On MRI of the knee, a T2 hyperintense linear signal within the medial meniscus extending to the inferior articular surface is classified as Stoller grade III signal. What is the significance of this finding?

• A Degenerative meniscal signal not reaching the surface — no tear
• B True meniscal tear with signal reaching the articular surface ✓
• C Normal hyperintense vascularity of the peripheral meniscus
• D Meniscal cyst within the substance without surface extension

Explanation

Stoller grading of meniscal signal on MRI: Grade I is focal globular intrasubstance signal (normal vascularity/early degeneration, does not reach surface), Grade II is linear intrasubstance signal not reaching the articular surface (horizontal cleavage plane — degenerative), Grade III is linear signal unambiguously reaching the articular surface, indicating a true meniscal tear on MRI with >90% sensitivity. Grade III signal is the criterion for diagnosis of meniscal tear and guides arthroscopic intervention. The signal must be seen on at least two consecutive images to avoid magic-angle artefact.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

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