The medial meniscus has a firmer capsular attachment than the lateral meniscus. This pattern of tear requires resection to prevent propagation of the tear as the flap gets caught within the joint during flexion. A case also can be made for medial meniscal root repairs for a symptomatic acute and possibly a chronic medial meniscal root tear in a non-obese patient older than 40 years with a MRI that does not have early arthritic changes. The procedure can reduce pain, improve mobility and stability, and get you back to life's activities. How to treat oblique tear of medial meniscus? Coronal proton weighted MRI of horizontal tear of lateral meniscus (white arrow) with complicating ganglion (black arrow) at the lateral margin of the meniscus, Australian Family Physician was the peer-reviewed, scholarly journal of The Royal Australian College of General Practitioners (RACGP) from 1971 to 2017. The MRI revealed a vertical flap (oblique) tear of the medial meniscus. All rights reserved. Guides you through the decision to have surgery for a torn meniscus. The Thessaly test for detection of meniscal tears: validation of a new physical examination technique for primary care medicine. Solomon L, Warwick D, Nayagam S. Apley's Concise System of Orthopaedics and Fractures. The meniscus is a piece of C-shaped cartilage that helps cushion the knee. Any tears appear as white lines. Weakness, grinding, instability or giving way rarely result from meniscal pathology. bucket-handle tear: displaced vertical tear parrot beak tear: oblique radial tear Radiographic features Plain radiograph On plain radiographs, meniscal tears are not visible. Surgery is most likely needed to resolve your problem. Those that extend through the entire width of the meniscus are particularly harmful (16a,16b), and even if such tears appear stable following repair, they are unlikely to regain the ability to provide hoop stress to the meniscus.13 Radial tears have therefore classically been treated with partial meniscectomy, though evolving surgical techniques have led to successful reports of the repair of radial tears that communicate with the meniscal periphery.11 A recent report has even described the successful repair of radial tears of the medial meniscal root,14 utilizing a tibial tunnel through which sutures are placed in the avulsed meniscus, a technique similar to that used in patients undergoing meniscal transplantation. 1075 Mason Ave., Daytona Beach, FL 32117, Twin Lakes Longitudinal tears do not disrupt the circumferential architecture of the meniscus, and thus repair of longitudinal tears leads to a meniscus with relatively normal biomechanical function. Before your visit, write down questions you want answered. With the realization that even partial meniscectomy leads to accelerated osteoarthritis,2 surgeons have increasingly turned to meniscal repair. A meniscal cyst may present with signs and symptoms consistent with typical meniscal pathology. The anatomic landmark for repair is anterior to the PCL footprint on the tibia. You may be asked about your physical and athletic goals to help your doctor decide on the best treatment for you. Intrasubstance/incomplete tear (top left) This type of tear is often a sign of degenerative changes in the meniscus tissue. Tears of the posterior medial meniscal root have shown to disrupt the normal motion of the knee, resulting in degenerative arthritis. Bring someone with you to help you ask questions and remember what your provider tells you. Mri of knee shows "oblique tear posterior horn medial meniscus, lateral patellar plica and minimal synovial knee effusion" will i need surgery? Skeletal Radiology 2004; 33:260-264. Also write down any new instructions your provider gives you. Meniscal tears within the body of the meniscus or at the meniscocapsular junction represent a well-understood and manageable condition encountered in clinical practice. The medial meniscus is the portion of the cartilage along the inside of the knee joint (closest to the other knee). AJR 2000; 174:161-164. 5 Horizontal tears, the most common meniscal tear pattern, lie parallel to the tibial plateau and separate the meniscus into upper and lower parts (4a,4b). In this short surgical video, a degenerative meniscus tear is smoothed down with a motorized shaver during a partial meniscectomy. Additional pain may be felt when flexing or twisting the knee. Develop pain gradually along the meniscus and joint line when you put stress on your knees (usually during a repeated activity). (3a) A fat-suppressed proton density-weighted axial image through the knee joint demonstrates the C-shaped menisci. The lateral meniscus has a symmetrical C-shape, whereas the medial meniscus is more crescentic (3a), as the posterior horn of the medial meniscus is always larger than the anterior horn. summary. Meniscal root tears are a form of radial tear that involves the central attachment of the meniscus (12a). Meniscal injury is common, and the medial meniscus is more frequently injured. When appropriate, tears that appear to involve the periphery, or red zone of the meniscus, should be described as such (9a), thereby alerting the surgeon to the fact that the tear is more amenable to repair. Likewise, physical exam findings of an effusion, a positive McMurray test and a positive Apley grind test are not usually present. This leads to decreased contact area and increased contact pressure and ultimately results in joint overloading and degenerative changes in the knee similar to a total meniscectomy state. Age of injury peaks at 2029 years.7 Partial meniscectomy (removal of the torn section) is one of the most commonly performed orthopaedic surgical procedures.8. The role of preoperative MRI in knee arthroscopy: a retrospective analysis of 2,000 patients. Meniscal pain occurs during torsional, weight bearing knee movements (classically pivoting on the knee while walking) as a sharp stab lasting several seconds, often followed by a dull ache for several hours. The medial meniscus is an important secondary stabilizer of the knee. Matthew H. Blake, MD, can be reached at the Kentucky Clinic, 740 Limestone, Suite K415, Lexington, KY 40536; email: Darren L. Johnson, MD, can be reached at the Kentucky Clinic, 740 S Limestone, Suite K415, Lexington, KY 40536; email: Jorge Chahla, MD; Andrew G. Geeslin, MD; and Robert F. LaPrade, MD, PhD, can be reached at Steadman Philippon Research Institute, The Steadman Clinic, 181 West Meadow Dr., Suite 400, Vail, CO 81657; Chahlas email. Meniscus Repair. Studies have also reported that patients who underwent a repair of the posterior root in the medial meniscus slowed the progression of arthritic changes compared with those who had a meniscectomy; although, this did not completely prevent the arthritic changes. About OrthoInfoEditorial Board Our ContributorsOur Subspecialty Partners Contact Us, Privacy PolicyTerms & Conditions Linking Policy AAOS Newsroom Find an FAAOS Surgeon. Doctors typically provide answers within 24 hours. pivoting). swelling . He/she will probably recommend surgery. Br Med Bull 2007;84:523. The second patient reviewed in this video is an 11-year-old girl who fell while playing tag and hit the front of her left lower leg. Usually you will be able to leave the hospital the same day. Adjunctive measures to promote vascularity and healing at the repair sites are also recommended. This information is not intended as a substitute for professional medical care. Complex tears like this are likely to be unstable. Lists risks and benefits of surgery for meniscus tear. Knee Surg Sports Traumatol Arthrosc 2010;18:5359. Pain may wake the patient from sleep as the tender medial aspect of the knee strikes the other side as the patient rolls over in bed. The meniscus is broken down into the outer, middle, and inner thirds. The primary objective is to control the disease process to avoid the complications . If mechanical symptoms are present in this subset of patients, a partial or subtotal meniscectomy may improve symptoms; although, these tears are not usually associated with traditional meniscal-based mechanical symptoms. Gillquist J, Hamberg P, Lysholm J. Endoscopic partial and total meniscectomy. Meniscus Surgery. Historically, medial meniscal root tears have been treated conservatively or by partial meniscectomy. As people age, they are more likely to have degenerative meniscus tears. Your doctor will hold your heel while you lie on your back and, with your leg bent, straighten your leg with his or her other hand on the outside of your knee as he or she rotates your foot inward. Other symptoms of a meniscus tear include: pain in your knee, which can vary in severity - the pain might only be mild, severe, or the pain may come and go. 15 Koski JA, Ibarra C, Rodeo SA. A torn meniscus often can be identified during a physical exam. In older patients, referral is appropriate if conservative management fails to improve symptoms. All material on this website is protected by copyright. The goal of meniscal root repair is to restore the joint to a near native function of the meniscus and prevent cartilage degradation associated with nonsurgical treatment or meniscectomy. Illustration and photo show a camera and instruments inserted through portals in a knee. Seldom are they the sign of a problem. Imaging tests X-rays. growth factors) on meniscus tissue is being investigated.2 These are currently only being trialled in younger patients7 and the routine use of most of these technologies is some time away. With meniscal repair, weight bearing may be severely limited for up to six weeks following surgery, and protection from heavy stress to the knee extends for up to six months. Displaced meniscal tears are by definition unstable, and should be repaired relatively quickly, as displaced meniscal fragments may fibrose and distort, making delayed repair difficult or impossible. The best known displaced tear that is amenable to repair is the bucket-handle tear. As such, it is critical to repair medial meniscal root tears during ACL reconstruction to help stabilize the knee, as well as to decrease stresses that the graft experiences. Treatment of meniscal tears includes simple observation, meniscectomy, and meniscal repair. Superior and inferior branches of the medial and lateral geniculate arteries supply the peripheral third of the menisci via the perimeniscal capillary plexus.3,4, Meniscal tears occur due to a shear force between the femur and tibia. However, coronal sections may reveal the presence of meniscal extrusion or vertical defects, and sagittal sections may reveal the ghost sign (absence of an identifiable meniscus or increased signal replacing the normal hypointense signal of meniscal tissue). An awkward twist when getting up from a chair may be enough to cause a tear in an aging meniscus. Treatment varies on a case-by-case basis. Following root repair, patients are required to remain non-weight-bearing for 6 weeks. Meniscal tears may be categorized into five common configurations, including horizontal, longitudinal, radial, oblique (parrot-beak), and complex.5 Horizontal tears, the most common meniscal tear pattern, lie parallel to the tibial plateau and separate the meniscus into upper and lower parts (4a,4b). The test is positive if symptoms are reproduced on rotation 10. Oblique tears give rise to flaps which are mechanical unstable and associated with mechanical symptoms. Two bones meet to form your knee joint: the femur and the tibia. Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. The meniscus is a C-shaped cartilage disk that is found in the knee. I could not really walk on it. Nonoperative treatments are often successful in patients with certain types of tear patients who have no loss of joint function, suffer minimal pain or swelling and are willing to reduce their activities temporarily or in the long term. In many cases, rehabilitation can be carried out at home, although your doctor may recommend working with a physical therapist. Am J Sports Med 2008;36:12839. Psterior horn of medial meniscus Poterior oblique ligament . The medial meniscus transmits approximately 50% of the total joint load of the knee medial compartment, thus protecting the articular cartilage from excessive force. Because other knee injuries can cause similar symptoms, your doctor may order imaging tests to help confirm the diagnosis. Meniscus tears simply do not heal on their own, regardless of conservative treatment. The RICE protocol is effective for most sports-related injuries. If your tear is on the outer one-third of the meniscus, it may heal on its own or be repaired surgically. Because there is no supply, there is little capacity for these tears to heal on their own. Referral to an orthopaedic surgeon is important if the diagnosis is uncertain or there is minimal improvement at clinical review. Video chat with a U.S. board-certified doctor 24/7 in less than one minute for common issues such as: colds and coughs, stomach symptoms, bladder infections, rashes, and more. Meniscus surgery is a common operation to remove or repair a torn meniscus, a piece of cartilage in the knee. Aged, worn tissue is more prone to tears. J Bone Joint Surg Am 2005;87:71524. On examination, there may be joint effusion, joint line tenderness, and the joint is held in a flexed position.1 in late presentations, there may be significant quadriceps wasting. In contrast, the inner two-thirds of the meniscus lacks a significant blood supply. Of course, if a displaced meniscal fragment is identified, the tear is by definition unstable. Strengthening exercises will gradually be added to your rehabilitation plan. There are two in each knee, for a total of four. Know the reason for your visit and what you want to happen. Parrot Beak Tear: MRI 3rd Edition. In some cases, your doctor may suggest an arthroscopyto examine and possibly treat your knee. As the risk of osteoarthritis is increased if meniscal structures are not optimally functional,7 it may also be appropriate to refer all young patients for opinion if symptoms do not rapidly improve. J Bone Joint Surg Am 1988;70:120917. Peripheral meniscal tears are located in the most vascular portion of the menisci and comprise 39-72 % [2, 3, 56, 69, 82] of all meniscal tears. The posterior horn of the medial meniscus is especially likely to develop tears as we get older. See your ortho for an evaluation. It has been reported that the force experienced by the medial meniscus in the ACL-deficient knee increased by 52% in full extension and by 197% at 60 of flexion under a 134-N load. Performing activities that involve aggressive pivoting and twisting of the knee puts you at a significantly higher risk of tearing your meniscus. London;1897. Oblique tear of the posterior horn and body of the medial meniscus involving inferior articular surface and peripheral meniscal margin. 2 The risk of osteoarthritis and its progression increase in line with reductions in tibial cartilage coverage. (8a) The curvilinear course of oblique tears often results in abnormal vertical signal (arrows) that progresses towards or away from the free edge of the meniscus on consecutive images, as seen in these sequential images of an oblique tear (arrows) of the posterior horn of the medial meniscus. Several variations in meniscal tear patterns have been granted specific names that recognize the unique characteristics of the tear. Know why a new medicine or treatment is prescribed, and how it will help you. No meniscal tears were observed. Tears that are stable, < 1 cm in length, and that do not cause significant . Other established anatomical variants include the transverse meniscal ligaments and the meniscofemoral ligaments, which mimic meniscal tears at their meniscal attachment sites. So the injury as seen in MRI scan means there is an tear in the medial meniscus towards the posterior side, that is towards the back of joint. A meniscus tear is an injury to one of the bands of rubbery cartilage that act as shock absorbers for the knee. This information is provided as an educational service and is not intended to serve as medical advice. Call us at(386) 255-4596to schedule an appointment. There may be some pain. This puts tension on a torn meniscus. An MRI is 70 to 90 percent accurate in identifying whether the meniscus has been torn and how badly. Conservative management is important in all patients with acute rest, intensive rehabilitation with physiotherapy and modification of activity. Meniscus tears are among the most common knee injuries. Ligaments: their nature and morphology. In comparison , however, meniscal root tears (MRTs) often go unnoticed and represent a unique injury pattern with unique biomechanical consequences. Repair of such lesions can result in dramatic clinical as well as MR imaging results (17a,17b). (10a) A GRE T2*-weighted sagittal image reveals a complex tear of the posterior horn of the medial meniscus, having horizontal (arrows) and longitudinal (arrowhead) components. Referral is also indicated if the diagnosis is uncertain for review and to access MRI. By using our website, you consent to our use of cookies. Depending on your duration of symptoms you can at least start off with physical therapy, a knee sleeve, and if there is arthritis present consider a c Dr. Christopher Ferguson and another doctor agree. Tears that lie within or contact the red zone are also more likely to be amenable to meniscal repair. Once the initial healing is complete, your doctor will prescribe rehabilitation exercises. Am J Sports Med 2004;32:67580. controlling the movements of the knee joint. Arthroscopic meniscus repairs typically takes about 40 minutes. It is important that these root avulsions are anatomically repaired back to the bone. Figure 4. They act as shock absorbers and stabilize the knee. Knee pain: Depending on your duration of symptoms you can at least start off with physical therapy, a knee sleeve, and if there is arthritis present consider a c Read More oblique tear of the posterior horn and body of the medial meniscus involving inferior articular surface and peripheral meniscal margin. An experimental study in dogs. Case Discussion Longitudinal tears, also known as vertical tears, occur perpendicular to the tibial plateau and parallel to the long axis of the meniscus splitting the meniscus into inner and outer parts. The menisci act as cushions between your shin bone (tibia) and your thigh bone (femur). 5 Jee WH, McCauley TR, Kim JM, et al. Sports-related meniscus injuries often occur along with other knee injuries, such as anterior cruciate ligament (ACL) tears. A tear in this "red" zone may heal on its own, or can often be repaired with surgery. swelling - this usually happens several hours after you injure your meniscus. If your meniscus tear is not severe, your doctor will likely recommend the following treatment: If you have a meniscus tear, physical therapy can help to strengthen the muscles around the knee as well the muscles in your legs which in turn will stabilize and support the knee. More often, the patient will complain of joint line pain with a minor traumatic event, such as squatting. New advances in musculoskeletal pain. 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. Every care is taken to reproduce articles accurately, but the publisher accepts no responsibility for errors, omissions or inaccuracies contained therein or for the consequences of any action taken by any person as a result of anything contained in this publication. This extrusion should disappear without stress. (5a) A longitudinal tear of the posterior horn of the medial meniscus is illustrated. Clin Sports Med 2010;29:81106. Presumptive subarticular stress reactions of the knee: MRI detection and association with meniscal tear patterns. One of the main tests for meniscus tears is the McMurray test. As stated above, the most common cause of Posterior Horn Medial Meniscus Tear can be trauma to the knee which can be sustained due to a sporting injury, a slip and fall, a blunt trauma to the knee, and in majority of the cases natural degeneration of the meniscus due to the work load of the knee. 7 Yao L, Stanczak J, Boutin RD. OKeefe R, et al. Sometimes conservative treatment doesnt work. Oblique tears commonly cause flaps and flaps are generally not good. These tears occur within the avascular zone of the meniscus where there is no blood supply. Additionally, the individual will not be able to move the joint due to pain. This is one of the first muscles to atrophy post knee immobilization Question options: is lis oblique is lis medius In rehabilitating an ACL, . Two months later, the post-operative image (17b) reveals a repaired, normal appearing lateral meniscal body (arrow), with resolution of the previously seen displaced fragment. Because of their importance and the clinical impact of meniscal tears, assessment of the menisci has become the most common indication for MR of the knee. Nonsteroidal anti-inflammatory drugs (NSAIDs), Inability to move your knee through its full range of motion. Conservative management of the patient with a meniscal tear. Bucket-handle tears are actually a form of longitudinal tear in which subsequent displacement of the inner rim of the tear results in a configuration that resembles the handle of a bucket (11a). Tell your doctor of any recurrent swelling or of your knee repeatedly giving way. Know how you can contact your provider if you have questions. Meniscal intra-substance signal abnormalities are defined as an increased signal that does not fulfill the criteria for a meniscal tear according the "two-slice-touch" rule (i.e., it does not reach the meniscal surface on two consecutive views) and is a common finding on routine MRI of the knee (Fig. The outer one-third of the meniscus has a rich blood supply. These are the menisci. The loss of the central attachment of the posterior horn may allow extrusion of the body of the meniscus relative to the joint (13a). Mui LW, Engelsohn E, Umans H. Comparison of CT and MRI in patients with tibial plateau fracture: can CT findings predict ligament tear or meniscal injury? See your ortho for an evaluation. The joint is fairly flexible only the last 10-15 degrees is painful, but the pain on walking constant and vulnerable to . There is no resting pain. Meniscal injury and repair: clinical status. With a bucket handle tear, a tear forms in the center of your meniscus. The posterior horn is the thickest and most important for overall function of the knee. Depending on the severity of the injury, surgical repair may or may not be needed. Sometimes, its possible to repair a torn meniscus, especially if you are a young adult. If your doctor suspects a torn meniscus, he or she will perform aphysicalexam. 2 Jaureguito JW, Elliot JS, Lietner T. The effects of arthroscopic partial lateral meniscectomy in an otherwise normal knee: a retrospective review of functional, clinical, and radiographic results. Proton weighted sagittal image demonstrates an example of a posterior horn medial meniscal horizontal tear (white arrow). We have two menisci in either knee. Our preferred repair method utilizes a two-tunnel transtibial pull-out technique. Although the pain improved, the patient could not flex her knee joint deeply. The body usually absorbs these over time. Most people can still walk on their injured knee, and many athletes are able to keep playing with a tear. De Carlo M, Armstrong B. Although some reports have described successful repair of the avascular portion of the meniscus,11 it is generally accepted that meniscal repair is more likely to be successful if it involves or at least communicates with the meniscal red zone, lying within three to four millimeters of the capsular rim.12 A basic principle of meniscal repair is to rasp the tear edges and the parameniscal synovium above and below the meniscus, which is thought to enhance the vascular healing process. Although a successful outcome of a meniscal root repair is predicated upon appropriate indications for the repair, not all medial meniscal root tears should be repaired. New surgical advances allow surgeons to repair these tears. The one towards the back of leg is the posterior horn. For potential or actual medical emergencies, immediately call 911 or your local emergency service. The Royal Australian College of General Practitioners. The arthroscope is inserted near the knee via a tiny incision. Most commonly it is impossible to fully extend the knee; more accurately described as stiffness (termed 'pseudo locking') due either to a small effusion (requiring increased force to bend the tense joint capsule) or to pain inhibition as the femoral condyle compresses the torn meniscus. Barrett GR, Field MH, Treacy SH, Ruff CG. In this procedure, the surgeon inserts a miniature camera through a small incision (portal) in the knee. We believe these tears are more degenerative in nature, and there is no evidence to support that by repairing these medial meniscal root tears, knee degeneration will be postponed or stopped. Requests for permission to reprint articles must be sent to permissions@racgp.org.au. Anti-inflammatory drugs such as aspirin, ibuprofen, and naproxen help reduce pain and swelling. Surgical treatment is usually reserved for younger patients with a vertical longitudinal tear within the vascularised outer third of the meniscus. It is estimated that only 10% of the injuries involving the tear of posterior horn medial meniscus are repairable. . The meniscus root attachment aids meniscal function by securing the meniscus in place and allowing for optimal shock-absorbi It has the shape of two C's. The medial meniscus is the C shape on the knee's inner side, and the lateral meniscus is the C shape on the outer side of the knee. Be unable to extend your leg comfortably and may feel better when your knee is bent (flexed). MR is also able to assess the stability of meniscal tears,6 an important factor, as unstable tears require operative treatment for symptom relief. There will also be skin discoloration and visible deformity at the site of the injury. Meniscal tear incidence may be as high as six per 1000 population6 with a 2.5 to 4 times male predominance. Normal knee anatomy. Scholten RJ, Deville WL, Opstelten W, Bijl D, van der Plas CG, Bouter LM. This is the most common type of meniscus tear. 1) [50], [51], [52].Its reported prevalence in middle-aged (45-55 years) individuals . As recognition of the critical function of the menisci in normal biomechanical function of the knee has grown, attempts at preserving meniscal tissue via repair as opposed to partial meniscectomy have also gained favor. 1890 LPGA Blvd., Suite 240 Daytona Beach, FL 32117, Port Orange North & South
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