Bucket-handle meniscal lesions: magnetic resonance imaging criteria for reparability.
OBJECTIVE
The purpose of this study was to determine the accuracy of magnetic resonance imaging (MRI) in predicting knee bucket-handle meniscal tear (BHMT) reparability.


METHODS
Twenty-eight patients who underwent knee arthroscopy by a single surgeon for BHMT with prior MRI examination were included. BHMTs were diagnosed by MRI based on the association of a displaced meniscal fragment on coronal images and one of the following three signs on sagittal slices: flipped meniscus sign, double posterior cruciate ligament, and meniscal fragment within the intercondylar notch. BHMT patients' MRIs were retrospectively reviewed independently to search for criteria of reparability by 2 observers with different degrees of experience in musculoskeletal radiology, and disagreements were arbitrated to consensus. The criteria for BHMT reparability were as follows: (1) rim width of less than 4 mm; (2) tear length of 1 cm or greater, regardless of total lesion length; and (3) generation of isosignals by the inner meniscal fragment and peripheral rim compared with the normal contralateral meniscus of the same knee. The first 2 criteria indicate an adequate meniscal lesion length in the vascularized zone (only the peripheral third), enabling meniscal healing after repair; the third criterion guarantees that the meniscus is nondegenerative.


RESULTS
Of the BHMTs, 5 (17.9%) were arthroscopically reparable and 23 (82.1%) were not. Interpretation of magnetic resonance images correctly predicted reparability in 4 of 5 reparable BHMTs and irreparability in 22 of 23 irreparable BHMTs (26/28 lesions). Interobserver agreement was good for the prediction of reparability (kappa = 0.7).


CONCLUSIONS
These results suggest that knee BHMTs that are predicted to be reparable by MRI would have a high likelihood of actually being reparable.


METHODS
Level II, development of diagnostic criteria on basis of consecutive patients and gold standard.
Thoreux
Patricia
P
Department of Orthopedic Surgery, Hôpital Avicenne-University Paris XIII, Bobigny, France. patricia.thoreux@avc.ap-hop-paris.fr
Réty
Frédérique
F
Nourissat
Geoffroy
G
Rivière
Xavier
X
Safa
Patrick
P
Durand
Sébastien
S
Masquelet
Alain-Charles
AC
D001182:Arthroscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008592:Menisci, Tibial / Q000601:surgery*; D015588:Observer Variation; D018579:Patient Selection; D016119:Posterior Cruciate Ligament / Q000293:injuries / Q000601:surgery; D011300:Preoperative Care; D016059:Range of Motion, Articular; D012008:Recurrence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D000070600:Tibial Meniscus Injuries; D016896:Treatment Outcome