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Characterization of the "Red Zone" of Knee Meniscus: MR Imaging and Histologic Correlation¹

¹ From the Departments of Radiology (O.H., L.R.F., R.D.B., N.L., C.B.C., D.R.) and Pathology (P.H.), University of California, San Diego, Veterans Affairs Medical Center, 3350 La Jolla Village Dr, San Diego, CA 92161. Received August 10, 1999; revision requested September 20; revision received December 13; accepted January 11, 2000. Supported by Veterans Administration grant SA-360. Address correspondence to D.R. (e-mail: dresnick@ucsd.edu).

View larger version (132K): [in a new window]   Figure 1. High-spatial-resolution FLASH MR image (100/9, 30° flip angle) of a cadaveric medial meniscus shows measurement of the radial dimension of the anterior horn from its free edge (straight arrow) to its peripheral border (curved arrow).

View larger version (93K): [in a new window]   Figure 2a. Sagittal fat-suppressed T1-weighted spin-echo MR images (600/14) obtained (a) before and (b) after intraarterial injection of a gadolinium-containing contrast material into a cadaveric knee specimen. Soft-tissue enhancement is substantially greater peripheral to the posterior horn (curved arrow) of the meniscus than that peripheral to the anterior horn (straight white arrow). No enhancement is observed in the periphery of the meniscus itself (black arrow).

View larger version (103K): [in a new window]   Figure 2b. Sagittal fat-suppressed T1-weighted spin-echo MR images (600/14) obtained (a) before and (b) after intraarterial injection of a gadolinium-containing contrast material into a cadaveric knee specimen. Soft-tissue enhancement is substantially greater peripheral to the posterior horn (curved arrow) of the meniscus than that peripheral to the anterior horn (straight white arrow). No enhancement is observed in the periphery of the meniscus itself (black arrow).

View larger version (85K): [in a new window]   Figure 3a. Coronal fat-suppressed T1-weighted spin-echo MR images (600/14) obtained (a) before and (b) after intraarterial injection of a gadolinium-containing contrast material into a cadaveric knee specimen. Soft-tissue enhancement is substantially greater peripheral to the body of the lateral meniscus (curved arrow) than the enhancement in the body of the medial meniscus (straight arrow). No enhancement is observed in the periphery of the meniscus itself (arrowhead).

View larger version (95K): [in a new window]   Figure 3b. Coronal fat-suppressed T1-weighted spin-echo MR images (600/14) obtained (a) before and (b) after intraarterial injection of a gadolinium-containing contrast material into a cadaveric knee specimen. Soft-tissue enhancement is substantially greater peripheral to the body of the lateral meniscus (curved arrow) than the enhancement in the body of the medial meniscus (straight arrow). No enhancement is observed in the periphery of the meniscus itself (arrowhead).

View larger version (119K): [in a new window]   Figure 4. Gross anatomic 3-mm-thick section of the posterior horn of a medial meniscus shows two distinctive zones: a peripheral reddish band (small straight arrow) and a central yellow portion (large straight arrow). Branching fibers (arrowhead) in the periphery of the meniscus also are visible. Fatty connective tissue (curved arrow) can be seen between the meniscus and the joint capsule.

View larger version (112K): [in a new window]   Figure 5. High-spatial-resolution FLASH MR image (100/9, 30° flip angle) of the medial meniscus of a cadaveric knee specimen (same specimen as in Fig 4) shows a branching network of intermediate-signal-intensity fibers (arrow) that arborize within the outer portion of the meniscus.

View larger version (155K): [in a new window]   Figure 6. Photomicrograph shows that the outer portion of the meniscus (m) contains delicate fibrovascular septa (s). Peripheral to the meniscus, perimeniscal soft tissues containing blood vessels (arrows), adipose tissue, and irregular collagen fibers (f) are visible. (Hematoxylin-eosin stain; objective magnification, x2.)

View larger version (165K): [in a new window]   Figure 7. Photomicrograph of the posterior horn of a cadaveric medial meniscus shows blood vessels (arrows) in the outer portion of the meniscus (m), as well as in the soft tissue peripheral to the meniscus. Small spaces within the meniscus represent tissue preparation artifact. (Factor VIII-related antigen immunoperoxidase and hematoxylin-eosin stains; objective magnification, x2.)

View larger version (84K): [in a new window]   Figure 8a. (a) Nonenhanced and (b) gadolinium-enhanced sagittal fat-suppressed T1-weighted spin-echo MR images (600/14) in a 67-year-old man with a clinical history of meniscal tear. Soft-tissue enhancement is substantially greater peripheral to the posterior horn (curved arrow) of the meniscus than that peripheral to the anterior horn (straight white arrow). No contrast enhancement is observed in the periphery (black arrow) of the meniscus itself.

View larger version (81K): [in a new window]   Figure 8b. (a) Nonenhanced and (b) gadolinium-enhanced sagittal fat-suppressed T1-weighted spin-echo MR images (600/14) in a 67-year-old man with a clinical history of meniscal tear. Soft-tissue enhancement is substantially greater peripheral to the posterior horn (curved arrow) of the meniscus than that peripheral to the anterior horn (straight white arrow). No contrast enhancement is observed in the periphery (black arrow) of the meniscus itself.

View larger version (86K): [in a new window]   Figure 9a. (a) Nonenhanced and (b) gadolinium-enhanced coronal fat-suppressed T1-weighted spin-echo MR images (600/14) in a 55-year-old woman with a clinical history of chronic knee pain and suspected meniscal tear. Soft-tissue enhancement is substantially greater at the periphery of the body of the lateral meniscus (curved arrow) than in the body of the medial meniscus (straight arrow). No enhancement is observed in the periphery (arrowhead) of the meniscus itself.

View larger version (74K): [in a new window]   Figure 9b. (a) Nonenhanced and (b) gadolinium-enhanced coronal fat-suppressed T1-weighted spin-echo MR images (600/14) in a 55-year-old woman with a clinical history of chronic knee pain and suspected meniscal tear. Soft-tissue enhancement is substantially greater at the periphery of the body of the lateral meniscus (curved arrow) than in the body of the medial meniscus (straight arrow). No enhancement is observed in the periphery (arrowhead) of the meniscus itself.

View larger version (101K): [in a new window]   Figure 10a. (a) Nonenhanced and (b) gadolinium-enhanced sagittal fat-suppressed T1-weighted fast spin-echo MR images (666/17 [effective]) in a 28-year-old man with posteromedial knee pain and a suspected meniscal tear. A peripheral meniscal tear (arrow), which shows enhancement after injection of the contrast material, is observed in the posterior horn of the medial meniscus.

View larger version (84K): [in a new window]   Figure 10b. (a) Nonenhanced and (b) gadolinium-enhanced sagittal fat-suppressed T1-weighted fast spin-echo MR images (666/17 [effective]) in a 28-year-old man with posteromedial knee pain and a suspected meniscal tear. A peripheral meniscal tear (arrow), which shows enhancement after injection of the contrast material, is observed in the posterior horn of the medial meniscus.

View larger version (103K): [in a new window]   Figure 11. Diagram shows the orientation of collagen fibers in the lateral meniscus in a coronal section. The majority of fibers are oriented concentrically (curved arrow) and course approximately parallel to the inner and outer margins of the meniscus in the axial plane. The radial "tie" collagen fibers (straight arrow) are oriented perpendicular to most other meniscal fibers and become progressively smaller as they course from the periphery toward the inner edge of the meniscus. (Adapted, with permission, from reference 28.)

View larger version (103K): [in a new window]   Figure 12. Sagittal intermediate-weighted spin-echo MR image (2,000/14) of the medial meniscus from a cadaveric knee specimen. A branching network of intermediate-signal-intensity fibers (arrow), corresponding to radial "tie" collagen fibers, arborizes within the outer portion of the posterior horn of the meniscus.

View larger version (92K): [in a new window]   Figure 13. High-spatial-resolution FLASH MR image (100/9, 30° flip angle) of the medial meniscus from a cadaveric knee specimen (almost identical level as that in Fig 12). Large radial "tie" collagen fibers (arrow) of intermediate signal intensity extend centrally from the periphery and arborize within the outer portion of the meniscus.