Abstract
The normal meniscus undergoes typical developmental changes during childhood, reaching a mature adult appearance by approximately 10 years of age. In addition to recognizing normal meniscal appearances in children, identifying abnormalities — such as tears and the different types of discoid meniscus and meniscal cysts, as well as the surgical implications of these abnormalities — is vital in pediatric imaging. The reported incidence of meniscal tears in adolescents and young adults has increased because of increased sports participation and more widespread use of MRI. This review discusses the normal appearance of the pediatric meniscus, meniscal abnormalities, associated injuries, and prognostic indicators for repair.
Similar content being viewed by others
References
Adirim TA, Cheng TL (2003) Overview of injuries in the young athlete. Sports Med 33:75–81
Stracciolini A, Casciano R, Levey Friedman H et al (2013) Pediatric sports injuries: an age comparison of children versus adolescents. Am J Sports Med 41:1922–1929
Darrow CJ, Collins CL, Yard EE et al (2009) Epidemiology of severe injuries among United States high school athletes: 2005–2007. Am J Sports Med 37:1798–1805
Franklin CC, Weiss JM (2012) Stopping sports injuries in kids. Curr Opin Pediatr 24:64–67
Monroe KW, Thrash C, Sorrentino A et al (2011) Most common sports-related injuries in a pediatric emergency department. Clin Pediatr 50:17–20
Backx FJ, Beijer HJ, Bol E et al (1991) Injuries in high-risk persons and high-risk sports. A longitudinal study of 1,818 school children. Am J Sports Med 19:124–130
Siow HM, Cameron DB, Ganley TJ (2008) Acute knee injuries in skeletally immature athletes. Phys Med Rehabil Clin N Am 19:319–345
Terzidis IP (2006) Meniscal tear characteristics in young athletes with a stable knee: arthroscopic evaluation. Am J Sports Med 34:1170–1175
Busch MT (1990) Meniscal injuries in children and adolescents. Clin Sports Med 9:661–680
Kramer DE, Micheli LJ (2009) Meniscal tears and discoid meniscus in children: diagnosis and treatment. J Am Acad Orthop Surg 17:698–707
Nettle H, Sprogis E (2011) Pediatric exercise: truth and/or consequences. Sports Med Arthrosc 19:75–80
Tuite MJ, Daffner RH, Weissman BN et al (2011) ACR Appropriateness Criteria® acute trauma to the knee. http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/AcuteTraumaKnee.pdf. Accessed 3 Feb 2014
Anderson MW (2002) MR imaging of the meniscus. Radiol Clin N Am 40:1081–1094
LaPrade RF, Burnett QM 2nd, Veenstra MA et al (1994) The prevalence of abnormal magnetic resonance imaging findings in asymptomatic knees. With correlation of magnetic resonance imaging to arthroscopic findings in symptomatic knees. Am J Sports Med 22:739–745
Quinn SF, Brown TR, Szumowski J (1992) Menisci of the knee: radial MR imaging correlated with arthroscopy in 259 patients. Radiology 185:577–580
Mink JH, Levy T, Crues JV (1988) Tears of the anterior cruciate ligament and menisci of the knee: MR imaging evaluation. Radiology 167:769–774
Fox MG (2007) MR imaging of the meniscus: review, current trends, and clinical implications. Radiol Clin N Am 45:1033–1053
Rath E, Richmond JC (2000) The menisci: basic science and advances in treatment. Br J Sports Med 34:252–257
Watanabe M, Takeda S, Ikeuchi H (1979) Atlas of arthroscopy, 3rd edn. Igaku-Shoin, sole distributor in U.S. Springer, Tokyo
De Maeseneer M, Van Roy F, Lenchik L et al (2000) Three layers of the medial capsular and supporting structures of the knee: MR imaging-anatomic correlation. Radiographics 20:S83–89
Bikkina RS, Tujo CA, Schraner AB et al (2005) The ‘floating’ meniscus: MRI in knee trauma and implications for surgery. AJR Am J Roentgenol 184:200–204
Jelaso DV (1975) The fascicles of the lateral meniscus: an anatomic-arthrographic correlation. Radiology 114:335–339
Peduto AJ, Nguyen A, Trudell DJ et al (2008) Popliteomeniscal fascicles: anatomic considerations using MR arthrography in cadavers. AJR Am J Roentgenol 190:442–448
Johnson RL, De Smet AA (1999) MR visualization of the popliteomeniscal fascicles. Skelet Radiol 28:561–566
Clark CR, Ogden JA (1983) Development of the menisci of the human knee joint. Morphological changes and their potential role in childhood meniscal injury. J Bone Joint Surg Am 65:538–547
Arnoczky SP, Warren RF (1982) Microvasculature of the human meniscus. Am J Sports Med 10:90–95
Takeda Y, Ikata T, Yoshida S et al (1998) MRI high-signal intensity in the menisci of asymptomatic children. J Bone Joint Surg (Br) 80:463–467
Shim SS, Leung G (1986) Blood supply of the knee joint. A microangiographic study in children and adults. Clin Orthop Relat Res Jul:119–125
Greis PE, Bardana DD, Holmstrom MC et al (2002) Meniscal injury: I. Basic science and evaluation. J Am Acad Orthop Surg 10:168–176
Lotysch M, Mink J, Crues JV et al (1986) Magnetic resonance imaging in the detection of meniscal injuries. Magn Reson Imaging 4:185
Ren A-H, Zheng Z-Z, Shang Y et al (2012) An anatomical study of normal meniscal roots with isotropic 3D MRI at 3 T. Eur J Radiol 81:e783–e788
Brody JM, Hulstyn MJ, Fleming BC et al (2007) The meniscal roots: gross anatomic correlation with 3-T MRI findings. AJR Am J Roentgenol 188:W446–W450
Crues JV 3rd, Mink J, Levy TL et al (1987) Meniscal tears of the knee: accuracy of MR imaging. Radiology 164:445–448
Lin E, Escott E, Garg K et al (2008) Practical differential diagnosis for CT and MRI, 1st edn. Thieme Medical Publishers, New York
Stoller DW, Martin C, Crues JV 3rd et al (1987) Meniscal tears: pathologic correlation with MR imaging. Radiology 163:731–735
Bellisari G, Samora W, Klingele K (2011) Meniscus tears in children. Sports Med Arthrosc 19:50–55
Millett PJ, Willis AA, Warren RF (2002) Associated injuries in pediatric and adolescent anterior cruciate ligament tears: does a delay in treatment increase the risk of meniscal tear? Arthroscopy 18:955–959
Samora WP 3rd, Palmer R, Klingele KE (2011) Meniscal pathology associated with acute anterior cruciate ligament tears in patients with open physes. J Pediatr Orthop 31:272–276
Stanitski CL, Harvell JC, Fu F (1993) Observations on acute knee hemarthrosis in children and adolescents. J Pediatr Orthop 13:506–510
Dumont GD, Hogue GD, Padalecki JR et al (2012) Meniscal and chondral injuries associated with pediatric anterior cruciate ligament tears: relationship of treatment time and patient-specific factors. Am J Sports Med 40:2128–2133
De Smet AA, Graf BK (1994) Meniscal tears missed on MR imaging: relationship to meniscal tear patterns and anterior cruciate ligament tears. AJR Am J Roentgenol 162:905–911
Ramnath RR (2006) 3 T MR imaging of the musculoskeletal system (part II): clinical applications. Magn Reson Imaging Clin N Am 14:41–62
Shapiro L, Staroswiecki E, Gold G (2010) MRI of the knee: optimizing 3 T imaging. Semin Roentgenol 45:238–249
Jaramillo D, Laor T (2008) Pediatric musculoskeletal MRI: basic principles to optimize success. Pediatr Radiol 38:379–391
Kowalchuk RM, Kneeland JB, Dalinka MK et al (2000) MRI of the knee: value of short echo time fast spin-echo using high performance gradients versus conventional spin-echo imaging for the detection of meniscal tears. Skelet Radiol 29:520–524
Cheung LP, Li KC, Hollett MD et al (1997) Meniscal tears of the knee: accuracy of detection with fast spin-echo MR imaging and arthroscopic correlation in 293 patients. Radiology 203:508–512
Escobedo EM, Hunter JC, Zink-Brody GC et al (1996) Usefulness of turbo spin-echo MR imaging in the evaluation of meniscal tears: comparison with a conventional spin-echo sequence. AJR Am J Roentgenol 167:1223–1227
Anderson MW, Raghavan N, Seidenwurm DJ et al (1995) Evaluation of meniscal tears: fast spin-echo versus conventional spin-echo magnetic resonance imaging. Acad Radiol 2:209–214
Rubin DA, Kneeland JB, Listerud J et al (1994) MR diagnosis of meniscal tears of the knee: value of fast spin-echo vs. conventional spin-echo pulse sequences. AJR Am J Roentgenol 162:1131–1135
Jaramillo D, Laor T, Mulkern RV (1994) Comparison between fast spin-echo and conventional spin-echo imaging of normal and abnormal musculoskeletal structures in children and young adults. Invest Radiol 29:803–811
Gokalp G, Nas OF, Demirag B et al (2012) Contribution of thin-slice (1 mm) axial proton density MR images for identification and classification of meniscal tears: correlative study with arthroscopy. Br J Radiol 85:e871–e878
Tarhan NC, Chung CB, Mohana-Borges AVR et al (2004) Meniscal tears: role of axial MRI alone and in combination with other imaging planes. AJR Am J Roentgenol 183:9–15
Dalm S (2007) Achieva dual-coil imaging. Field strength. Publication for the Philips MRI Community. Philips, Best, The Netherlands. Available via http://incenter.medical.philips.com/doclib/enc/fetch/5025656/09_FS32_Aptip_Achieva_dual-coil.pdf%3fnodeid%3d5026350%26vernum%3d1. Accessed 04 April 2014
Jung JY, Yoon YC, Kwon JW et al (2009) Diagnosis of internal derangement of the knee at 3.0-T MR imaging: 3D isotropic intermediate-weighted versus 2D sequences. Radiology 253:780–787
Bredella MA, Tirman PF, Peterfy CG et al (1999) Accuracy of T2-weighted fast spin-echo MR imaging with fat saturation in detecting cartilage defects in the knee: comparison with arthroscopy in 130 patients. AJR Am J Roentgenol 172:1073–1080
Lee SY, Jee W-H, Kim J-M (2008) Radial tear of the medial meniscal root: reliability and accuracy of MRI for diagnosis. AJR Am J Roentgenol 191:81–85
Jones A, Houang M, Low R et al (2006) Medial meniscus posterior root attachment injury and degeneration: MRI findings. Australas Radiol 50:306–313
De Smet AA, Blankenbaker DG, Kijowski R et al (2009) MR diagnosis of posterior root tears of the lateral meniscus using arthroscopy as the reference standard. AJR Am J Roentgenol 192:480–486
Anderson AF, Irrgang JJ, Dunn W et al (2011) Interobserver reliability of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification of meniscal tears. Am J Sports Med 39:926–932
Atay OA, Pekmezci M, Doral MN et al (2007) Discoid meniscus: an ultrastructural study with transmission electron microscopy. Am J Sports Med 35:475–478
Silverman JM, Mink JH, Deutsch AL (1989) Discoid menisci of the knee: MR imaging appearance. Radiology 173:351–354
Jordan (1996) Lateral meniscal variants: evaluation and treatment. J Am Acad Orthop Surg 4:191–200
Kelly BT, Green DW (2002) Discoid lateral meniscus in children. Curr Opin Pediatr 14:54
Ahn JH, Shim JS, Hwang CH et al (2001) Discoid lateral meniscus in children: clinical manifestations and morphology. J Pediatr Orthop 21:812
Fleissner PR, Eilert RE (1999) Discoid lateral meniscus. Am J Knee Surg 12:125–131
Yaniv M, Blumberg N (2007) The discoid meniscus. J Child Orthop 1:89–96
Mitsuoka T, Shino K, Hamada M et al (1999) Osteochondritis dissecans of the lateral femoral condyle of the knee joint. Arthroscopy 15:20–26
Deie M, Ochi M, Sumen Y et al (2006) Relationship between osteochondritis dissecans of the lateral femoral condyle and lateral menisci types. J Pediatr Orthop 26:79–82
Singh K, Helms CA, Jacobs MT et al (2006) MRI appearance of Wrisberg variant of discoid lateral meniscus. AJR Am J Roentgenol 187:384–387
Wong T, Wang C-J (2011) Functional analysis on the treatment of torn discoid lateral meniscus. Knee 18:369–372
Vande Berg BC, Poilvache P, Duchateau F et al (2001) Lesions of the menisci of the knee: value of MR imaging criteria for recognition of unstable lesions. AJR Am J Roentgenol 176:771–776
Good CR, Green DW, Griffith MH et al (2007) Arthroscopic treatment of symptomatic discoid meniscus in children: classification, technique, and results. Arthroscopy 23:157–163
Woods GW, Whelan JM (1990) Discoid meniscus. Clin Sports Med 9:695–706
Moser MW, Dugas J, Hartzell J et al (2007) A hypermobile Wrisberg variant lateral discoid meniscus seen on MRI. Clin Orthop Relat Res 456:264–267
Harvell JC Jr, Fu FH, Stanitski CL (1989) Diagnostic arthroscopy of the knee in children and adolescents. Orthopedics 12:1555–1560
Hagino T, Ochiai S, Watanabe Y et al (2013) Usefulness of knee arthroscopy for diagnosis of knee pain in pediatric patients: comparison with preoperative clinical diagnosis. Arch Orthop Trauma Surg 133:669–673
Araki Y, Ashikaga R, Fujii K et al (1998) MR imaging of meniscal tears with discoid lateral meniscus. Eur J Radiol 27:153–160
Rohren EM, Kosarek FJ, Helms CA (2001) Discoid lateral meniscus and the frequency of meniscal tears. Skelet Radiol 30:316–320
Yoo WJ, Lee K, Moon HJ et al (2012) Meniscal morphologic changes on magnetic resonance imaging are associated with symptomatic discoid lateral meniscal tear in children. Arthroscopy 28:330–336
Ryu KN, Kim IS, Kim EJ et al (1998) MR imaging of tears of discoid lateral menisci. AJR Am J Roentgenol 171:963–967
Pai DR, Strouse PJ (2011) MRI of the pediatric knee. AJR Am J Roentgenol 196:1019–1027
Micheli LJ, Kocher MS (2006) The pediatric and adolescent knee, 1st edn. Saunders/Elsevier, Philadelphia
VanderWilde RS, Peterson HA (1992) Meniscal cyst and magnetic resonance imaging in childhood and adolescence. J Pediatr Orthop 12:761–765
Stern A, Hallel T (1988) Medial discoid meniscus with cyst formation in a child. J Pediatr Orthop 8:471–473
Campbell SE, Sanders TG, Morrison WB (2001) MR imaging of meniscal cysts: incidence, location, and clinical significance. AJR Am J Roentgenol 177:409–413
Pedowitz RA, Feagin JA, Rajagopalan S (1996) A surgical algorithm for treatment of cystic degeneration of the meniscus. Arthroscopy 12:209–212, discussion, 213–216
Anderson JJ, Connor GF, Helms CA (2010) New observations on meniscal cysts. Skelet Radiol 39:1187–1191
Tschirch FTC, Schmid MR, Pfirrmann CWA et al (2003) Prevalence and size of meniscal cysts, ganglionic cysts, synovial cysts of the popliteal space, fluid-filled bursae, and other fluid collections in asymptomatic knees on MR imaging. AJR Am J Roentgenol 180:1431–1436
Tasker AD, Ostlere SJ (1995) Relative incidence and morphology of lateral and medial meniscal cysts detected by magnetic resonance imaging. Clin Radiol 50:778–781
Hunter R, Sgaglione NA (2010) Arthroscopy Association of North America. AANA advanced arthroscopy: the knee. Saunders/Elsevier, Philadelphia
Mariani PP, Gillquist J (1981) The blind spots in arthroscopic approaches. Int Orthop 5:257–264
Yagishita K, Muneta T, Ogiuchi T et al (2004) Healing potential of meniscal tears without repair in knees with anterior cruciate ligament reconstruction. Am J Sports Med 32:1953–1961
Fitzgibbons RE, Shelbourne KD (1995) ‘Aggressive’ nontreatment of lateral meniscal tears seen during anterior cruciate ligament reconstruction. Am J Sports Med 23:156–159
Millett PJ, Pennock AT, Sterett WI et al (2004) Early ACL reconstruction in combined ACL-MCL injuries. J Knee Surg 17:94–98
Manzione M, Pizzutillo PD, Peoples AB et al (1983) Meniscectomy in children: a long-term follow-up study. Am J Sports Med 11:111–115
Atay ÖA, Doral MN, Leblebicioğlu G et al (2003) Management of discoid lateral meniscus tears: observations in 34 knees. Arthroscopy 19:346–352
Rodeo SA (2000) Arthroscopic meniscal repair with use of the outside-in technique. Instr Course Lect 49:195–206
Ryu RK, Ting AJ (1993) Arthroscopic treatment of meniscal cysts. Arthroscopy 9:591–595
Conflicts of interest
None
Author information
Authors and Affiliations
Corresponding author
Additional information
This article has been selected as the CME activity for the current month. Please visit the SPR Web site at www.pedrad.org on the Education page and follow the instructions to complete this CME activity.
Rights and permissions
About this article
Cite this article
Francavilla, M.L., Restrepo, R., Zamora, K.W. et al. Meniscal pathology in children: differences and similarities with the adult meniscus. Pediatr Radiol 44, 910–925 (2014). https://doi.org/10.1007/s00247-014-3022-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00247-014-3022-0