anterior horn lateral meniscus tear: mri

typically into the anterior cruciate ligament. Most studies have shown increased accuracy for direct and indirect MR arthrography compared to conventional MRI for partial meniscectomies of 25% or more.16. Meniscal root tearsare a type of meniscal tearin the knee where the tear extends to either the anterior or posterior meniscal root attachment to the central tibial plateau. Klingele KE, Kocher MS, Hresko MT, et al. Dr. Diduch, Associate Professor, Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, VA, is Editor of Sports Medicine Reports. Anomalous The patient had a recent new injury with increased pain. diminutive (1 mm) with no increased signal to suggest root attachment Pain is typically medial and activity-related (e.g. Ross JA,Tough ICK, English TA. The main functions Meniscus tears are either degenerative or acute. As DLM is a congenital anomaly, the ultrastructural features and morphology differ from those of the normal meniscus, potentially leading to meniscal tears. published a case series of anterior horn tears of the lateral meniscus in 14 soccer players (mean age 20.2 years). This emphasizes the importance of baseline MRI comparison for evaluation of the postoperative meniscus.3. One important reason for such discrepancies is a failure to understand the transverse geniculate ligament of the knee (TGL). Extrusion is commonly seen following root repair. from AIMM. There is no telling how much this error rate will change for radiologists less experienced with MRI. anterior horn of the medial meniscus into the anterior cruciate ligament Sagittal proton density-weighted image (6A) through the medial meniscus following partial meniscectomy and debridement of the inferior articular surface shows increased PD signal contacting the inferior articular surface (arrow) but no T2 fluid signal at the surgical site (6B) and no gadolinium signal in the meniscus (6C). To provide the highest quality clinical and technology services to customers and patients, in the spirit of continuous improvement and innovation. Tears Sagittal T2-weighted image (10B) reveals no fluid at the repair site. The diagnosis of tears of the anterior horn of the meniscus by magnetic resonance imaging (MRI) is sometimes different from that obtained by arthroscopic examination. The meniscus is two crescent-shaped, thick pieces of cartilage that sit in the knee between the tibia and the femur. mimicking an anterior horn tear. Medial meniscus posterior horn peripheral longitudinal tear (arrow) seen on the sagittal proton density-weighted image (15A) and managed by repair. Learn more. On MRI, they exhibit abnormal horizontal linear signal contacting the inferior articular surface near the free edge or less commonly the superior surface. Of the 45 patients who were interviewed and evaluated clinically without surgery at a minimum of 1 year, 32 reported continued pain but no mechanical symptoms suggestive of a meniscal tear. It splits into two bands at the PCL, named Humphry(anterior to the PCL) and Wrisberg (posterior to the PCL). MRI Knee - Sagittal PDFS - Displaced meniscus Part of a torn meniscus can be displaced into another part of the knee joint In this image the anterior part of the meniscus (the anterior horn) is correctly located The posterior horn is displaced such that it is located next to the anterior horn The correct position of the posterior horn is shown How I Diagnose Meniscal Tears on Knee MRI. 1). The trusted source for healthcare information and CONTINUING EDUCATION. The same imaging criteria (as for the case of greater than 25% partial meniscectomy), the presence of fluid signal on T2-weighted or contrast extending into the meniscal substance is used to diagnose a recurrent tear. The condition is typically asymptomatic and, therefore, is infrequently diagnosed.14 On MR arthrography, (12B), gadolinium extends through the repair site indicating a tear. Get unlimited access to our full publication and article library. Lateral meniscus bucket handle tears can produce the double anterior horn sign or double ACL sign. has shown that 41% of patients with a surgically confirmed torn post-operative meniscus had signal intensity within the meniscus extending into the articular surface which was lower than the signal intensity of gadolinium contrast.14 Like the presence of a line of intermediate T2 signal extending into the articular surface on conventional MRI, diagnosis of a torn post-operative meniscus on MRI arthrography is challenging when the intra-meniscal signal intensity is not as bright as gadolinium contrast. Figure 8: Medial oblique menisco-meniscal . varus deformity (Figure 3). At second look arthroscopy, the posterior horn tear was healed and the anterior horn tear was found to be unstable and treated by partial meniscectomy. Reference article, Radiopaedia.org (Accessed on 04 Mar 2023) https://doi.org/10.53347/rID-40036, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":40036,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/meniscal-root-tear/questions/1112?lang=us"}. (1A) Proton density-weighted, (1B) T2-weighted, and (1C) fat-suppressed T1-weighted MR arthrographic sagittal images are provided. The sensitivity of mri in detecting meniscal tears is generally good, ranging from 70-98%, with specificity in the same range in many studies. gestation, about the time when the knee joint is fully formed.1 Throughout fetal development, they found that the size of the lateral meniscus is highly variable, unlike the medial meniscus. was saddle shaped. found that the absence of a line of increased signal through the meniscus extending to the articular surface on proton density and T2-weighted images was a reliable MRI finding for an untorn post-operative meniscus with 100% sensitivity. no specific MR criteria for classifying discoid medial menisci, and the meniscal diameter. Clinical History: An 18 year-old male with a history of a posterior horn medial meniscus peripheral longitudinal tear treated with meniscal repair at age 16 presents for MR imaging. of the AIMM into the ACL is classified as Type 1 (inferior third), Type 2 partly divides a joint cavity, unlike articular discs, which completely History of a longitudinal medial meniscus tear managed by repair and concurrent ACL reconstruction. This is a well-done study with clinical correlation and adequate follow-up. Longitudinal medial meniscus tear managed by repair (arrow). Cho JM, Suh JS, Na JB, et al. Magnetic resonance imaging (MRI), was performed in another facility and, showed normal medial and lateral menisci except for the absence of a medial posterior root insertion both on coronal and on sagittal images. A tear of the anterior horn of the lateral meniscus is damage to the front part of one of the two structures that act as shock absorbers between the thigh bone and the lower leg, explains The Steadman Clinic. AJR Am J Roentgenol. trauma; however, other symptoms include clicking, snapping, and locking Definite surfacing signal or distortion on only one image represents a possible tear. At least one meniscofemoral ligament is present in 7093 % Of knees of a case of discoid medial cartilage, with an embryological note. Congenital discoid cartilage. 800-688-2421. We look forward to having you as a long-term member of the Relias This arises from the posterior horn of the lateral meniscus and attaches to the lateral aspect of the medial femoral condyle. Synopsis: In a consecutive series of nearly 1000 knee MRIs, there was a 74% false-positive rate for the diagnosis of anterior horn meniscal tears. The patient underwent a successful partial medial meniscectomy and was encouraged to seek low-impact exercise. The reported prevalence is 0.06% to 0.3%.25 It is believed that discoid normal knee. 2008;191(1):81-5. A tear of the ACL should also, in practice, not be a Posterior meniscal root repairs: outcomes of an anatomic transtibial pull-out technique. What is a Lateral Meniscus Tear? Complete radial tears, root tears and large partial meniscectomies result in markedly increased contact forces at the articular surface; and in this case, full-thickness chondral loss and subchondral fractures on both sides of the joint. MR imaging evaluation of the postoperative knee. Nakajima T, Nabeshima Y, Fujii H, et al. mesenchymal mass that differentiates into the tibia, femur, and This scan showed a radial MMT. Am J Sports Med. Discoid medial menisci are much less common than discoid lateral menisci,24 and they may be bilateral. Lateral meniscus posterior horn peripheral longitudinal tear managed by repair. are reported cases of complete absence of the medial meniscus as Medial meniscus posterior horn peripheral longitudinal tear treated with repair. However, the tear changes plane of orientation over its course. Most lateral meniscal tears are due to twisting or turning activities or falls. This case features the following signs of meniscal tear: absent bow tie appearance of the lateral meniscus ghost meniscus: empty location of the anterior horn of the lateral meniscus Recent evidence suggests that decreased extrusion may correlate to better clinical outcomes.18. Materials and methods . 1427-143. this may extend to to the mid body." is this a bucket tear? Tolo VT. Congenital absence of the menisci and cruciate ligaments of the knee: A case report. By continuing to use our site, you consent to the use of cookies outlined in our Privacy Policy. Description. MRI failed to detect anterior horn injury of lateral meniscus in six (16.7%) cases, all of which were longitudinal fissure in the red zone. Case 9: posterior root of medial meniscus, View Yuranga Weerakkody's current disclosures, see full revision history and disclosures, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, Ahlback classification system in assessing osteoarthritis of the knee joint, Kellgren and Lawrence system for classification of osteoarthritis, anterior cruciate ligament mucoid degeneration, MRI grading system for meniscal signal intensity, shortening or absence of the root on sagittal images, vertical fluid cleft on coronal fluid-sensitive (T2) images. The meniscal body is firmly attached to the deep portion of the medial collateral ligament complex via the meniscotibial ligament. In the previously reported cases, as well as in this case, the American Board of Orthopaedic Surgery Practice of the Orthopaedic Surgeon: Part-II, certification examination case mix. These include looking for a If a meniscus tear shows up on a MRI, it is considered a Grade 3. joint: Morphologic changes and their potential role in childhood 2019: Factors associated with bilateral discoid lateral meniscus tear in patients with symptomatic discoid lateral meniscus tear using MRi and X-ray Orthopaedics and Traumatology Surgery and Research: Otsr 105(7): 1389-1394 The MRI also demonstrated moderate degenerative spurring at the lateral joint compartment, a large knee joint effusion with . Renew or update your current subscription to Applied Radiology. proximal medial tibia was convex and the distal medial femoral condyle 9 The lateral meniscus is more loosely attached than the medial and can translate approximately 11mm with normal knee motion. may simulate a peripheral tear (Figure 6).23 The only hypermobility. discoid meniscus, although discoid medial menisci can occur much less Radial Meniscal Tear: Pearls May be degenerative or traumatic, vertical, millimeters in size, on the inner edge of the lateral meniscus more commonly than the medial meniscus Another MRI was later performed due to worsening symptoms, and demonstrated a bucket-handle tear with complete anterior luxation of the posterior horn of the left lateral meniscus (Figs. problem in practice. of the meniscus. 2014; 43:10571064, McCauley TR. Davidson D, Letts M, Glasgow R. Discoid meniscus in children: Treatment and outcome. For information on new subscriptions, product In this case, the patient never obtained relief from the initial surgery, and the surgeon felt this was a residual tear (failed repair) rather than a recurrent tear. Repair devices including arrows, darts and sutures are used to approximate the torn edges of the meniscus. The anterior horn of the menisci, especially the lateral meniscus, is an area commonly confused on MRI. Disadvantages include patient discomfort, increased cost, physician time needed for the procedure and radiation exposure during fluoroscopy. The posterior cruciate ligament is intact. Congenital absence of the meniscus is extremely rare and has been documented in TAR syndrome and in isolated case reports.2,3 Knee Surg Sports Traumatol Arthrosc 2011; 19:147157, Gwathmey F.W., Golish S.R., Diduch D.R., et al: Complications in brief: meniscus repair. menisci occurs. Bilateral hypoplasia of the medial meniscus has also been For DSR inquiries or complaints, please reach out to Wes Vaux, Data Privacy Officer, The anterior and posterior meniscofemoral ligaments (Humphrey and Wrisberg respectively) are commonly present with one or both found in 93-100% of patients. Discoid medial meniscus. Grades 1 and 2 are not considered serious. You have reached your article limit for the month. After failing conservative management with NSAIDs, PT, and activity modification, he underwent an MRI. Increased intrameniscal signal is commonly seen in the transplanted allograft but does not correlate with clinical outcome. snapping knee due to hypermobility. In contrast to the medial meniscus, the posterior horn of the lateral meniscus is additionally secured by the meniscofemoral ligaments (MFL). We hope you found our articles High signal close to fluid intensity contacts the tibial surface on the sagittal T2-weighted image (11B) and is equivocal. On the proton density-weighted image (12A) persistent high signal extends to the tibial and femoral surfaces (arrow). the example shown (Figures 1 and 2), the entire medial meniscus is An MRI of plaintiff's left knee conducted in May 2018 demonstrated a complex 7 tear of the posterior horn of the lateral meniscus and a suspected horizontal tear of the anterior horn of the lateral meniscus. Tears of the anterior horn of the medial meniscus, an inferior patella plica, and ACL tears can be mistaken for AIMM, but carefully tracing the ligament will help to exclude these conditions. Diagnosis of meniscal tears on MRI improves when these guidelines are followed to optimize signal-to-noise ratio: high-field-strength magnets are preferable (1.5 T and stronger); a high-resolution surface coil should be used; the field of view should only encompass the necessary structures and routinely be 16 cm or less; image slices should not be too thick (34 mm); and the matrix size should be at least 256192 or higher [, A normal meniscus is low signal on all sequences. They often tend to be radial tears extending into the meniscal root. Note the symmetrical shape of the lateral meniscus (left) with similar size of the anterior and posterior horns. congenital absence of the cruciate ligaments. Zonal variation is also seen in the density of meniscus cells and their phenotypes with a chondrocytic inner zone and fibroblastic outer zone. The most widely used diagnostic modalities to assess the ligament injuries are arthroscopy and Magnetic Resonance Imaging (MRI). Lateral meniscus extrusion was present in six (23%) of 26 LMRTs and five (2.2%) of 231 patients with normal meniscus roots ( P < .001). Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Posterior Instability and Labral Pathology, Imaging Evaluation of the Painful or Failed Shoulder Arthroplasty, Other Entities: PLRI, HO, Triceps, and Plica, MRI-Arthroscopy Correlations in the Overhead Athlete, Acetabular Fossa, Femoral Fovea, and the Ligamentum Teres. Meniscal tears are common and often associated with knee pain. The superior, middle and inferior geniculate arteries are the main vascular supply to the menisci. Radiographs may The ligament of Humphrey inserted on average 0.9 consecutive images lateral to the PCL without an PHLM tear and 4.7 with an PHLM tear; the ligament of Wrisberg inserted on average 3.0 consecutive images without an PHLM tear and 4.5 with an PHLM tear . runs from the anterior horn of the medial meniscus to either the ACL or The anterior meniscofemoral ligament (Humphrey ligament) attaches proximally on the medial femoral condyle, inferior to the PCL insertion. Following a meniscal repair procedure, the meniscus can be categorized as healed if there is no fluid signal in the repair, partially healed if fluid signal extends into less than 50% of the repair site, or not healed if fluid signal extends into greater than 50% of the repair site. (Figure 1). Following partial meniscectomy, the knee is at increased risk for osteoarthritis. Bilateral discoid medial menisci: Case report. About KOL ; Learn more about our technology and how more and more universities, research organizations, and companies in all industries are using our data to lower their costs. Repair techniques include inside-out, outside-in or all-inside approaches. horns to the meniscal diameter on a sagittal slice that shows a maximum Meniscal surgery is common and requires accurate post-operative imaging interpretation to guide the treatment approach. Torn lateral meniscus with superomedial and posterior flipped anterior horn. 2002; 222:421429, Ciliz D, Ciliz A, Elverici E, Sakman B, Yuksel E, Akbulut O. MRI has high sensitivity and specificity for detecting meniscus tears in patients without prior knee surgery. It is often explained by fibers of the anterior cruciate ligament and the covering synovium . In On the sagittal fat-suppressed T2-weighted image (7B), fluid extends into the tear. Partial meniscectomy is by far the most common procedure. They are most frequently seen at the posterior horn of the medial meniscus. Surgery is useful if they are unstable and flipping in and out of the joint causing pain. is much greater than in a discoid lateral meniscus, and the prevalence A 22-years old male presented with injury to right knee in a road traffic accident MRI images shows double posterior horn of lateral meniscus and absent anterior horn in coronal (A: PD; B: STIR; C . We will review the common meniscal variants, which (PubMed: 17114506), BakerJC, FriedmanMV, RubinDA (2018) Imaging the postoperative knee meniscus: an evidence-based review. Stein T, Mehling AP, Welsch F, von EisenhartRothe R, Jger A. tissue only persists at the edges, where differentiation into the Thirty-one of these patients underwent subsequent arthroscopic evaluation to allow clinical correlation. The example above illustrates marked degenerative changes caused by loss of meniscal function. This is a critical differentiation because the latter represents meniscal tears that can be De Smet A. Longitudinal (longitudinal, peripheral-vertical) tears run parallel to the circumference of the meniscus along its longitudinal axis, separating the meniscus into central and peripheral portions (Fig. 5. Magnetic resonance imaging (MRI) of both knee joints showed an almost complete absence of the anterior and posterior horns of the medial meniscus, except for the peripheral portion, hypoplastic anterior horns and tears in the posterior horns of the lateral meniscus in both knees (Fig. Their conclusion that one should not perform surgery unless clinical correlation exists with effusions, mechanical catching or locking, or the failure to respond to nonoperative measures I believe is a good recommendation that we can all follow. noted to be diminutive, with the posterior horn measuring 7 mm to 8 mm. Tears can be characterized by length, depth, shape, gap, displacement, stability, dysplasia (discoid) This case features the following signs of meniscal tear: Case courtesy, Prof. Dr. Khaled Matrawy, Professor of radiology, Alexandria university, Egypt. of the transverse ligament is comparable to the general population.5. Sagittal proton density-weighted image (7A) through the medial meniscus demonstrates increased signal extending to the tibial surface (arrow). 2012;20(10):2098-103. Normal Fukuta S, Masaki K, Korai F. Prevalence of abnormal findings in magnetic resonance images of asymptomatic knees. A detached posterior root is functionally equivalent to a total meniscectomy with loss of its ability to withstand hoop stress. Direct intraarticular injection of 20-50 mL of dilute iodinated contrast is performed with rapid image acquisition using multidetector CT with high spatial resolution and multiplanar reformatted images. Radial or oblique tear congurations close to or within the meniscus . CT arthrography is a recommended alternative for patients who are not MR eligible. small meniscus is also seen in the wrist joint. meniscal injury. MRI appearance of Wrisberg variant of discoid lateral meniscus. You can use Radiopaedia cases in a variety of ways to help you learn and teach. Sagittal T2-weighted (18B) and fat-suppressed sagittal proton density-weighted sagittal (18C) images demonstrate fluid-like signal in the posterior horn suggestive of a recurrent tear. Symptomatic anomalous insertion of the medial meniscus. The medial meniscus is more firmly attached to the tibia and capsule than the lateral meniscus, presumably leading to the increased incidence of tears of the medial meniscus [. Continuous meniscal tissue bridged the anterior and posterior horns of the lateral meniscus on 3 consecutive sagittal slices (Figure 1B). This has also been described as grade 2 signal [, Sagittal fat-suppressed T2 image of a 14-year-old patient showing a grade 2 signal in the posterior horn of the medial meniscus (PHMM). However, the use of MRI arthrography should be considered for post-operative menisci with equivocal findings on conventional MRI as the presence of high gadolinium-like signal within the meniscus would allow for a definitive diagnosis of re-tear. menisci (Figure 8). Kocher MS, Klingele K, Rassman SO. Normal course and intensity of both cruciate ligaments. tear. Kim SJ, Moon SH, Shin SJ. Conventional MRI is useful for evaluation of posterior root morphology at the tibial tunnel fixation site, meniscal extrusion and articular cartilage. Brody J, Lin H, Hulstyn M, Tung G. Lateral Meniscus Root Tear and Meniscus Extrusion with Anterior Cruciate Ligament Tear. Anterior tibial marrow edema and organized trabecular fracture measuring 16 mm AP, 18 mm transverse. Posterior root repair (Figure 16) is being performed with increasing frequency and has been shown to have better outcomes and decreased risk of osteoarthritis compared to posterior root tears treated non-operatively. What is a Grade 3 meniscus tear? 1991;7(3):297-300. 3. Resnick D, Goergen TG, Kaye JJ, et al. The most commonly practiced Discoid lateral meniscus. Kaplan EB. 10 Studies on meniscus root tears have investigated the relationship of osteoarthritis and an anterior cruciate ligament tear. The meniscus root plays an essential role in maintaining the circumferential hoop tension and preventing meniscal displacement. ligament, and the posterior horn may translate or rotate due to MRI features are consistent with torn lateral meniscus with flipped anterior horn superomedial and posterior, resting superior to the posterior horn. Most patients are asymptomatic, but injury to the meniscus can History of medial meniscus posterior horn and body partial meniscectomy. Create a new print or digital subscription to Applied Radiology. Considered a feature of knee osteoarthritis. Discoid lateral meniscus was originally believed to result from an MR imaging is useful for evaluation of many possible complications following meniscal surgery. To assess the prevalence of meniscal extrusion and its . AJR Am J Roentgenol 2009;193:515-523. Development of the menisci of the human knee Diagnosis of recurrent meniscal tears: prospective evaluation of conventional MR imaging, indirect MR arthrography, and direct MR arthrography. Tear between 1-4 cm vertical tear red-red meniscal root <40 yo Maybe concominant ACL surgery . An intact meniscal repair was confirmed at second look arthroscopy. MRI plays a critical role in influencing the treatment decision and enables information that would obviate unnecessary surgery including diagnostic arthroscopy. The MRI revealed a vertical flap (oblique) tear of the medial meniscus. 2002;30(2):189-192. ligaments and menisci causing severe knee dysplasia in TAR syndrome. {"url":"/signup-modal-props.json?lang=us"}, El-Feky M, Flipped meniscus - anterior horn lateral meniscus. Magnetic resonance imaging (MRI) is the most accurate imaging technique in the diagnosis of meniscal lesions and represents a standard tool in knee evaluation. Meniscal tears were found on MRI or arthroscopy in all 28 patients with a lateral cyst overlying the body or posterior horn of the lateral meniscus, whereas a tear was found on MRI or arthroscopy in only 14 (64%) of 22 patients with cysts adjacent to or extending to the lateral meniscus anterior horn (p = 0.006). Meniscal root tears are a form of radial tear that involves the central attachment of the meniscus (12a). Root tears are associated with a high risk for osteoarthritis. Each meniscus attaches to the tibia bone in the back and front via the "meniscal roots." The primary role of the meniscus is to serve as a shock-absorber and protect the underlying articular cartilage and bone. The aim of this study was to evaluate diagnostic values involved in conventional magnetic resonance imaging (MRI) features of MM posterior root tears (MMPRTs) and find other MRI-based findings in patients with partial MMPRTs. The most frequent symptom is pain that usually begins with a minor Direct and indirect MR arthrography have been shown to be superior to conventional MRI for detection of recurrent meniscal tears in greater than 25% partial meniscectomies and meniscal repairs; however, conventional MRI is commonly used for initial evaluation of the postoperative meniscus with MR arthrography reserved for equivocal cases. Knee Surg Sports Traumatol Arthrosc. They maintain a relatively constant distance from the periphery of the meniscus [. The posterior horn is always larger than the anterior horn. Radiographs are usually not diagnostic, but they may show a The articular cartilage is well seen on the pre-operative sagittal proton density-weighted image (19B). Sagittal proton density-weighted image (8A) through the medial meniscus demonstrates signal extending to the tibial surface (arrow). An abnormal shape may indicate a meniscal tear or a partial meniscectomy. We use cookies to create a better experience. Radial Tear of the Medial Meniscal Root: Reliability and Accuracy of MRI for Diagnosis. They may not even be apparent with an arthroscopic examination. Criteria for a recurrent tear after greater than 25% meniscectomy Definite surfacing T2 fluid signal (or high T1 signal isointense to intra-articular gadolinium on MR arthrography) on 2 or more images or displaced meniscal fragment.17 Definite surfacing fluid signal on only one image represents a possible tear. The sagittal proton density-weighted image (13A) demonstrates linear high signal extending to the femoral and tibial surfaces (arrow). Schwenke M, Singh M, Chow B Anterior Cruciate Ligament and Meniscal Tears: A Multi-modality Review. 2020;49(1):42-49. of the distal femur and proximal tibia, and in the case report of Mild irregularities of the meniscal contour may be present, particularly in the first 6-9 months after surgery which tend to smooth out and remodel over time.15 For partial meniscectomies involving less than 25% of the meniscus, conventional MRI is used with the same imaging criteria for evaluating a tear as the native meniscus linear intrasubstance increased signal extending to the articular surface, visualized on 2 images, either consecutively in the same orientation or in the same region in 2 different planes or displaced meniscal fragment (based on the assumption that imaging is spaced at 3 mm intervals). The lateral meniscus is more circular, and its anterior and posterior horns are nearly equivalent in size in cross section. In cases like this, MR arthrography is quite helpful. Biologic augmentation with application of exogenous fibrin clot or growth factors may be combined with the repair to promote healing. joint, and they also protect the hyaline cartilage.

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