Meniscocapsular separation
Meniscocapsular separation refers to detachment of the meniscus from its capsular attachments. It is an uncommon injury.
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Clinical presentation
Clinical findings are nonspecific and can include pain, instability, and joint effusion.
Pathology
Location
- it is more common in the medial (more frequently posterior horn region 5) than in the lateral compartment of the knee
- ramp lesions are a specific type of meniscocapsular injury associated with ACL-deficient knees 6
- meniscofemoral detachment is more common than meniscotibial detachment 4
Associations
While it can uncommonly occur in isolation, it is more often associated with other ligamentous injuries.
Radiographic features
MRI
Meniscocapsular separation is usually diagnosed arthroscopically and the positive predictive value (PPV) of MRI has been traditionally described as being low 3 (as low as 9% medially and 13% laterally).
Low predictive value MRI findings that have been correlated with meniscocapsular separation include 1-2:
- interposition of fluid between the meniscus and the medial collateral ligament
- meniscal corner tears: according to one study had a PPV of 0% medially and 50% laterally 3
- perimeniscal fluid
- meniscofemoral and meniscotibial extension tears
- irregular meniscal outline
- increased distance between the meniscus and the medial collateral ligament
- visualization of fluid from the superior all the way to the inferior end of the meniscus has been described as a more suggestive feature 5 (PPV unknown)
On MR arthrography meniscocapsular separations have been correlated with interposition of contrast medium between the meniscus and the medial collateral ligament.
Treatment and prognosis
It may heal after conservative treatment or after re-suturing the meniscus into the capsule.
Complications
Potential complications include:
- increased meniscal mobility and resultant meniscal tears 5
Differential diagnosis
On MRI consider a normal menisco-synovial recess / perimeniscal recess 4.
Related Radiopaedia articles
Knee pathology
The knee is a complex synovial joint that can be affected by a range of pathologies:
- bone and cartilage
-
knee fractures
- distal femoral condyle fracture
- tibial plateau fracture (classification)
- patella fracture
-
avulsion fractures of the knee
- arcuate complex avulsion fracture (arcuate sign)
- anterior cruciate ligament avulsion fracture
- biceps femoris avulsion fracture
- iliotibial band avulsion fracture
- patella fracture
- posterior cruciate ligament avulsion fracture
- reverse Segond fracture
- Segond fracture
- semimembranosus tendon avulsion fracture
- Stieda fracturechronic avulsion injuries
- dislocation
- chondromalacia patellae
- osteoarthritis of the knee
- osteochondral defects
- osteochondritis dissecans of the knee
- patterns of bone bruise in knee injury
-
knee fractures
- ligaments
- anterior cruciate ligament tear
- anterior cruciate ligament ganglion cyst
- anterior cruciate ligament mucoid degeneration
- posterior cruciate ligament tear
- medial collateral ligament tear
- lateral collateral ligament tear
- medial patellofemoral ligament tear
- posterolateral corner injury
- posteromedial corner injury
- tendons
- meniscal lesions
- bursosynovial lesions
- fat pad
- popliteal fossa
- fascia
- alignment
- knee
- patellofemoral
- gamut