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Wrisberg rip and medial meniscal bucket handle tear

Case contributed by Andrew Lawson
Diagnosis certain

Presentation

Locking knee after a motor vehicle accident.

Patient Data

Age: 25 years
Gender: Male
  • large bucket-handle tear of the medial meniscus with a flipped fragment into the intercondylar fossa
  • intact medial collateral ligament
  • large Wrisberg rip extending from the outer margin of the posterior lateral meniscus towards the intercondylar fossa with no displacement
  • intact posterolateral corner structures
  • intact posterior cruciate ligament
  • anterior cruciate ligament fibers severely attenuated secondary to a previous injury
  • small low signal focus within the medial patellofemoral joint space measuring approximately 4 mm possibly representing a loose intra-articular body
  • slight prominent fatty atrophy within the lateral head of the biceps muscle but no clear evidence of a denervation injury

Impression: 

  • 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 meniscofemoral ligament (most commonly the ligament of Wrisberg) with the posterior horn of the lateral meniscus. When seen on only one or two sagittal slices, this represents a pseudo-tear that 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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