunar fibrocartilage) is a fibrocartilaginous band that spans the lateral side of the interior of the knee joint. Structure. The medial meniscus is also fixed to the inferior margin of the tibial plateau by the coronary ligament. It is one of two menisci of the knee, the other being the medial meniscus.It is nearly circular and covers a larger portion of the articular surface than the medial. The collateral ligaments both originate proximally on the respective epicondyles of the femur. Its posterior end is fixed to the posterior intercondyloid fossa of the tibia, between the attachments of the lateral meniscus and the posterior cruciate ligament. The medial meniscus is more commonly injured because it is firmly attached to the medial collateral ligament and joint capsule. This exercise is used to prevent quadriceps muscles from wasting away in the early stages of injury. This combination might be better denominated the menisco-tibio-popliteus-fibular complex (MTPFC). It is the component of the meniscus between its tibial attachment and the point on the tibial margin where cartilage ends. A case with combined ACL rupture and lateral menisco-capsular desinsertion. Figure 1: anterior and posterior root attachments of the medial (MM) and lateral meniscus (LM). Login to view comments. The collateral ligaments both originate proximally on the respective epicondyles of the femur. Image: Cayenne Medical, Inc. This C-shaped, rubbery, cartilage plays a key role in maintaining stability of the knee. 17.3 and 17.4). Compression of the meniscus is achieved with bone contact. The lateral meniscus, on the outside of the knee, is more circular in shape. Attachments of anterior and posterior horns of the lateral meniscus are near each other. Discoid lateral meniscus in children. The meniscal body is anchored less firmly to the tibia and femur through the coronary ligament, which varies between medial and lateral menisci. Fibrous connections extending from the ante-rior horn of the lateral meniscus attachment to the ACL bundles are constant (the anterior aspect of the anterior horn of the lateral meniscus attach-ment is aligned with the AM bundle, whereas the posterior aspect fibrous attachments are aligned January 7, 2015. When a semimembranosus tendon attachment to the posterior horn of the lateral meniscus is present, its normal insertion is difficult to differentiate from a lateral meniscus tear in MRI and this may cause misdiagnosis. The AM root attachment had a mean area of 110.4 mm 2 (95% CI, 92.2-128.5) with a central attachment of 56.3 mm 2 (95% CI, 46.9-65.8). There is an association between the presence of a transvers ligament's attachment and the presence of tears in the medial meniscus []. Figure 1: Anatomy of the meniscal attachments. Lateral Menisco-Capsular Re-Attachment. 6. The anterior and posterior attachments of the lateral meniscus are much closer together than that of the medial meniscus (see Fig. Snapping and pain are common symptoms, with . The lateral meniscus, on the outside of the knee, is more circular in shape. There are five types of meniscal root tears, with the most common being a Type 2 radial root tear.10 Most patients present with complaints of posterior knee pain, or of feeling a pop, A lateral meniscus tear is an injury to the cartilage meniscus. The medial meniscus has a third point of attachment at the Medial Collateral Ligament (MCL) which is found on the medial (inner) side of the knee. MeSH terms Genetic Variation Humans In a previous post reviewed the popliteus muscle and it's relationship to the lateral meniscus. Left knee posterior lateral meniscus root tear involving more than 50% of the root. Posterior horn is wider than the anterior horn. The lateral meniscus has an intricate attachment to the tibia that includes the lateral menisco-tibial ligament (LMTL), the popliteo-fibular ligament (PFL) and the popliteo-meniscal ligament (PML). High-spatial-resolution imaging of the . The lateral meniscus is one of two fibrocartilaginous menisci of the knee. The robust peripheral capsular attachments and the meniscotibial attachment of the medial meniscus enhance its role as a secondary stabiliser, most notably in preventing anteroposterior motion. They act as shock absorbers and stabilize the knee. In this stage, weight-bearing and more difficult exercises may be either not advised or too difficult. Instead, the lateral margin extends to the medial intercondylar tubercle. and at the posterior root of the medial meniscus attachment (arrow) which is . Symptoms include: Pain on the outside of your knee, along the joint line. (A) Superior view and (B) posterior view. The mechanism of injury as pro-posed by Forkel and Petersen8 is an anterior translation Increasing the likelihood of having a second meniscus injury such as a bucket-handle tear (longitudinal) or transverse tearing. Management of discoid lateral meniscus tears: observations in 34 knees. The lateral meniscus sits further on the side of the knee than the medial meniscus, which lies in the middle. 20,28,29 Root Tear: This is a tear of the posterior attachment of the medial meniscus. The meniscus attaches to the tibia via coronary ligaments.. Its anterior end, thin and pointed, is attached to the anterior intercondyloid fossa of the tibia, in front of the anterior cruciate ligament; . The meniscal roots and the coronary ligaments can be thought of as static stabilizers of the lateral meniscus. posterior horn is attached to the posterior intercondylar area of the tibial plateau , between PCL insertion posteriorly and posterior root attachment of lateral meniscus, anteriorly lateral meniscus the anterior horn of the lateral meniscus attaches immediately lateral to the tibial attachment of the ACL on the intercondylar area As DLM is a congenital anomaly, the ultrastructural features and morphology differ from those of the normal meniscus, potentially leading to meniscal tears. The medial collateral ligament inserts distally on the tibia distal to the medial condyle and has attachments to the medial meniscus. Damage to the medial meniscus is more common because it is attached to a ligament, while the lateral meniscus is more mobile because it has no attachment. On routine MRI examinations, we analyzed the prevalence of a distinct fibrous connection between the anterolateral aspect of the lateral meniscus and the iliotibial band—which we have termed the "accessory iliotibial band-meniscal ligament" or "AIML"—and . You will find ligaments that attaché to the tibia, cranial and caudal to the spine. root attachment of the lateral meniscus is located poster-omedial to the lateral tibial eminence apex, anterior to the posterior cruciate ligament (PCL) tibial attachment, and anterolateral to the medial meniscus posterior root attachment18 (Figure 1). Type 2: An incomplete slab of meniscal tissue with 80% coverage of the lateral tibial plateau. See this post to learn more about how a meniscus functions. As the medial meniscus has 3 points of attachment, compared to only 2 points for the lateral meniscus, there is less freedom of movement of the medial meniscus in the knee joint. For . 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