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J Knee Surg 2021; 34(12): 1337-1348
DOI: 10.1055/s-0040-1709135
Original Article

Evaluation of Meniscal Tissue after Meniscal Repair Using Ultrahigh Field MRI

Beate Stelzeneder
1   Division of Trauma Surgery, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
,
Bernhard Michael Trabauer
1   Division of Trauma Surgery, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
2   Landeskliniken Holding Korneuburg-Stockerau, Stockerau, Austria
,
Silke Aldrian
1   Division of Trauma Surgery, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
,
David Stelzeneder
3   Department of Orthopaedics and Trauma Surgery, Hanusch-Krankenhaus, Vienna, Austria
4   Division of Orthopedics, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
,
Vladimir Juras
5   High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
6   Department of Imaging Methods, Institute of Measurement Science, Bratislava, Slovakia
,
Christian Albrecht
1   Division of Trauma Surgery, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
7   I. Orthopaedic Department, Orthopaedic Hospital Speising GmbH, Vienna, Austria
,
Stefan Hajdu
1   Division of Trauma Surgery, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
,
Patrick Platzer
8   Department of Trauma Surgery and Sports Traumatology, University Hospital St. Poelten, St. Poelten, Austria
,
Siegfried Trattnig
5   High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
9   Christian Doppler Laboratory for Clinical Molecular MR Imaging, Vienna, Austria
10   Austrian Cluster for Tissue Regeneration, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
› Author Affiliations Funding This study has received funding by Austrian Science Fund (FWF) KLI541-B30.
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Abstract

The study evaluates the meniscal tissue after primary meniscal suturing using 7-Tesla (T) magnetic resonance imaging with T2* mapping at 6 and 12 months after surgery to investigate the differences between repaired meniscal tissue and healthy meniscal tissue in the medial and lateral compartment. This prospective study included 11 patients (9m/2f) with a mean age of 30.6 years (standard deviation 9.0). Patients with a meniscal tear that was treated arthroscopically with meniscus suturing, using an all-inside technique, were included. All patients and seven healthy volunteers were imaged on a 7-T whole-body system. T2* mapping of the meniscus was applied on sagittal slices. Regions-of-interest were defined manually in the red and white zone of each medial and lateral meniscus to measure T2*-values. In the medial posterior and medial anterior horn similar T2*-values were measured in the red and white zone at 6- and 12-month follow-up. Compared with the control group higher T2*-values were found in the repaired medial meniscus. After 12-months T2*-values decreased to normal values in the anterior horn and remained elevated in the posterior horn. In the red zone of the lateral posterior horn a significant decrease in the T2*-values (from 8.2 milliseconds to 5.9 milliseconds) (p = 0.04), indicates successful repair; a tendency toward a decrease in the white zone between the 6 and 12 months follow-up was observed. In the red zone of the lateral anterior horn the T2*-values decreased significantly during follow-up and in the white zone of the lateral anterior horn T2*-values were comparable. In comparison to the control group higher T2*-values were measured at 6-months; however, the T2*-values showed comparable values in the repaired lateral meniscus after 12 months. The T2* mapping results of the current study indicated a better healing response of the red zone of the lateral posterior horn compared with the medial posterior horn.

Keywords

magnetic resonance imaging - meniscus - meniscal repair - T2* mapping

Note

The study was performed at the Department of Orthopedics and Trauma Surgery, Division of Trauma Surgery, Medical University of Vienna.


MRI was performed at the High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna.




Publication History

Received: 08 June 2019

Accepted: 16 February 2020

Article published online:
08 April 2020

© 2020. Thieme. All rights reserved.

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  • References

  • 1 Feeley BT, Liu S, Garner AM, Zhang AL, Pietzsch JB. The cost-effectiveness of meniscal repair versus partial meniscectomy: a model-based projection for the United States. Knee 2016; 23 (04) 674-680
    CrossrefPubMedGoogle Scholar
  • 2 Roemer FW, Kwoh CK, Hannon MJ. et al. Partial meniscectomy is associated with increased risk of incident radiographic osteoarthritis and worsening cartilage damage in the following year. Eur Radiol 2017; 27 (01) 404-413
    CrossrefPubMedGoogle Scholar
  • 3 Englund M, Lohmander LS. Patellofemoral osteoarthritis coexistent with tibiofemoral osteoarthritis in a meniscectomy population. Ann Rheum Dis 2005; 64 (12) 1721-1726
    CrossrefPubMedGoogle Scholar
  • 4 Sgaglione NA, Steadman JR, Shaffer B, Miller MD, Fu FH. Current concepts in meniscus surgery: resection to replacement. Arthroscopy 2003; 19 (Suppl. 01) 161-188
    CrossrefPubMedGoogle Scholar
  • 5 Robson MD, Gatehouse PD, Bydder M, Bydder GM. Magnetic resonance: an introduction to ultrashort TE (UTE) imaging. J Comput Assist Tomogr 2003; 27 (06) 825-846
    CrossrefPubMedGoogle Scholar
  • 6 McWalter EJ, Gold GE. UTE T2* mapping detects sub-clinical meniscus degeneration. Osteoarthritis Cartilage 2012; 20 (06) 471-472
    CrossrefPubMedGoogle Scholar
  • 7 Rauscher I, Stahl R, Cheng J. et al. Meniscal measurements of T1rho and T2 at MR imaging in healthy subjects and patients with osteoarthritis. Radiology 2008; 249 (02) 591-600
    CrossrefPubMedGoogle Scholar
  • 8 Koff MF, Shah P, Pownder S. et al. Correlation of meniscal T2* with multiphoton microscopy, and change of articular cartilage T2 in an ovine model of meniscal repair. Osteoarthritis Cartilage 2013; 21 (08) 1083-1091
    CrossrefPubMedGoogle Scholar
  • 9 Stelzeneder D, Shetty AA, Kim SJ. et al. Repair tissue quality after arthroscopic autologous collagen-induced chondrogenesis (ACIC) assessed via T2* mapping. Skeletal Radiol 2013; 42 (12) 1657-1664
    CrossrefPubMedGoogle Scholar
  • 10 Gatehouse PD, He T, Puri BK, Thomas RD, Resnick D, Bydder GM. Contrast-enhanced MRI of the menisci of the knee using ultrashort echo time (UTE) pulse sequences: imaging of the red and white zones. Br J Radiol 2004; 77 (920): 641-647
    CrossrefPubMedGoogle Scholar
  • 11 Deligianni X, Bär P, Scheffler K, Trattnig S, Bieri O. High-resolution Fourier-encoded sub-millisecond echo time musculoskeletal imaging at 3 Tesla and 7 Tesla. Magn Reson Med 2013; 70 (05) 1434-1439
    CrossrefPubMedGoogle Scholar
  • 12 Hoffelner T, Resch H, Forstner R, Michael M, Minnich B, Tauber M. Arthroscopic all-inside meniscal repair—does the meniscus heal? A clinical and radiological follow-up examination to verify meniscal healing using a 3-T MRI. Skeletal Radiol 2011; 40 (02) 181-187
    CrossrefPubMedGoogle Scholar
  • 13 Hantes ME, Zachos VC, Zibis AH. et al. Evaluation of meniscal repair with serial magnetic resonance imaging: a comparative study between conventional MRI and indirect MR arthrography. Eur J Radiol 2004; 50 (03) 231-237
    CrossrefPubMedGoogle Scholar
  • 14 Juras V, Apprich S, Zbýň Š. et al. Quantitative MRI analysis of menisci using biexponential T2* fitting with a variable echo time sequence. Magn Reson Med 2014; 71 (03) 1015-1023
    CrossrefPubMedGoogle Scholar
  • 15 Blutsch B, Aldrian S, Albrecht C. et al. The meniscal repair assessment score (MERAS)—a new MRI scoring tool for evaluation of the healing success after primary meniscus refixation—preliminary results. Paper presented at: Joint Annual Meeting ISMRM-ESMRMB Milan. Italy: Beate Blutsch; 2014
    Google Scholar
  • 16 Majeed H, Karuppiah S, Sigamoney KV, Geutjens G, Straw RG. All-inside meniscal repair surgery: factors affecting the outcome. J Orthop Traumatol 2015; 16 (03) 245-249
    CrossrefPubMedGoogle Scholar
  • 17 Westermann RW, Wright RW, Spindler KP, Huston LJ, Wolf BR. ; MOON Knee Group. Meniscal repair with concurrent anterior cruciate ligament reconstruction: operative success and patient outcomes at 6-year follow-up. Am J Sports Med 2014; 42 (09) 2184-2192
    CrossrefPubMedGoogle Scholar
  • 18 Vedi V, Williams A, Tennant SJ, Spouse E, Hunt DM, Gedroyc WM. Meniscal movement. An in-vivo study using dynamic MRI. J Bone Joint Surg Br 1999; 81 (01) 37-41
    CrossrefPubMedGoogle Scholar
  • 19 George L, Caldwell J, Answorth AA, Freddie HF. Functional Anatomy and Biomechanics of the Meniscus. Operative Techniques in Sports Medicine. Philadelphia, PA: W.B. Saunders Company; 1994
    Google Scholar
  • 20 Davis KW. MRI of the Knee, An Issue of Magnetic Resonance Imaging Clinics of North America. Philadelphia: Elsevier Health Sciences; 2014
  • 21 Baker BE, Peckham AC, Pupparo F, Sanborn JC. Review of meniscal injury and associated sports. Am J Sports Med 1985; 13 (01) 1-4
    CrossrefPubMedGoogle Scholar
  • 22 Muriuki MG, Tuason DA, Tucker BG, Harner CD. Changes in tibiofemoral contact mechanics following radial split and vertical tears of the medial meniscus an in vitro investigation of the efficacy of arthroscopic repair. J Bone Joint Surg Am 2011; 93 (12) 1089-1095
    CrossrefPubMedGoogle Scholar
  • 23 Ode GE, Van Thiel GS, McArthur SA. et al. Effects of serial sectioning and repair of radial tears in the lateral meniscus. Am J Sports Med 2012; 40 (08) 1863-1870
    CrossrefPubMedGoogle Scholar
  • 24 Bedi A, Kelly N, Baad M. et al. Dynamic contact mechanics of radial tears of the lateral meniscus: implications for treatment. Arthroscopy 2012; 28 (03) 372-381
    CrossrefPubMedGoogle Scholar
  • 25 Juras V, Mlynarik V, Szomolanyi P, Valkovič L, Trattnig S. Magnetic resonance imaging of the musculoskeletal system at 7T: morphological imaging and beyond. Top Magn Reson Imaging 2019; 28 (03) 125-135
    CrossrefPubMedGoogle Scholar
  • 26 Wyatt C, Guha A, Venkatachari A. et al. Improved differentiation between knees with cartilage lesions and controls using 7T relaxation time mapping. J Orthop Translat 2015; 3 (04) 197-204
    CrossrefPubMedGoogle Scholar
  • 27 Wei H, Dibb R, Decker K. et al. Investigating magnetic susceptibility of human knee joint at 7 Tesla. Magn Reson Med 2017; 78 (05) 1933-1943
    CrossrefPubMedGoogle Scholar
  • 28 Sneag DB, Shah P, Koff MF, Lim WY, Rodeo SA, Potter HG. Quantitative ultrashort echo time magnetic resonance imaging evaluation of postoperative menisci: a pilot study. HSS J 2015; 11 (02) 123-129
    CrossrefPubMedGoogle Scholar
  • 29 Williams A, Qian Y, Golla S, Chu CR. UTE-T2* mapping detects sub-clinical meniscus injury after anterior cruciate ligament tear. Osteoarthritis Cartilage 2012; 20 (06) 486-494
    CrossrefPubMedGoogle Scholar
  • 30 Chu CR, Williams AA, West RV. et al. Quantitative magnetic resonance imaging UTE-T2* mapping of cartilage and meniscus healing after anatomic anterior cruciate ligament reconstruction. Am J Sports Med 2014; 42 (08) 1847-1856
    CrossrefPubMedGoogle Scholar
  • 31 Barber FA, Click SD. Meniscus repair rehabilitation with concurrent anterior cruciate reconstruction. Arthroscopy 1997; 13 (04) 433-437
    CrossrefPubMedGoogle Scholar
  • 32 Morgan CD, Wojtys EM, Casscells CD, Casscells SW. Arthroscopic meniscal repair evaluated by second-look arthroscopy. Am J Sports Med 1991; 19 (06) 632-637 , discussion 637–638
    CrossrefPubMedGoogle Scholar
  • 33 Haas AL, Schepsis AA, Hornstein J, Edgar CM. Meniscal repair using the FasT-Fix all-inside meniscal repair device. Arthroscopy 2005; 21 (02) 167-175
    CrossrefPubMedGoogle Scholar
  • 34 Nepple JJ, Dunn WR, Wright RW. Meniscal repair outcomes at greater than five years: a systematic literature review and meta-analysis. J Bone Joint Surg Am 2012; 94 (24) 2222-2227
    CrossrefPubMedGoogle Scholar
  • 35 Lee GP, Diduch DR. Deteriorating outcomes after meniscal repair using the meniscus arrow in knees undergoing concurrent anterior cruciate ligament reconstruction: increased failure rate with long-term follow-up. Am J Sports Med 2005; 33 (08) 1138-1141
    CrossrefPubMedGoogle Scholar
  • 36 Siebold R, Dehler C, Boes L, Ellermann A. Arthroscopic all-inside repair using the Meniscus Arrow: long-term clinical follow-up of 113 patients. Arthroscopy 2007; 23 (04) 394-399
    CrossrefPubMedGoogle Scholar
  • 37 Steenbrugge F, Verdonk R, Hürel C, Verstraete K. Arthroscopic meniscus repair: inside-out technique vs. Biofix meniscus arrow. Knee Surg Sports Traumatol Arthrosc 2004; 12 (01) 43-49
    CrossrefPubMedGoogle Scholar
  • 38 Logan M, Watts M, Owen J, Myers P. Meniscal repair in the elite athlete: results of 45 repairs with a minimum 5-year follow-up. Am J Sports Med 2009; 37 (06) 1131-1134
    CrossrefPubMedGoogle Scholar
  • 39 Wasserstein D, Dwyer T, Gandhi R, Austin PC, Mahomed N, Ogilvie-Harris D. A matched-cohort population study of reoperation after meniscal repair with and without concomitant anterior cruciate ligament reconstruction. Am J Sports Med 2013; 41 (02) 349-355
    CrossrefPubMedGoogle Scholar