2017 ISAKOS Biennial Congress ePoster #1313

 

Indirect MR Arthrography for Evaluation of Meniscal Healing

Sachin Ramchandra Tapasvi, MBBS, MS, DNB, FRCS, Pune, Maharashtra INDIA
Anshu Shekhar, MS, Pune, Maharashtra INDIA
Aparna Chandorkar, MBBS, MD(Radio), Pune, Maharashtra INDIA
Anupama Sunil Patil, MBBS, MD(Radio), Pune, Maharashtra INDIA
Shantanu S. Patil, MBBS, MS(Orth), Kattankulathur, Tamilnadu INDIA

The Orthopaedic Speciality Clinic, Pune, Maharashtra, INDIA

FDA Status Cleared

Summary

The study validates use of Indirect MR arthrography for evaluation of meniscal repair surgery.

Abstract

Introduction

Meniscal repair surgery has become increasingly common in recent years. The precarious vascular supply however precludes a consistent predictable outcome in spite of better techniques and advanced instrumentation, especially in tears greater than 2.5cm in length.
A second-look arthroscopy is the gold standard in assessing meniscal healing, though it is an invasive procedure. MRI is a non-invasive diagnostic technique to assess meniscal healing, the pitfall being, edematous or fibrous scar tissue formed during the healing process may give rise to persistent signals and interfere with image interpretation. The accuracy of MRI can be improved by either direct arthrography (Intra-articular contrast) or indirect arthrography (intravenous paramagnetic contrast agent) to improve the contrast between structures.
Since diagnostic ability of direct and indirect MR arthrography is similar, the use of less invasive indirect MR arthrography has been proposed. The intravenous contrast agent enhances vascular and cellular proliferation within the ?brovascular scar tissue that is seen histologically at the margins of torn or healing menisci. This allows better evaluation of various stages of the repair tissue.
The objective of the study was to non-invasively evaluate the meniscus repaired using any of the described meniscus repair techniques, in tears greater than 2.5cm , with multiple conventional MRI sequences as well as indirect (intravenous) MR arthrography techniques.

Materials And Methods

30 patients (18M:12F) with mean age of 34 years (Range 13 –54), diagnosed with a meniscal tear greater that 2.5 cm and undergone meniscal repair with any of the available techniques were prospectively recruited after informed consent and IRB review. 3 patients had both menisci torn and repaired. At minimum of 6 months post-surgical follow-up, all patients were evaluated clinically noting presence of joint line tenderness, effusion, history of locking and a McMurray’s test. Post-operative IKDC scores, KOOS and Tegner Lysholm activity scores were recorded at time of latest clinical follow-up. They also underwent MR Imaging to assess meniscal integrity. Crues’ criteria were used to determine the meniscal integrity and the MRI findings were correlated clinically with the outcome scores. Following conventional MRI sequences, intravenous Gadodiamide (0.1 mmol/kg) was administered for Indirect MRA sequences after an interval.

Results

The mean IKDC, KOOS and Tegner-Lysholm scores were 79 (range 58-99); 88 (range 74-99) and 94 (range 80-100 respectively. MRI study was carried out at a mean of 21 months post-surgical repair. 16 of the 30 patients were symptom free in their operated knee while 14 had some complaints.26 out of the 30 patients had concurrent ACL reconstruction at same surgery. 22 of these ACL reconstructions were fully healed with an intact graft while 4 showed some abnormality. 24 of the 33 repaired menisci showed full healing with scar on Indirect MRA. 2 showed incomplete healing with some granulation tissue.3 out of 33 menisci were either unhealed or had a retear at the repair site and were symptomatic. 9 of the symptomatic patients had other pathologies.

Conclusion

This study establishes the role of Indirect MR arthrography for evaluation of meniscal repair, avoiding the invasive second look arthroscopy.