Tears are typically vertical in young patients and horizontal in the elderly (Figure 5). In addition, focal chondral lesions occur more commonly with medial than lateral-sided injuries. 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. With regard to tear morphology, the classic ideal candidate for meniscal repair is the peripheral longitudinal tear. The meniscus is a piece of rubber-like cartilage in the knee situated within the femur and tibia, or thigh bone and shin bone. Arthroscopy. Still, many people with a torn meniscus can walk, stand, sit, and sleep without pain. swelling . Complex degenerative tear. 1) [50], [51], [52].Its reported prevalence in middle-aged (45-55 years) individuals . This is what my MRI says: Radial tear poster medial meniscus, degeneration fraying medial meniscus, moderate bone contusion medial tibial plateau with degenerative changes, moderate bakers cyst.My doctor says I should get a clean-up on my knee. The test is positive if symptoms are reproduced on rotation 10. The typical meniscal pain profile comprises well localised joint-line pain (with medial pain generally being indicative of a medial tear and vice-versa). Most likely, your doctor will recommend that you rest, use pain relievers, and. Radiographs may or may not show medial joint space narrowing. Currently, routine MR images do not reveal signal intensity differences between the red and white zones of the menisci. Because other knee injuries can cause similar symptoms, your doctor may order imaging tests to help confirm the diagnosis. This region of the outer meniscus, sometimes referred to as the red zone, is thought to occupy approximately 15% of the peripheral meniscus.4 Tears that occur within the red zone of the meniscus are more likely to heal than those in the avascular, white zone of the meniscus. Nicholas Colyvas, MDClinical ProfessorDepartment of Orthopaedic Surgeryorthosurg.ucsf.edu Location -A tear may be located in the anterior horn, body, or posterior horn.A posterior horn tear is the most common. The menisci of the knee have several important roles: The medial meniscus is 'C' shaped whereas the lateral is a shorter incomplete circle with closer spaced 'horns'. Most oblique meniscus tears are happen in the posterior third of the medial meniscus. 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. Brain Res Rev 2009;60:187201. They will check for tenderness along the joint line where the meniscus sits. The Thessaly test is the most sensitive and specific clinical test to diagnose meniscal injury. This means that athletes, especially those who participate in contact sports like football, are at a higher risk of sustaining this injury. Arthroscopic total meniscectomy Occasionally, a large tear of the outer meniscus can best be treated by arthroscopic total meniscectomy, a procedure in which the entire meniscus is removed. London;1897. They will manipulate your leg into various positions, observe you while you walk, and bend at the knee. We have the medial meniscus on the inner side of the knee and the lateral meniscus on the outer side of the knee. Both of them have 2 causes. X-rays and MRIsallow the doctor to evaluate the bone and soft tissue at the knee. Long ago, the menisci were felt to be vestigial structures that served no useful purpose in humans.1 Of course, we now realize that the menisci are vital structures that play a key role in the normal biomechanical function of the 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. Educational text answers on HealthTap are not intended for individual diagnosis, treatment or prescription. This part of the tibia is also known as the tibial plateau. Although the pain improved, the patient could not flex her knee joint deeply. AJSM 2002; 30:589-600. 10 DeHaven KE. In the present case, a full-thickness radial tear of the medial meniscus is visualized (Fig 1).An arthroscopic torpedo shaver (Arthrex, Naples, FL, U.S.A.) is used to debride the meniscus tear edges back to a healthy, stable rim (Fig 2).For improved access to the medial meniscus, an 18-gauge spinal . Medial meniscus tears are most frequently addressed with a partial meniscectomy, which involves arthroscopically removing the damaged portion of cartilage. By using our website, you consent to our use of cookies. Operative Arthroscopy, 3rd Edition, 2002, Lippincott Williams and Wilkins. The described meniscal tears will lead to possible necessary total knee replacement. Tears that lie within or contact the red zone are also more likely to be amenable to meniscal repair. A medial meniscus tear on the inside of the knee is more common. What to Do If Your Orthopaedic Surgery Is Postponed. Nonsurgical treatment is an option for elderly patients, those with significant comorbidities and those with advanced OA (Outerbridge grade 3 or 4 chondromalacia of the ipsilateral compartment). Available at www.health.gov.au/internet/ main/publishing.nsf/Content/MBRT-DI-submissions-018/$FILE/018%20 RACGP%20Submission.pdf [Accessed 15 August 2011]. 11 Plain radiography is only useful to exclude differentials and computed tomography (CT) is markedly inferior to MRI for meniscal imaging.12 Magnetic resonance imaging is the gold standard, first choice for investigation of suspected meniscal tears.2,1316. 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. Biomechanical studies have demonstrated that repair of medial meniscus posterior root tears leads to improved contact mechanics. Walking can become difficult. We have two menisci in either knee. 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. In this case, a portion may break off, leaving frayed edges. While visualization of the meniscal root may be difficult due to MRI slice size, type of MRI and strength of MRI, an extrusion larger than 3 mm highly correlates with a root tear. w/severe pain? Because these two tear patterns differ greatly in prognosis and treatment approach, vertical is therefore not the preferred descriptor for such meniscal tears, unless paired with the proper category, such as vertical longitudinal. Conservative management is important in all patients with acute rest, intensive rehabilitation with physiotherapy and modification of activity. In contrast, the inner two-thirds of the meniscus lacks a significant blood supply. This presents with a combination of tear patterns. Know why a new medicine or treatment is prescribed, and how it will help you. Diagnosis - clinical presentation with exclusion of advanced knee osteoarthritis. Jul 2000;35(3):217-30. Meniscus tears are among the most common knee injuries. However, meniscus tears do not always appear on MRIs. To learn more, please visit our. A longitudinal tear is an example of this kind of tear. In (17a), the preoperative study, a large displaced "handle" (arrow) from the body of the lateral meniscus is seen near the intercondylar notch. Patients describe meniscal tears in a variety of ways. 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. Meniscal tear configurations: categorization with MR imaging. Treatment or management protocols for posterior horn menial meniscus tears are quite challenging. It is therefore quite important in treatment planning for the pre-operative MR to provide information that can be used to determine whether meniscal repair rather than partial meniscectomy is to be performed. Magnetic resonance imaging as a tool to predict reparability of longitudinal full-thickness meniscus lesions. Knowing where and how a meniscus was torn helps the doctor determine the best treatment.. Two wedge-shaped pieces of fibrocartilage act as shock absorbers between your femur and tibia. Both of these factors increase contact forces across the joint, leading to accelerated osteoarthritis and predisposing the patient to the development of subchondral insufficiency fractures.7. 1075 Mason Ave., Daytona Beach, FL 32117, Twin Lakes Radiology 2007;242:8593. (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. Lateral meniscus is intact. This type of tear is particularly devastating to meniscal function. 15 Koski JA, Ibarra C, Rodeo SA. Characterization of the red zone of knee meniscus: MR imaging and histologic correlation. How to treat oblique tear of medial meniscus? Solomon L, Warwick D, Nayagam S. Apley's Concise System of Orthopaedics and Fractures. The treatment may be conservative or sometimes surgery may be required to treat the fracture. Question options: . Arthroscopic repair of meniscal tears extending into the avascular zone in patients younger than twenty years of age. Tears are noted by how they look, as well as where the tear occurs in the meniscus. The RICE protocol is effective for most sports-related injuries. Grade 3 meniscus tears usually require surgery, which may include: Tips to help you get the most from a visit to your healthcare provider: Cedars-Sinai has a range of comprehensive treatment options. I read on a medical site that it is difficult to get to the posterior horn of the meniscus and sometimes there is a need to make an incision or the knee becomes dislocated. When a meniscus tear occurs, you may hear a popping sound around your knee joint. 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. There is no resting pain. The medial meniscus is on the inner side of the knee joint. Meniscus tears can vary widely in size and severity. Historically, medial meniscal root tears have been treated conservatively or by partial meniscectomy. Meniscal tear incidence may be as high as six per 1000 population6 with a 2.5 to 4 times male predominance. Coronal MRI sequences are generally considered the best images for visualization of medial meniscal root tears (Figure 1). All rightsreserved. what is the treatment? The surgery requires a few small incisions and takes about an hour. In some cases, your doctor may suggest an arthroscopyto examine and possibly treat your knee. Call us at(386) 255-4596to schedule an appointment. 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. Any tears appear as white lines. Steroid injection. Tears of the posterior medial meniscal root have shown to disrupt the normal motion of the knee, resulting in degenerative arthritis. Medial meniscal root tears are more frequently diagnosed in patients who are older than 40 years, are overweight and cannot recall an inciting event. 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. Top answers from doctors based on your search: Created for people with ongoing healthcare needs but benefits everyone. or ? Your meniscus acts like a cushion between your thigh bone (femur) and shin bone (tibia). It presents as a wedge-shaped defect resembling a parrot beak at the free edge of the meniscus as a result of displaced oblique vertical orientation. Copyright 1995-2021 by the American Academy of Orthopaedic Surgeons. Meniscal root tears are a form of radial tear that involves the central attachment of the meniscus (12a). . 17 Old Kings Road N., Suite K Palm Coast, FL 32137, East Coast Surgery Center The clinician applies axial pressure to the foot and rotates the tibia internally and externally. https://www.webmd.com/pain-management/knee-pain/meniscus-tear-injury We have also seen complete meniscal root avulsions in the cruciate ligament-injured knee with complete injury of the medial ligament and posterior oblique ligament that opens in full extension. Trauma to medial collateral ligament usually also involves medial meniscus. Although C, a vertical tear, is commonly used to describe such an appearance, the better answer is D, a longitudinal tear. The skilled interpreter of MR of the knee must do more than simply identify the presence of a meniscal tear. The views expressed by the authors of articles in Australian Family Physician are their own and not necessarily those of the publisher or the editorial staff, and must not be quoted as such. Great Britain: Hodder Arnold, 2005. The posterior horn is the thickest and most important for overall function of the knee. Surgical treatment is usually reserved for younger patients with a vertical longitudinal tear within the vascularised outer third of the meniscus. Develop pain gradually along the meniscus and joint line when you put stress on your knees (usually during a repeated activity). 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. Damaged avascular meniscus must be removed.27 However, meniscectomy causes long term osteoarthritis,28 so is only performed when the patient suffers joint locking or mensical pain that is refractory to conservative management. Meniscal repair is a more difficult surgical technique and requires a motivated, diligent patient in order to be successful. This makes the medial meniscus less mobile and is one reason why the medial meniscus is more prone to injury.3 In adults, only the periphery of the meniscus remains vascularized. 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. Singapore: World scientific, 2010. Other established anatomical variants include the transverse meniscal ligaments and the meniscofemoral ligaments, which mimic meniscal tears at their meniscal attachment sites. 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. They act as shock absorbers and stabilize the knee. Description of Medial Meniscus Tear The medial meniscus is an important shock absorber on the inside (medial) aspect of the knee joint. The degenerative aetiology and reduced vascularisation secondary to ageing also means that meniscal tears in the elderly population are less likely to be amenable to surgical management;7 only about 6% of patients over 40 years of age have operable lesions.24 To prevent re-injury of the meniscus, activity modification is important for example, ceasing sports such as soccer or netball. In this short surgical video, a degenerative meniscus tear is smoothed down with a motorized shaver during a partial meniscectomy. If you continue to use this site we will assume that you are happy with it. w/severe pain? Rotator Cuff and Shoulder Conditioning Program. 1 Sutton JB. 8 Ruff C, Weingardt J, Russ P, Kilcoyne R. MR imaging patterns of displaced meniscus injuries of the knee. Meniscus Surgery. These are the horns. X-rays provide images of dense structures, such as bone. The medial meniscus is an important secondary stabilizer of the knee. The medial meniscus is more frequently torn, partly because of this different shape but also because of its attachment to the medial collateral ligament, whereas the lateral is pulled out of the way of compression between femur and tibia by politeus. RICE stands for Rest, Ice, Compression, and Elevation. Am J Sports Med 2006;34:91927. The menisci the medial meniscus and lateral meniscus - are crescent-shaped bands of thick, rubbery cartilage attached to the shinbone (tibia). Not all meniscal tear types, however, are amenable to repair, and thus an accurate description of meniscal tears on MR can have a dramatic impact on preoperative planning. (6a) A radial tear of the body of the lateral meniscus also appears vertical on sagittal MR images (arrow), though in the case of radial tears, the lesion is oriented perpendicular to the c-shaped fibers of the meniscus. If your symptoms persist with nonsurgical treatment, your doctor may suggest arthroscopic surgery. 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. Incisions were made in the dorsal root of the oblique popliteal ligament and the joint capsule . Pain, especially when twisting or rotating your knee. AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. 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. Magnetic resonance imaging (MRI) scans. This provides a clear view of the inside of the knee. 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. (11a) A 3D illustration of a bucket handle tear demonstrates that these tears actually are longitudinal in nature (arrows), coursing parallel to the c-shaped fibers of the meniscus. The amount of pain and first appearance of swelling can give important clues about where and how bad the injury is. Symptoms. Makris EA, Hadidi P, Athanasiou KA. It is generally divided into 3 separate portions, the anterior horn, the mid-body and the posterior horn. Arthroscopy 1998;14:8249. Know how you can contact your provider if you have questions. In circumstances where the flap causes catching in the knee, the flap can simply be removed. The lateral meniscus is on the outermost side of your knee, so the tear location is outside-front. The procedure can reduce pain, improve mobility and stability, and get you back to life's activities. Have swelling, stiffness or tightness in your knee. The most commonly encountered signs are posterior knee pain with deep flexion and joint line tenderness. Injury, degeneration, or surgical removal of all or part of the meniscus is associated with an increased risk of developing knee osteoarthritis. The loss of the central attachment of the posterior horn may allow extrusion of the body of the meniscus relative to the joint (13a). Barrett GR, Field MH, Treacy SH, Ruff CG. One or two other small incisions are made for inserting instruments. Tears present as severe pain, swelling, and possibly catching, clicking, difficulty on deep knee bending and locking of the knee in partial flexion. Peripheral meniscal tears are among the most common causes of meniscal pathology, particularly occurring in conjunction with anterior cruciate ligament (ACL) injury or deficiency. The ideal candidate for a medial meniscal root repair is an individual younger than 40 years who presents after an acute, traumatic event with a BMI less than 30 and a MRI that shows a medial meniscal root tear without secondary signs of osteoarthrosis or varus malalignment. McMurray (Figure 1) and Apley tests (Figure 2) are often positive, although these are specific but not sensitive specificity being 5798% and 8099%, and sensitivity being 1066% and 1658% respectively.2,9 The most useful clinical test for meniscal injury is the Thessaly test, which is demonstrated in Figure 3. An experimental study in dogs. 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. Medial meniscal posterior root tears represent an often unrecognized pathology with potentially devastating long-term effects. Although all bucket handle tears are repair candidates,16 the bucket handle tear is an example of when the more severe appearing tear is actually better for the patient. Scuderi G, Tria A. Complex or degenerative tears are where two or more tear patterns exist. However, it may also occur in older athletes through gradual degeneration. The kneecap (patella) sits in front of the joint to provide some protection. The medial meniscus is the cushion that is located on the inside part of the knee. 13 Newman AP, Daniels AU, Burks RT. Locking presents in two ways. Unhappy Triad: Stress is put on medial side of the knee which potentially tears three related structures If you have unusual pain and discomfort in your knee, let us help you get back to doing the things you love. I have an oblique tear of the posterior horn of the medial meniscus, what is the treatment for that? In some cases, a meniscal repair may also be possible, though this is dependent on the size and location of the tear. Krych AJ, McIntosh AL, Voll AE, Stuart MJ, Dahm DL. Acute meniscus tears often happen during sports. Whats the best way to treat an oblique fracture? How to treat an oblique tear of the posterior horn of the medial meniscus? From January 2018, it was superseded by AJGP: Australian Journal of General Practice, The Royal Australian College of General Practitioners 2021. Choose a doctor and schedule an appointment. 2023 The Orthopedic Clinic. Medial Meniscus: oblique tear of the posterior portion with a separated and unstable fragment. I have an oblique tear of the posterior horn medial meniscus with prominent interior medial extrusion. Before your visit, write down questions you want answered. It is estimated that only 10% of the injuries involving the tear of posterior horn medial meniscus are repairable.

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