The present case describes a 36-year-old man who sought a consultation at an orthopedics hospital. He complained of knee pain associated with clamping and crepitation, common symptoms during every day clinical practice, except that, in this case, he had a finding of anatomical variation of the menisci on MRI showing fusion of posterior horns of the menisci and posterior insertion to the ACL.
Based on the normal anatomy of the menisci, they can be divided into three parts: body, anterior horn, and posterior horn. The function of both anterior and posterior horns is to secure the menisci in the tibia’s plateau; these are critical structures for its biomechanical function [6, 7]. Lesions in this region cause a loss in menisci biomechanical function, leading to an early degeneration of the articular cartilage, and, thereby, causing osteoarthritis [8, 9].
Among the morphological variations of the menisci, the most common is the DM, which probably has an embryological etiology. In DM, the meniscus shape resembles a disk instead of the usual shape (with an ascending shape), with greater incidence on the lateral meniscus (77%) [10, 11]. Its clinical presentation is variable, from asymptomatic to the presence of pain, crepitation, and decreased range of motion, especially in children and young adults [6, 12]. With the exception of the lateral meniscus, other malformations are infrequent, having a total incidence of 0.3% . These anatomical changes may present as a meniscus with a ringed shape, having two layers, meniscal ossicle, or insertional abnormalities, such as anomalous insertion of the meniscus posterior horn into the ACL [3, 14].
The ring-shaped meniscus presents a circular form, with its external part being similar to the one of a normal meniscus: well-defined and angular, with no inner portion mobility, near the intercondylar notch. There is also a description of the meniscal ossicle, which is an uncommon alteration that normally occurs in the posterior horn of medial meniscus; it is defined as the presence of cortical and trabecular bone with bone marrow surrounded by meniscal fibrocartilage .
A study on the anatomy of the menisci anterior horns points to a change of its insertion in the ACL, identified in 35 knees from cadavers of Ghana’s population . The anomalous insertion of the medial meniscus anterior horn in the ACL may also occur in the posterior horn of the medial or lateral meniscus [17–19]. Other changes are much less frequent, with an incidence of 0.3% . They are more frequent in the Asian population, and the lateral meniscus is the most affected. Mostly, these changes are asymptomatic [1, 20].
The meniscal variation presented in this study was not described in any other study on meniscal abnormalities. Additional investigation of similar cases is required so that a suitable description can be added among the possible anatomical variations of the menisci.
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