Morphological research of normal menisci in children and adolescents based on MRI measurements

doi:10.21203/rs.3.rs-3129611/v1

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Research Article

Morphological research of normal menisci in children and adolescents based on MRI measurements

https://doi.org/10.21203/rs.3.rs-3129611/v1

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Objective

To measure the morphological parameters of the normal meniscus in children and provide a reference for diagnosing and treating children's meniscus-related diseases.

Methods

The imaging data of children who underwent 3.0T knee joint magnetic resonance plain scan were retrospectively analyzed, and the children were divided into group A, group B, group C, and group D according to age. Fifty children were randomly selected in each group, with 200 knee joints, including 400 menisci (200 cases on the inner side and 200 cases on the outer side). Retrieve T2WI images, measure tibial plateau width (TPW), medial tibial plateau width (MTPW), lateral tibial plateau width (LTPW), tibial intercondylar ridge width (TIRW), tibial intercondylar ridge height (TIRH), lateral meniscus body thickness (LMBT), lateral meniscus body width (LMBW), medial meniscus body thickness (MMBT), and medial meniscus body width (MMBW) on the coronal plane; in the sagittal plane, measure the lateral meniscus anterior horn thickness (LMAT), lateral meniscal anterior horn width (LMAW), lateral meniscal posterior horn thickness (LMPT), lateral meniscal posterior horn width (LMPW), lateral meniscal sagittal diameter (LMSD), medial meniscal posterior horn Thickness (MMAT), medial meniscal anterior horn width (MMAW), medial meniscal posterior horn thickness (MMPT), medial meniscal posterior horn width (MMPW), and medial meniscal sagittal diameter (MMSD). They were divided into groups by age, sex, inside and outside, and statistical analysis was carried out. P < 0.05 was considered statistically significant.

Results

We obtained morphological data on the meniscus (anterior horn, body, and posterior horn), tibial plateau, and tibial intercondylar ridge in children of all ages. Through pairwise comparisons between age groups, we found that the indicators of group A are smaller than those of group B (except LMAT), and group B's indicators are lower than group C's (except TIRW). However, in the comparison between group C and group D, there was no statistical difference in some meniscus indexes (LMBT, LMPW, LMSD, MMAT, MMBT, MMPT; P values were 0.15, 0.70, 0.38, 0.13, 0.82, 0.16, respectively), and the rest The meniscus-related indicators in group C were greater than those in group D (LMAT, LMAW, LMBW, LMPT, MMAW, MMBW, MMPW, MMSD); the data of tibial plateau and intercondylar crest in group C were smaller than those in group D (TPW, LTPW, MTPW, TIRW ). The comparison of the inner and outer meniscus shows obvious differences in shape between the two. Through gender group comparison, we found that the meniscus morphology parameters of men and women were consistent.

Conclusion

We obtained the morphological data of the normal meniscus, tibial plateau, and tibial intercondylar ridge in children, which provides a reference for the diagnosis and treatment of meniscus diseases. Within the range of 0–15 years old, the meniscus gradually increases with growth and development; after 15 years old, the meniscus no longer increases, and some areas show degeneration. The lateral meniscus is generally larger than the medial meniscus. There was no significant correlation between meniscal shape and gender.

Pediatric

meniscus

morphology

MRI

tibial intercondylar ridge

With the development of sports medicine, the vital role of the meniscus in the knee joint has been more and more clearly understood. The menisci are essential in lubricating joints, transmitting loads, and cushioning shocks. A normal meniscus is a prerequisite for coordinated and stable activities of the knee joint. Currently, the clinical research on meniscus mainly focuses on the damaged and diseased meniscus, but the morphological study on normal meniscus is rarely reported. The morphological data of normal meniscus is the theoretical basis for doctors to diagnose and treat meniscus diseases. For example, meniscus allografting requires an exact match of the morphology of the graft to the native meniscus (1), which relies on having sufficient data on the normal meniscus. Magnetic resonance imaging (MRI) can clearly visualize the meniscus, cartilage, and surrounding soft tissues. Compared with computed tomography (CT), MRI has more advantages in the application of young children(2). MRI is the preferred imaging method for diagnosing meniscus-related diseases, so obtaining MRI data of normal meniscus is very important.

Children are rapidly growing, and the meniscus is also constantly growing and developing. Children are not small adults(3). It is unclear whether children's meniscus can be simply regarded as the proportional reduction of adults. In addition, the tibial plateau and tibial intercondylar ridge are very important structures in the knee joint. The tibial plateau provides an attachment point for the meniscus, and decreased coverage of the tibial plateau by the meniscus is associated with the progression of osteoarthritis(4). The tibial intercondylar ridge is the insertion point of the menisci and the anterior cruciate ligament(5). Both the tibial plateau and the intercondylar ridge have a close relationship with the meniscus. Therefore, in this study, the relevant indicators of the tibial plateau and tibial intercondylar ridge were included in the measurement to provide a reference for clinical practice.

Based on MRI images, this study measured the morphological data of the meniscus in children and adolescents of different ages. We obtained normal values for the anterior angle, body, and posterior angle of the menisci and normal values for the tibial plateau and tibial intercondylar ridge. Next, we discussed the meniscus changes with age through statistical analysis to provide valuable reference information for the diagnosis and treatment of meniscus-related diseases. This is also the first study to measure morphological data of normal menisci in children.

Research object

From January 1, 2018, to December 31, 2022, the data of children who underwent 3.0T MRI of the knee joint in Shenzhen Children's Hospital were collected. The children were divided into four groups according to age, as follows: Group A, age ≤ 5 years; Group B, 5 < age ≤ 10 years; Group C, 10 < age ≤ 15 years; Group D, 15 < age ≤ 18 years. Fifty children were randomly selected in each group, a total of 200 children, including 400 meniscus (200 cases on the inner side, 200 cases on the outer side). The ethics committee of this hospital approved this study.

Inclusion and exclusion criteria

Inclusion criteria: 1. Age less than 18 years old; 2. MRI images are clear without moving artifacts; 3. The meniscus shape is basically complete, without severe tearing and tear displacement.Exclusion criteria: 1. Previous history of knee surgery; 2. Previous systemic diseases may affect the knee, such as rheumatoid arthritis and ankylosing spondylitis; 3. MRI showed tumors, fractures, knee valgus and knee varus, and other diseases; 4. discoid meniscus.

Magnetic resonance examination method

This study used a Skyra 3.0T magnetic resonance imaging machine (Germany, Siemens) and a knee joint phased array coil. We performed routine coronal and sagittal scans of the knee joint, including T1WI, T2WI, and fat-suppressed sequences, with a slice thickness of 3-4mm. For young children who cannot cooperate, 10% chloral hydrate (0.5ml/kg) enema is used before the examination, and MRI scanning is performed after the children fall asleep. The patient is supine with the knees in a neutral position. MRI scans range from the distal femur to the proximal tibia, including the complete knee joint. All acquired MRI images are uploaded to the PACS workstation.

Measurement methods

On the coronal images of the T2WI sequence, the researchers measured the tibial plateau width(TPW), medial tibial plateau width(MTPW), lateral tibial plateau width(LTPW), tibial intercondylar ridge width(TIRW), tibial intercondylar ridge height(TIRH), lateral meniscus body thickness(LMBT), lateral meniscus body width(LMBW), medial meniscus body thickness(MMBT), and medial meniscus body width(MMBW) (Fig. 1);

On the sagittal image of the T2WI sequence, the researchers measured the lateral meniscus Plate anterior horn thickness (LMAT), the lateral meniscal anterior horn width (LMAW), the lateral meniscal posterior horn thickness (LMPT), the lateral meniscal posterior horn width (LMPW), the lateral meniscal sagittal diameter (LMSD), and the medial meniscal posterior horn thickness (MMAT), the medial meniscal anterior horn width (MMAW), the medial meniscal posterior horn thickness (MMPT), the medial meniscal posterior horn width (MMPW), and the medial meniscal sagittal diameter (MMSD) (Fig. 2, Fig. 3).

In order to ensure the accuracy of the measurement, all the above indicators were independently measured by two experienced physicians, and finally, the average value was taken. Detailed measurement methods are provided in Supplementary Material.

Statistical method

SPSS22.0 software was used for data analysis, and all measured values were count data, expressed as (x ± s). The t-test was used for those that obeyed the normal distribution; the non-parametric test was used for those that did not obey the normal distribution. P < 0.05 is statistically significant.

1. Baseline data

A total of 200 people were included in this study, including 104 males, 96 females, 94 left and 106 right. The age, gender and affected side data of each group are shown in Table 1

Table 1

Baseline data
	Age	Gender		Side
	Age	Male	Female	Left	Right
A	3.98 ± 1.186	21	29	24	26
B	8.02 ± 1.67	30	20	21	29
C	12.38 ± 1.22	23	27	24	26
D	16.30 ± 0.56	30	20	25	25

2. Morphological data of medial and lateral menisci

Among the anterior horn, posterior horn, and body of the lateral meniscus, the body is the thickest (4.49 ± 0.36mm, 5.63 ± 0.93mm, 7.51 ± 1.30mm, 7.12 ± 1.19 mm. The results of this part are displayed in the order of A, B, C, D), the rear corner is the second thickest (3.93 ± 0.49mm, 4.96 ± 0.43mm, 6.61 ± 0.60mm, 6.26 ± 0.96mm), and the front corner is the thinnest (3.58 ± 0.43mm, 3.79 ± 0.56mm, 4.69 ± 0.54mm, 4.39 ± 0.70mm). The body width of the lateral meniscus was also greater than the anterior and posterior horn widths (8.42 ± 0.90mm, 9.51 ± 1.31mm, 10.85 ± 1.73mm, 10.09 ± 1.95mm vs. 5.92 ± 0.61mm, 8.64 ± 0.97mm, 10.26 ± 0.70 mm, 8.6 ± 1.56mm and 5.87 ± 0.70mm, 7.16 ± 1.26mm, 9.61 ± 1.26mm, 9.47 ± 1.15mm). The measurement results are shown in Table 2. In the measurement data of the medial meniscus, except group A, the body thickness of the other groups was greater than that of the anterior horn and posterior horn (5.09 ± 0.74mm, 6.23 ± 1.13mm, 6.29 ± 0.96mm vs. 4.14 ± 0.57mm, 5.72 ± 0.98mm, 5.42 ± 1.04mm and 4.66 ± 0.65mm, 5.75 ± 0.70mm, 5.53 ± 0.95mm); the width of the back angle is greater than that of the front angle and body (10.09 ± 1.62mm, 12.70 ± 1.41mm, 11.49 ± 0.83mm vs. 6.23 ± 0.95mm, 8.18 ± 0.96mm, 6.98 ± 1.10mm and 9.80 ± 1.16mm, 10.60 ± 1.63mm, 8.06 ± 1.18mm). Among the four groups, there was little difference in the thickness of the front and back corners (3.80 ± 0.42mm, 4.14 ± 0.57mm, 5.72 ± 0.98mm, 5.42 ± 1.04mm vs. 3.61 ± 0.41mm, 4.66 ± 0.65mm, 5.75 ± 0.70mm, 5.53 ± 0.95mm). The width of the body is significantly greater than the width of the front horn (7.39 ± 1.13mm, 9.80 ± 1.16mm, 10.60 ± 1.63mm, 8.06 ± 1.18mm vs. 5.30 ± 0.50mm, 6.23 ± 0.95mm, 8.18 ± 0.96mm, 6.98 ± 1.10mm ). The measurement results are shown in Table 3.

Table 2

Morphological data of the lateral meniscus
	LMAT	LMAW	LMBT	LMBW	LMPT	LMPW	LMSD
A	3.58 ± 0.43	5.92 ± 0.61	4.49 ± 0.36	8.42 ± 0.90	3.93 ± 0.49	5.87 ± 0.70	20.22 ± 1.61
B	3.79 ± 0.56	8.64 ± 0.97	5.63 ± 0.93	9.51 ± 1.31	4.96 ± 0.43	7.16 ± 1.26	26.57 ± 1.95
C	4.69 ± 0.54	10.26 ± 0.70	7.51 ± 1.30	10.85 ± 1.73	6.61 ± 0.60	9.61 ± 1.26	33.14 ± 2.17
D	4.39 ± 0.70	8.60 ± 1.56	7.12 ± 1.19	10.09 ± 1.95	6.26 ± 0.96	9.47 ± 1.15	32.71 ± 2.87

Table 3

Morphological data of the medial meniscus
	MMAT	MMAW	MMBT	MMBW	MMPT	MMPW	MMSD
A	3.80 ± 0.42	5.30 ± 0.50	3.64 ± 0.34	7.39 ± 1.13	3.61 ± 0.41	5.98 ± 0.90	25.44 ± 1.66
B	4.14 ± 0.57	6.23 ± 0.95	5.09 ± 0.74	9.80 ± 1.16	4.66 ± 0.65	10.09 ± 1.62	34.98 ± 2.67
C	5.72 ± 0.98	8.18 ± 0.96	6.23 ± 1.13	10.60 ± 1.63	5.75 ± 0.70	12.70 ± 1.41	40.27 ± 1.89
D	5.42 ± 1.04	6.98 ± 1.10	6.29 ± 0.96	8.06 ± 1.18	5.53 ± 0.95	11.49 ± 0.83	41.87 ± 2.92

3.Morphological data of relevant skeleton

Overall, the tibial plateau width, medial tibial platform width, lateral tibial platform width, tibial intercondylar ridge width, and tibial intercondylar ridge height all gradually increased with age, and the difference between the medial tibial platform width and the lateral tibial platform width was not significant. Obvious (15.57 ± 0.71mm, 18.55 ± 1.82mm, 22.35 ± 1.78mm, 23.23 ± 1.97mm vs. 14.3 ± 1.05mm, 19.20 ± 2.69mm, 22.47 ± 0.76mm, 24.38 ± 1.46mm). The tibial intercondylar crest width measurements were greater than height measurements (17.15 ± 1.76mm, 23.86 ± 2.25mm, 23.95 ± 1.92mm, 25.32 ± 2.63mm vs. 6.82 ± 0.51mm, 8.96 ± 0.98mm, 10.54 ± 0.71mm, 10.51 ± 0.65mm). The results are shown in Table 4.

Table 4

Morphological data of relevant skeleton
	TPW	LTPW	MTPW	TIRW	TIRH
A	47.28 ± 1.97	14.30 ± 1.05	15.57 ± 0.71	17.15 ± 1.76	6.82 ± 0.51
B	60.37 ± 5.23	19.20 ± 2.69	18.55 ± 1.82	23.86 ± 2.25	8.96 ± 0.98
C	68.98 ± 4.26	22.47 ± 0.76	22.35 ± 1.78	23.95 ± 1.92	10.54 ± 0.71
D	73.55 ± 4.74	24.38 ± 1.46	23.23 ± 1.97	25.32 ± 2.63	10.51 ± 0.65

4.The results for comparison between groups

We compared the four age groups pairwise, and only the relatively essential results are shown here, including A versus B, B versus C, and C versus D. The rest of the comparison results are shown in Table 5.

Table 5

P values for comparison between groups
	Indicators of the lateral meniscus							Indicators of the medial meniscus							Indicators of relevant skeleton
	LMAT	LMAW	LMBT	LMBW	LMPT	LMPW	LMSD	MMAT	MMAW	MMBT	MMBW	MMPT	MMPW	MMSD	TPW	LTPW	MTPW	TIRW	TIRH
(0,5] versus (5,10]	0.0693	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	0.0041	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001
(0,5] versus (10,15]	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001
(0,5] versus (15,18)	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	0.0169	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001
(5,10] versus (10,15]	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	0.0051	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	0.9877	< 0.0001
(5,10] versus (15,18)	< 0.0001	0.7954	< 0.0001	0.1535	< 0.0001	< 0.0001	< 0.0001	< 0.0001	0.0005	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	< 0.0001	0.0085	< 0.0001
(10,15] versus (15,18)	0.0172	< 0.0001	0.1525	< 0.0001	0.0319	0.6967	0.3819	0.1282	< 0.0001	0.8194	< 0.0001	0.1754	< 0.0001	0.0043	< 0.0001	< 0.0001	0.0117	0.0057	0.9959

4.1 A versus B

The results showed that, except for the thickness of the anterior horn of the lateral meniscus, the other indicators in group A were smaller than those in group B, P < 0.0001. The anterior horn thickness of the lateral meniscus in group A was 3.58 ± 0.43mm, and in group B was 3.79 ± 0.56mm, P = 0.0693.

4.2 B versus C

The results showed that, except for the width of the tibial intercondylar ridge, the other indicators in group B were smaller than those in group C, P < 0.0001. The height of the tibial intercondylar ridge in group B was 23.86 ± 2.25mm, and the height of the tibial intercondylar ridge in group C was 23.95 ± 1.92mm, P = 0.9877.

4.3 C versus D

The comparison between groups C and D is the most meaningful part of the results of this study. The results showed that there was no statistical difference in some indexes between the two groups (LMBT、LMPW、LMSD、MMAT、MMBT、MMPT; P values were 0.15, 0.70, 0.38, 0.13, 0.82, 0.16, respectively). This result indicated that these indicators did not increase with growth and development. Although there were statistical differences in the other part of the indicators between the two groups, they were all greater in group C than in group D (LMAT、LMAW、LMBW、LMPT、MMAW、MMBW、MMPW、MMSD), this result indicated that these indicators gradually decreased with growth and development. The comparison results of tibial plateau width, tibial lateral plateau width, tibial medial plateau width, and tibial intercondylar ridge width between the two groups showed that group C was more minor than group D, which indicated that the development of the bone structure of knee joint was consistent with the overall development.

5. The comparison of medial and lateral menisci

We compared the inner and outer menisci in each age group. In comparing the anterior angle of the meniscus, the results of the four age groups were consistent, the thickness of the lateral anterior horn was smaller than that of the medial one, but the width of the anterior horn was larger than that of the medial one. In comparing the meniscus body, the thickness of the lateral body was greater than that of the medial body; the width of the lateral meniscus body in groups A and D was greater than that of the medial meniscus body. There was no difference in medial and lateral body width between groups B and C (9.80 ± 1.16mm vs. 9.51 ± 1.31mm, P = 0.31, 10.60 ± 1.63mm vs. 10.85 ± 1.73mm, P = 0.44); In the comparison, the posterior horn thickness of the lateral side was greater than that of the medial side, and the width of the posterior horn of the lateral meniscus in groups B, C and D was smaller than that of the medial side, while there was no difference in the width of the posterior horn of the medial and lateral sides in group A (5.98 ± 0.90mm vs. 5.87 ± 0.70mm, P = 0.45); in the comparison of sagittal diameter, the sagittal diameter of the lateral meniscus in the four age groups was smaller than that of the medial meniscus. The results are shown in Table 6.

Table 6

Lateral meniscus versus medial meniscus
	A	B	C	D
LMAT	3.58 ± 0.43	3.79 ± 0.56	4.69 ± 0.54	4.39 ± 0.70
MMAT	3.80 ± 0.42	4.14 ± 0.57	5.72 ± 0.98	5.42 ± 1.04
P	0.0122	0.003	< 0.0001	< 0.0001
LMAW	5.92 ± 0.61	8.64 ± 0.97	10.26 ± 0.70	8.6 ± 1.56
MMAW	5.30 ± 0.50	6.23 ± 0.95	8.18 ± 0.96	6.98 ± 1.10
P	< 0.0001	< 0.0001	< 0.0001	< 0.0001
LMBT	4.49 ± 0.36	5.63 ± 0.93	7.51 ± 1.30	7.12 ± 1.19
MMBT	3.64 ± 0.34	5.09 ± 0.74	6.23 ± 1.13	6.29 ± 0.96
P	< 0.0001	0.0026	< 0.0001	0.001
LMBW	8.42 ± 0.90	9.51 ± 1.31	10.85 ± 1.73	10.09 ± 1.95
MMBW	7.39 ± 1.13	9.80 ± 1.16	10.60 ± 1.63	8.06 ± 1.18
P	< 0.0001	0.3079	0.4426	< 0.0001
LMPT	3.93 ± 0.49	4.96 ± 0.43	6.61 ± 0.60	6.26 ± 0.96
MMPT	3.61 ± 0.41	4.66 ± 0.65	5.75 ± 0.70	5.53 ± 0.95
P	0.0013	0.0301	< 0.0001	0.0005
LMPW	5.87 ± 0.70	7.16 ± 1.26	9.61 ± 1.26	9.47 ± 1.15
MMPW	5.98 ± 0.90	10.09 ± 1.62	12.70 ± 1.41	11.49 ± 0.83
P	0.4485	< 0.0001	< 0.0001	< 0.0001
LMSD	20.22 ± 1.61	26.57 ± 1.95	33.14 ± 2.17	32.71 ± 2.87
MMSD	25.44 ± 1.66	34.98 ± 2.67	40.27 ± 1.89	41.87 ± 2.92
P	< 0.0001	< 0.0001	< 0.0001	< 0.0001

6. The comparison of men and women

We compared male and female data from each group, including data on the lateral meniscus, medial meniscus, and associated skeletal morphology. The results showed that in the four age groups, except for individual indicators, there was basically no difference in the morphological data between men and women on the whole. Among them, the intercondylar ridge height of male children in group A was greater than that of female children (6.99 ± 0.50mm vs 6.69 ± 0.48mm, P = 0.04). In group B, the body width of the medial meniscus in male children was larger than that in female children (10.11 ± 1.14mm vs 9.34 ± 1.06mm, P = 0.0203). In group C, the width of the posterior horn of the medial meniscus in male children was larger than that in female children (13.20 ± 1.27mm vs 12.27 ± 1.39mm, P = 0.0286). In group D, the medial tibial platform width of male children was larger than that of female children (23.70 ± 1.91mm vs 22.54 ± 1.90mm, P = 0.0381). The results are shown in Table 7.

Table 7

The results of the comparison between men and women
		Indicators of the lateral meniscus							Indicators of the medial meniscus							Indicators of relevant skeleton
		LMAT	LMAW	LMBT	LMBW	LMPT	LMPW	LMSD	MMAT	MMAW	MMBT	MMBW	MMPT	MMPW	MMSD	TPW	LTPW	MTPW	TIRW	TIRH
A	Male	3.57 ± 0.48	6.02 ± 0.58	4.52 ± 0.40	8.40 ± 0.77	3.79 ± 0.45	5.60 ± 0.55	20.11 ± 1.72	3.83 ± 0.42	5.20 ± 0.47	3.55 ± 0.26	7.62 ± 1.04	3.56 ± 0.40	5.75 ± 0.82	25.71 ± 1.68	47.55 ± 1.92	14.11 ± 1.01	15.66 ± 0.70	17.10 ± 1.65	6.99 ± 0.50
	Female	3.59 ± 0.40	5.84 ± 0.64	4.47 ± 0.33	8.43 ± 0.98	4.04 ± 0.50	5.678 ± 0.78	20.30 ± 1.55	3.79 ± 0.43	5.37 ± 0.51	3.70 ± 0.38	7.22 ± 1.78	3.65 ± 0.42	6.15 ± 0.93	25.25 ± 1.64	47.08 ± 2.01	14.43 ± 1.07	15.51 ± 0.73	17.18 ± 1.86	6.69 ± 0.48
	P	0.8329	0.2496	0.5337	0.8796	0.0911	0.2775	0.6295	0.7304	0.2378	0.1315	0.2178	0.46	0.1533	0.3316	0.3612	0.2955	0.449	0.9573	0.04
B	Male	3.85 ± 0.54	8.64 ± 0.89	5.72 ± 0.83	9.31 ± 1.28	4.95 ± 0.43	6.36 ± 1.29	26.40 ± 2.01	4.18 ± 0.60	6.12 ± 1.03	5.12 ± 0.75	10.11 ± 1.14	4.66 ± 0.62±	9.99 ± 1.60	35.04 ± 2.55	60.75 ± 5.24	19.28 ± 2.79	18.74 ± 1.84	23.83 ± 2.06	8.80 ± 0.88
	Female	3.69 ± 0.57	8.66 ± 0.10	5.49 ± 1.06	9.82 ± 1.33	4.96 ± 0.43	6.87 ± 1.18	26.81 ± 1.88	4.09 ± 0.54	6.40 ± 0.81	5.04 ± 0.74	9.34 ± 1.06	4.65 ± 0.71	10.23 ± 1.68	34.89 ± 2.89	59.79 ± 5.29	19.08 ± 2.60	18.26 ± 1.81	23.91 ± 2.55	9.20 ± 1.09
	P	0.3142	0.9961	0.402	0.1505	0.9886	0.1811	0.4762	0.5583	0.3181	0.699	0.0203	0.9442	0.5521	0.8426	0.529	0.795	0.3627	0.7201	0.1646
C	Male	4.57 ± 0.45	10.22 ± 0.69	7.72 ± 1.37	10.93 ± 1.93	6.79 ± 0.61	9.82 ± 1.12	32.68 ± 1.98	5.61 ± 1.11	8.07 ± 0.93	6.07 ± 1.10	10.78 ± 1.62	5.79 ± 0.73	13.20 ± 1.27	40.29 ± 2.12	69.60 ± 3.97	22.67 ± 0.69	22.80 ± 1.67	24.28 ± 1.12	10.66 ± 0.73
	Female	4.79 ± 0.59	10.29 ± 0.72	7.34 ± 1.23	10.77 ± 1.57	6.46 ± 0.55	9.43 ± 1.30	33.53 ± 2.28	5.82 ± 0.88	8.28 ± 1.00	6.37 ± 1.16	10.44 ± 1.65	5.72 ± 0.68	12.27 ± 1.39	40.25 ± 1.71	68.44 ± 4.51	22.30 ± 0.79	21.97 ± 1.81	23.67 ± 1.73	10.43 ± 0.70
	P	0.2419	0.7171	0.3708	0.6605	0.0586	0.3164	0.1668	0.466	0.4521	0.4082	0.5019	0.7316	0.0286	0.9422	0.3457	0.0845	0.0837	0.4308	0.2918
D	Male	4.45 ± 0.66	8.33 ± 1.60	7.32 ± 1.09	9.90 ± 1.85	6.36 ± 0.43	9.72 ± 1.26	33.26 ± 2.98	5.52 ± 1.09	7.17 ± 1.09	6.34 ± 1.04	8.17 ± 1.32	5.58 ± 0.95	11.66 ± 0.79	42.07 ± 2.71	74.60 ± 4.59	24.23 ± 1.51	23.70 ± 1.91	25.61 ± 2.67	10.54 ± 0.64
	Female	4.30 ± 0.78	9.01 ± 1.45	6.82 ± 1.29	10.37 ± 2.09	6.11 ± 0.98	9.09 ± 1.10	31.88 ± 2.58	5.27 ± 0.97	6.70 ± 1.09	6.22 ± 0.85	7.90 ± 0.93	5.45 ± 0.97	11.23 ± 0.85	41.57 ± 3.25	71.97 ± 4.62	24.60 ± 1.37	22.54 ± 1.90	24.88 ± 2.58	10.48 ± 0.69
	P	0.3625	0.1533	0.1398	0.4083	0.3669	0.0545	0.108	0.4637	0.1444	0.5071	0.5788	0.6327	0.1393	0.558	0.069	0.1746	0.0381	0.3438	0.7468

A normal meniscus performs essential functions such as load bearing, stability enhancement, lubrication, and nutrition(6). Once the shape of the meniscus changes, the contact stress of the knee articular cartilage will also change, which may lead to the occurrence and progression of osteoarthritis(7–9). During meniscus transplantation, smaller grafts cannot bear the load and stabilize the knee joint, while larger grafts are easily squeezed and torn(9). Therefore, restoring the normal shape of the meniscus is critical to the long-term health of the knee joint. In addition, diagnosing a discoid meniscus also relies on our knowledge of the normal meniscus. Currently, there are no morphological studies of normal menisci in children. We measured the morphological indexes of the meniscus, tibial plateau, and intercondylar ridge for children of different ages. We also compared the medial and lateral menisci to draw their morphological differences. Finally, we also compared the menisci of men and women and found no significant differences in meniscus morphology between men and women.

Morphological studies of the meniscus in children. In this study, the menisci can be clearly identified on MRI images. The edge of the meniscus is clear, and the measurement error is small. To a certain extent, it can reflect the general shape of the children's meniscus and provide a data basis for tissue engineering. Lee(10) and Zhang(11) performed meniscus transplantation in sheep and rabbits, respectively, effectively preventing knee osteoarthritis progression. This is because the meniscal graft and the knee joint based on 3D printing technology have an excellent structural match. A high-strength artificial meniscus substitute based on hydrogel synthesis showed good biomechanical properties in cadaver and rabbit models(12). In addition to simulating the microscopic structure of the meniscus, this artificial meniscus substitute also needs to be close to the original meniscus in general shape to play the role of load and cushioning better.

Shen X(13)and others measured the meniscus of adults based on the 3D-DESS sequence of MRI, and multiple data in Group D of this study are consistent with it. Group D was similar to that of an adult. The thickness and width of the lateral meniscus body, the thickness of the posterior horn of the lateral meniscus, and the width of the posterior horn of the lateral meniscus in group D were 7.12 ± 1.19 mm, 10.09 ± 1.95 mm, and 6.26 mm, respectively. ±0.96, 9.47 ± 1.15. The results of Shen X were 7.21 ± 0.86 mm, 10.39 ± 1.90 mm, 6.47 ± 0.66, and 9.93 ± 2.03, respectively. The data from the two studies were very close. The medial meniscus also has a number of consistent data, including the body's width and thickness and the posterior horn's width. Furthermore, our results showed that the width of the posterior horn of the medial meniscus was greater than that of the anterior horn and body (11.49 ± 0.83mm vs. 6.98 ± 1.10 mm, 8.06 ± 1.18 mm). This may be why the posterior horn of the medial meniscus is prone to tearing because a wider width means a larger contact area and force-bearing area(14–16).

Measurement of normal meniscal width in children is helpful in the diagnosis and treatment of discoid menisci. At present, the diagnostic standard of discoid meniscus is to scan with a layer thickness of 5 mm on the sagittal plane, and there are 3 or more layers connected at the front and rear corners of the meniscus, forming a "bow tie"-like change, or the width of the meniscus body on the coronal plane greater than 15mm(17, 18). However, this standard is formulated for adults. In this study, the body widths of the lateral meniscus in groups A, B, C, and D were 8.42 ± 0.90 mm, 9.51 ± 1.31 mm, 10.85 ± 1.73 mm, and 10.09 ± 1.95 mm, respectively of which 8.42 ± 0.90mm and 9.51 ± 1.31 mm are much smaller than 15mm, suggesting that the diagnostic criteria for adults are not fully applicable to children, and new diagnostic criteria should be formulated for children. At the same time, clarifying the width of the normal meniscus in children of different ages is also helpful for the implementation of discoid meniscus surgery, suggesting the width of the meniscus that the surgeon should retain when performing partial meniscectomy.

Through the comparison among the groups, we found that within the range of 0–15 years old, the meniscus showed an overall increasing trend, and each area gradually became wider and thicker. However, after age 15, the meniscus no longer increases, and even the meniscus area becomes narrower and thinner. This exciting phenomenon suggests that cells and signaling pathways may be related to the development and degeneration of the meniscus. Sun H(19, 20) et al. identified the cellular heterogeneity of human mature normal meniscus by single-cell RNA sequencing and found that CD146 + meniscus cells had the characteristics of progenitor cells, but the specific cell types and sources of these cells were not yet clear. Subsequently, Sun H(21) and others discovered the existence of smooth muscle cells in the meniscus and revealed that smooth muscle cells are the precursors of meniscus progenitor cells. HEYL Fibrosis of the meniscus can weaken inhibition of NOTCH3 signaling pathway in meniscus smooth muscle cells exacerbates meniscus degeneration.

Our results indicate that the morphology of the lateral meniscus differs significantly from that of the medial meniscus. In comparing the 4 groups, although individual data showed no difference between the medial and lateral menisci, overall, the medial and lateral menisci had noticeable morphological differences, which remained consistent among the 4 groups. The anterior horn of the lateral meniscus is thinner and wider, the body is thicker and wider, the posterior horn is thicker and narrower, and the sagittal diameter of the lateral meniscus is smaller than that of the medial meniscus. This result is consistent with Shen X's research(13) et al.

There was no difference in this study's results between men and women. Studies by Shen X(13) et al. have shown that some anatomical parameters of the meniscus are related to height, weight, and BMI. This result may explain the meniscus comparison results of young men and women in this study because the height, weight, and BMI of males and females were the same in young children. However, among adolescents, there should be significant differences in the demographics of men and women. Since this study did not collect these demographic data, this part of the results awaits further study.

After measurement, we obtained the morphological data of the normal lateral meniscus, medial meniscus, tibial plateau, and tibial intercondylar ridge, which provided a reference for diagnosing and treating meniscus diseases. Within the range of 0–15 years old, the meniscus gradually widens and thickens as a whole and gradually increases with growth and development; after 15 years of age, the meniscus no longer increases with growth and development, some areas stop growing, and other parts Instead, the region degenerates. The bony structures, such as the tibial plateau and the intercondylar ridge, still gradually increase with growth and development. Compared with the inner and outer menisci, the anterior horn of the outer meniscus is thinner and broader on the whole, the body is thicker and more comprehensive, and the posterior horn is thicker and narrower. The sagittal diameter of the outer meniscus is larger than that of the medial meniscus. The meniscus, tibial plateau, and intercondylar ridge morphology were the same in males and females.

Tibial plateau width, TPW

Medial tibial plateau width, MTPW

Lateral tibial plateau width, LTPW

Tibial intercondylar ridge width, TIRW

Tibial intercondylar ridge height, TIRH

Lateral meniscus body thickness, LMBT

Lateral meniscus body width, LMBW

Medial meniscus body thickness, MMBT

Medial meniscus body width, MMBW

Lateral meniscus anterior horn thickness, LMAT

Lateral meniscal anterior horn width, LMAW

Lateral meniscal posterior horn thickness, LMPT

Lateral meniscal posterior horn width, LMPW

Lateral meniscal sagittal diameter, LMSD

Medial meniscal posterior horn Thickness, MMAT

Medial meniscal anterior horn width, MMAW

Medial meniscal posterior horn thickness, MMPT

Medial meniscal posterior horn width, MMPW

Medial meniscal sagittal diameter, MMSD

Ethics approval and consent to participate

All the following procedures were approved by the Medical Ethics Committee of the Shenzhen Children’s Hospital. Informed consent was waived because of the register design of this study, which did not involve any additional risk for patients. The need for written informed consent was waived by the Shenzhen Children’s Hospital ethics committee due to retrospective nature of the study. All the methods included in this study are in accordance with the declaration of Helsinki

Consent for publication

Not applicable.

Availability of data and materials

All data generated or analysed during this study are included in this published article and its supplementary information files.

Competing interests

For all authors, none was declared.

Funding

This study was supported by Guangdong High-level Hospital Construction Fund and Sanming Project of Medicine in Shenzhen (SZSM202011012).

Authors' contributions

Tianfeng Zhu, Yongjie Xia and Chao Deng wrote the manuscript. Yibiao Zhou, Xin Qiu, Hansheng Deng, Yiyuan Sun and Jiachen Tang collected the clinical data. Guibing Fu, Shengping Tang and Chao You designed the research protocol and revised the manuscript.

Acknowledgments

We would like to express gratitude to all the patients and their families.

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No competing interests reported.

Supplementarytable1.xlsx
Supplementary table 1: The raw data of group A
Supplementarytable2.xlsx
Supplementary table 2: The raw data of group B
Supplementarytable3.xlsx
Supplementary table 3: The raw data of group C
Supplementarytable4.xlsx
Supplementary table 4: The raw data of group D

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Morphological research of normal menisci in children and adolescents based on MRI measurements

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Abstract

Objective

Methods

Results

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Background

Materials and methods

Research object

Inclusion and exclusion criteria

Magnetic resonance examination method

Measurement methods

Statistical method

Result

1. Baseline data

2. Morphological data of medial and lateral menisci

3.Morphological data of relevant skeleton

4.The results for comparison between groups

4.1 A versus B

4.2 B versus C

4.3 C versus D

5. The comparison of medial and lateral menisci

6. The comparison of men and women

Discussion

Conclusion

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