What causes Marching Cleft Sign in knee on MRI?
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The Marching Cleft Sign represents a radial meniscal tear, typically at the junction of the meniscal body and posterior horn, appearing as a linear high-signal cleft that changes position relative to the free edge of the meniscus on sequential sagittal MRI images. Radial tears result from traumatic shear forces or degenerative changes in the fibrocartilaginous menisci, leading to instability and potential progression to complex tears; clinically associated with knee pain, locking, and swelling, often requiring meniscectomy due to poor healing potential.
Why is it called so?:
The sign is named “marching cleft” because the tear cleft appears to progressively “march” or shift towards or away from the meniscal free edge across consecutive sagittal images, reflecting the oblique orientation of the radial tear relative to the imaging plane.
Pathophysiology:
A radial tear propagates perpendicular to the circumferential collagen fibers of the meniscus, oriented obliquely to both coronal and sagittal planes. On sequential sagittal slices, this obliquity causes the cleft to move dynamically relative to the periphery, unlike longitudinal tears which remain parallel to the meniscal long axis and maintain constant distance.
Alternative names: None
Other associated named signs: Truncated triangle sign, Cleft sign, Ghost meniscus sign
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