Nearly consecutive patients today. First an 80 y/o with sudden onset of severe knee pain.
[80yoghoststress1.jpg]
[80yoghoststress5.jpg]
[80yoghoststress2.jpg]
[80yoghoststress3.jpg]
Second patient is a 67 y/o patient who felt a pop and now with severe pain.
[67yoradtearstress1.jpg]
[67yoradtearstress3.jpg]
[67yoradtearstress2.jpg]
[67yoradtearstress4.jpg]
Both have a “ghost meniscus sign” indicating a radial tear and a secondary stress (or insufficiency) fracture. Pretty common association in my experience.
(I may not be using the correct terminology. I consider these fractures in demineralized elderly patients as insufficiency being on abnormal bone).
I believe the association of an unstable meniscal tear and fracture was first recognized from MRI.
The MFC lesion used to be called SONK by many folks. In fact I received a call from a referring orthopedist just a month ago who told me he disagreed with a reading and said the patient has SONK. I said “man that’s so 25 years ago.” (we have a good relationship).
Phil Tirman
I should have said: I believe the association of an unstable meniscus and fracture was first recognized from MRI.
Good points here. Bringing it public.
From: Hilary
Here’s the reason I distinguish between them.
Standard portals don’t get you to the meniscus root.
In the rare instance that there is no DJD, you can repair the meniscal root because it is well vascularized…but not everyone is experienced at doing this.
Debriding the meniscus won’t do a damn bit of good if you’ve torn the root.
So I would report this as a “radial tear of the PH medial meniscal root without tear of the medial meniscus proper.
There is extrusion of the medial meniscal body with subchondral insufficiency fracture of the MFC.”
100% agree. My report says(I have it as autotext since it is so common): There is a radial root attachment tear of the posterior horn of the medial meniscus resulting in a “ghost meniscus sign” seen on sagittal []. [<>]The meniscus is [].
Pretty close:-)