Wrisberg rip and medial meniscal bucket handle tear

Case contributed by Dr Andrew Lawson

Presentation

Locking knee post MVA.

Patient Data

Age: 25
Gender: Male

There is a large bucket-handle tear of the medial meniscus with a flipped fragment into the intercondylar fossa. The medial collateral ligament is intact. There is a large Wrisberg rip extending from the outer margin of the posterior lateral meniscus towards the intercondylar fossa with no displacement. The posterolateral corner structures are intact. The PCL is intact. ACL fibres are severely attenuated secondary to a previous injury. There is a small low signal focus within the medial patellofemoral joint space measuring approximately 4 mm. This may represent a loose intra-articular body. There is slight prominent fatty atrophy within the lateral head of the biceps muscle but no clear evidence of a denervation injury.

Comment There is a large bucket-handle tear of the medial meniscus with a flipped fragment into the intercondylar fossa. Wrisberg rip of the lateral meniscus.

Case Discussion

Important to identify this slightly less common tear of the root of the lateral meniscus - Wrisberg rip: longitudinal tear in the posterior horn of the lateral meniscus that extends laterally from the Wrisberg ligament attachment.

The Wrisberg rip should be differentiated from the normal appearance of the so-called Wrisberg pseudo-tear: a vertical/oblique signal intensity region at the junction of the a meniscofemoral ligament (most commonly the ligament of Wrisberg) with the posterior horn of the lateral meniscus. When seen on only one sagittal slice, the pseudotear is thought to be caused by a volume averaging of the ligament connection with the meniscus. It can also be seen on multiple slices depending on the angle of insertion of the meniscofemoral ligament.

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Case Information

rID: 26109
Case created: 29th Nov 2013
Last edited: 29th Sep 2015
Inclusion in quiz mode: Included

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