Medial meniscus flap tear (CT arthrogram)

Case contributed by Dr Dai Roberts

Presentation

Medial knee pain, with minimal degenerative changes on prior radiograph. Unable to have MRI.

Patient Data

Age: 50 years
Gender: Male

Displaced horizontal longitudinal flap tear of the medial meniscus posterior third, with the flap component within the tibial recess.  Partial-thickness fissures and uniform loss of the weight-bearing medial compartment articular cartilage. Partial-thickness fissure of the lateral patellar facet. 

No intra-articular bodies.  Intact cruciates and collaterals.  The arthrogram solution distends the knee joint. 

Ultrasound

Images from the US-guided injection to administer the arthrogram mixture, which consisted of 40ml of solution in total, made up of 50% iohexol 300 and 50% 0.9% saline. 

A transverse in-plane approach was used with a 22-gauge Quincke needle, targeting the suprapatellar pouch, deep to the quadriceps tendon.   

Case Discussion

CT arthrograms are excellent alternatives to MRI when MRI is contraindicated if meniscal pathology is suspected, or if there is further need to assess articular surfaces in smaller joints, i.e. the ankle.  CT arthrograms can also be used as an alternative to shoulder MRI arthrography.

Knee joint injections for CT arthrograms can be performed using ultrasound, fluoroscopy, or CT guidance.  The arthrogram mixture used in this case consisted of equal parts (50:50) iohexol 300 and 0.9% saline, and 40ml was injected in total. 

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Case information

rID: 82436
Published: 26th Sep 2020
Last edited: 27th Sep 2020
Inclusion in quiz mode: Included

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