This is a 20-year-old college athlete who plays soccer, competing for a national championship in his senior year. He has anterolateral knee pain. You are shown two coronal PD SPIR images (image 1 and image 2), a sagittal T2 SPIR or fat-suppression image (image 3), and a sagittal T1 (image 4).
Q1 – How would you describe this tear (arrows)? Would you let him play?
The tear is a horizontal tear (yellow arrows). While most horizontal or cleavage tears are chronic and degenerative in older adults, they occur traumatically. The tear (higher signal) is like the turkey on a sandwich with the meniscus (lower signal) sitting on either side like the pieces of bread.
Because there is no clear articular surface communication on any of the sequences, one might describe this as a “closed” traumatic tear, predominantly horizontal, of at least 2cm in length. One should carefully point out that the tear has precipitated active inflammation which manifest as swelling just anterior to the meniscal pathology, sagittal image 3 and 4 (anterior oblique green arrow).
Initial reaction to a tear that is so conspicuous in a young patient is to sit the patient down. However, given the fact that this patient is a senior in college, his college career is coming to an end, there is an important game coming forth, and the risk of splitting this meniscus into two or exacerbating the horizontal tear is very low in the absence of discoid meniscus, this patient was allowed to play. However, he did receive a steroid injection to diminish his pain. Another medication that is used in performance athletes, especially professional athletes in situations such as this, is Toradol. Finally, “closed” cleavage tears, as suggested above, are particularly common in discoid meniscus.
Check out MRI Online for more case review.
If you enjoyed this case, you may also enjoy:
What can be learned from this 17-year-old’s knee injury?
What type of tear is causing this 20-year-old athlete’s knee pain?
How should you approach this 24-year-old’s knee case?