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    Subjects/MRI Knee — Menisci
    MRI Knee — Menisci
    medium

    A 28-year-old male footballer presents with acute left knee pain and mechanical locking after a twisting injury during a match. MRI sagittal view shows a vertical longitudinal tear of the structure marked **A** with an inner fragment displaced into the intercondylar notch, creating a "double PCL sign." Which of the following best describes why this injury pattern in structure **A** is more common than similar tears in the lateral meniscus?

    A. The medial meniscus is C-shaped and more firmly attached to the MCL, rendering it less mobile and more prone to entrapment during twisting injuries
    B. The lateral meniscus is located in the posterior compartment and is protected from direct rotational forces
    C. The lateral meniscus is O-shaped and has greater mobility, allowing it to escape from compressive forces during rotational stress
    D. The medial meniscus has a larger surface area and bears more weight during weight-bearing activities

    Explanation

    ## Why option 1 is right The medial meniscus (structure **A**) is C-shaped and firmly attached to the joint capsule and medial collateral ligament (MCL). This firm attachment restricts its mobility, making it more susceptible to being trapped and torn during twisting injuries on a flexed, weight-bearing knee—accounting for approximately 70% of all meniscal tears. The "bucket handle" tear pattern (vertical longitudinal tear with displacement into the intercondylar notch) is a classic presentation of medial meniscal injury in young athletes, and the displaced fragment creates the characteristic "double PCL sign" on sagittal MRI. This anatomical constraint is the fundamental reason medial meniscal tears are more common than lateral meniscal tears (Apley 10e). ## Why each distractor is wrong - **Option 2**: While true that the lateral meniscus is O-shaped and more mobile, this is the reason it is LESS commonly torn, not more. The question asks why structure **A** (medial meniscus) tears are MORE common. This option reverses the logic. - **Option 3**: The medial meniscus does not have a larger surface area than the lateral meniscus. Both menisci have similar load-bearing roles, and surface area is not the primary determinant of tear susceptibility. Attachment pattern and mobility are the key factors. - **Option 4**: Both menisci are located in the tibiofemoral joint and experience similar rotational forces. The lateral meniscus is not protected by virtue of location; rather, its greater mobility allows it to escape compressive forces during rotation. **High-Yield:** Medial meniscus = C-shaped + firm MCL attachment → immobile → 70% of tears; lateral meniscus = O-shaped + mobile → escapes injury. [cite: Apley 10e]

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