What are the limitations of plain radiographs for diagnosing meniscal tears and which imaging modality provides definitive assessment?

• A. Plain radiographs do not visualize menisci well; MRI provides definitive evaluation
• B. Plain radiographs are sufficient; MRI is rarely used
• C. Ultrasound is superior to MRI for menisci
• D. Nuclear medicine is definitive for meniscal tears

Answer: (A)

Plain radiographs focus on bone and joint space, not soft tissues like the menisci. Because the menisci are intra-articular cartilage inside the knee, a standard X-ray can miss a tear, even when pain and symptoms are present. Magnetic resonance imaging, on the other hand, provides excellent soft-tissue contrast and can directly visualize meniscal fibers, tears, and associated injuries to ligaments, cartilage, and bone marrow. That direct visualization makes MRI the definitive modality for assessing meniscal pathology.

Ultrasound isn’t reliable for detecting most meniscal tears due to limited acoustic windows and the deep, intra-articular location of the menisci, though it can assess some superficial aspects of the knee. Nuclear medicine studies aren’t used to diagnose meniscal tears because they lack the specificity and anatomical detail needed to identify a tear.