We use cookies to ensure that we give you the best experience on our website. Radiology 2007;242:8593. Many tears are repaired with dartlike devices that are inserted and placed across the tear to hold it together. For patients requiring meniscectomy, meniscal autograft has been utilised with good outcomes,2931 but is only performed in specialist centres. . If an ACL tear is also present, meniscal repairs are more successful if the ACL is also repaired, likely due to the protection afforded by knee stability. Although C, a vertical tear, is commonly used to describe such an appearance, the better answer is D, a longitudinal tear. The menisci act as cushions between your shin bone (tibia) and your thigh bone (femur). If you have a meniscus tear, this movement may cause pain, clicking, or a clunking sensation within the joint. and oblique tear . Medial meniscus tears are most frequently addressed with a partial meniscectomy, which involves arthroscopically removing the damaged portion of cartilage. Scuderi G, Tria A. 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. If you have a meniscus tear, this movement may cause pain, clicking, or a clunking sensation within the joint. Feb 1995;11(1):29-36. 10 DeHaven KE. These can occur through either a contact or non-contact injury for example, a pivoting or cutting injury. Meniscus tears simply do not heal on their own, regardless of conservative treatment. Although surgical repair has led to improved patient-reported function, there are conflicting reports on the progression of cartilage degeneration. The accuracy of physical diagnostic tests for assessing meniscal lesions of the knee: a meta-analysis. This is a large horizontal tear of the meniscus. The one towards the back of leg is the posterior horn. Makris EA, Hadidi P, Athanasiou KA. 2013. How can I tell if I have an oblique fracture? The vertical flap tear is a displaced type of radial tear that often occurs in the posterior medial meniscus. How is Oblique Fracture Treated? One of the most common knee injuries is a torn meniscus. Fat suppressed proton density-weighted (15a) coronal and (15b) sagittal images reveal a tibial sided flap tear of the body of the medial meniscus, with displacement of the undersurface component (arrows) into the inferior gutter. Complex or degenerative tears are where two or more tear patterns exist. This is because this area has rich blood supply and blood cells can regenerate meniscus tissue or help it heal after surgical repair. Your doctor might move your knee and leg into different positions, watch you walk, and ask you to squat to help pinpoint the cause of your signs and symptoms. These tears often occur in association with ACL tears, but even if found in isolation, are highly likely to be clinically relevant, as the displaced meniscal fragment frequently results in knee locking. 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. Acute meniscus tears often happen during sports. 6 It seems that in the above knee, the biology of the medial compartment has gone off the ski slope in a degenerative fashion and reversing that ski slope fall seems to be unproven at this time, particularly in the patient with low functional demands, who is older than 40 years and who has a BMI greater than 30. The relationships among MM radial/oblique tears, MM extrusion (MME), and the effect of arthroscopic meniscal repair are not established. Oblique tears give rise to flaps which are mechanical unstable and associated with mechanical symptoms. Each knee joint has two crescent-shaped cartilage menisci. The posterior horn of the medial meniscus is especially likely to develop tears as we get older. The difference in tear type between these populations is explained by the three-dimensional fibrous structure of the meniscus: horizontal delamination occurs in degenerative injuries, while the fibrous structure is ruptured in a vertical fashion in younger patients. A referral to an orthopedic physician should result in guidance it means you need to see in orthopedist and get an opinion as to whether. Semin Roentgenol. Flaps cause mechanical instability - meaning they interrupt the smooth function of the knee joint and will make your knee joint feel unstable. This often causes the knee to become stuck due to a portion of the meniscus blocking the knees normal motion. (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. Knee Surg Sports Traumatol Arthrosc 2010;18:5359. Transtibial pullout repair is a new arthroscopic technique to repair meniscal root tears, . Adjunctive measures to promote vascularity and healing at the repair sites are also recommended. Description of Medial Meniscus Tear The medial meniscus is an important shock absorber on the inside (medial) aspect of the knee joint. Explains two kinds of surgery. We have the medial meniscus on the inner side of the knee and the lateral meniscus on the outer side of the knee. Lim HC, Bae JH, Wang JH, Seok CW, Kim MK. There are numerous types of meniscus tears, including: 1. The medial meniscus is on the inner side of the knee joint. Tears should be characterized with regard to morphology, size, location, and stability, all of which are important factors that may influence the choice of operative treatment. However, these patients are rare. Results: Medial meniscus posterior horn longitudinal tears in ACL-deficient knees resulted in a significant increase in anterior-posterior tibial translation at all flexion angles except 90 (P < .05). The knee meniscus: structure-function, pathophysiology, current repair techniques, and prospects for regeneration. (13a) A coronal image from another patient with a medial meniscal root tear demonstrates associated severe medial subluxation of the meniscal body (arrow). 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. The Royal Australian College of General Practitioners, 100 Wellington Parade, East Melbourne, Victoria 3002, Australia. The best known displaced tear that is amenable to repair is the bucket-handle tear. He/she will probably recommend surgery. 2nd ed. Magnetic resonance imaging can also be effectively used to estimate the vascular zone classification (see Treatment) of tears.18 This is useful for the orthopaedic surgeon to predict meniscal repairability, assisting informed discussion with patients and scheduling appropriate operating theatre time.18 It is essential to remember that just because a tear can be seen on MRI, this does not mandate surgery. Medial meniscal posterior root tears represent an often unrecognized pathology with potentially devastating long-term effects. AJSM 2003; 31:216-220. These injuries have been reported to change joint loading due to failure of the meniscus to convert axial loads into hoop stresses. Metcalf MH, Barrett GR. A barely noticeable tear may resurface years later, triggered by something as simple as tripping over a sidewalk curb. There are two menisci, a medial one on the "inside" of the knee and a lateral one on the "outside" of the knee. Rosemont, Ill. American Academy of Orthopaedic Surgeons. Proton weighted sagittal image demonstrates an example of a posterior horn medial meniscal horizontal tear (white arrow). 2023 The Orthopedic Clinic. They act as shock absorbers and stabilize the knee. Doctors typically provide answers within 24 hours. If this cartilage tears, the result is pain, stiffness, and swelling. 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. A tear can also develop slowly as the meniscus loses resiliency. Unhappy Triad: Stress is put on medial side of the knee which potentially tears three related structures 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. Medial meniscal root tears are more frequently diagnosed in patients who are older than 40 years, are overweight and cannot recall an inciting event. (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. [Epub ahead of print]. 5 Jee WH, McCauley TR, Kim JM, et al. Displacement of the inner rim of the tear (arrowheads) results in the classic "bucket-handle" configuration. The Thessaly test is the most sensitive and specific clinical test to diagnose meniscal injury. 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. Immediate conservative measures include the RICE regimen: Longer term measures include activity modification, nonsteroidal antiinflammatory drugs (NSAIDs) and physiotherapy.4,1921 Nonsteroidal anti-inflammatory drugs are often recommended for 812 weeks,20 although paracetamol can be considered if NSAIDs are contraindicated or poorly tolerated.22 Where available, intensive physiotherapy is very useful and should include range of motion, proprioceptive work and muscle strengthening exercises. Unfortunately, general practitioners cannot currently order Medicare funded MRI, although this may change with The Royal Australian College of General Practitioners recent submission to the Australian Government Department of Health and Ageing. Sometimes this type of tear can heal on its own but it may require surgery if symptoms dont subside. Torn meniscus symptoms Symptoms are usually sudden onset, however, can develop gradually over time. Currently, routine MR images do not reveal signal intensity differences between the red and white zones of the menisci. Sekiya JK, West RV, Groff YJ, Irrgang JJ, Fu FH, Harner CD. The tear can be seen as a white line through the dark body of the meniscus. summary. 2nd edn. It is estimated that only 10% of the injuries involving the tear of posterior horn medial meniscus are repairable. Now, 49 I have had intense pain 2 days after a 3 hour steep mountain walk- the first in 6 months. The oblique meniscomeniscal ligament is but one of several known structures that can mimic meniscal pathology. Symptomatic treatment with rest, ice, NSAIDs and/or an unloader brace may help alleviate symptoms in some cases. 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. This extrusion should disappear without stress. A medial meniscus tear on the inside of the knee is more common. Although the pain improved, the patient could not flex her knee joint deeply. A comparative study with a short term follow up. How to treat oblique tear of medial meniscus? Oblique tears commonly cause flaps and flaps are generally not good. 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. A tear can also develop slowly as the meniscus loses resiliency. Other nonsurgical treatment. This means that athletes, especially those who participate in contact sports like football, are at a higher risk of sustaining this injury. Harrison BK, Abell BE, Gibson TW. Arthroscopic repair An arthroscope is inserted into the knee to see the tear. what is the treatment? Depending on the cut thickness, axial MRI images may display the root tear (Figure 3). 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. X-rays. Physical therapy should start immediately after surgery and include early passive range of motion from 0 to 90 for the initial 2 weeks and progress to full range of motion thereafter. Tears of the posterior medial meniscal root have shown to disrupt the normal motion of the knee, resulting in degenerative arthritis. Scholten RJ, Deville WL, Opstelten W, Bijl D, van der Plas CG, Bouter LM. An oblique tear (7a,8a) is often referred to as a parrot-beak tear, as the tear shape resembles a parrots beak. They include: Those with a meniscus tear are also more likely to develop osteoarthritis in the injured knee. Fax Without nutrients from blood, tears in this "white" zone with limited blood flow cannot heal. In younger patients, this is typically a twisting force on a weightloaded flexed knee. The healing of an Oblique Fracture can take a minimum of four to six weeks to completely heal. The meniscus root attachment aids meniscal function by securing the meniscus in place and allowing for optimal shock-absorbi New advances in musculoskeletal pain. Chahla and Geeslin report no relevant financial disclosures. In contrast, the inner two-thirds of the meniscus lacks a significant blood supply. In this procedure, the surgeon inserts a miniature camera through a small incision (portal) in the knee. 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. 1 Sutton JB. I could not really walk on it. The ghost sign or absence of an identifiable meniscus anterior to the posterior cruciate ligament is also indicative of a root tear (Figure 2). I have a oblique grade 3 tear posterior horn of the medial meniscus. The treatment may be conservative or sometimes surgery may be required to treat the fracture. Meniscal repairs are more likely to be successful when performed near the time of injury. Meniscal repair is a more difficult surgical technique and requires a motivated, diligent patient in order to be successful. However, anyone at any age can tear the meniscus. 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. The preferred nomenclature for this tear pattern is: A gradient-echo T2*-weighted sagittal image, A. Your doctor will generally ask you how the injury occurred, how your knee has been feeling since the injury and whether you have had other knee injuries. Conservative management of the patient with a meniscal tear. 3 Thornton DD, Rubin DA. 12 Sources By Jonathan Cluett, MD The meniscus can tear from acute trauma or as the result of degenerative changes that happen over time. Non-operative treatment of degenerative posterior root tear of the medial meniscus. 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). Cole BJ, Dennis MG, Lee SJ, et al. Any tears appear as white lines. 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). This "C" shaped cartilage helps disperse impact and displace force exerted upon the knee while walking, running, and other mild to high-energy and impact motions. The absent bow tie sign in bucket-handle tears of the menisci in the knee. Meniscal tears within the body of the meniscus or at the meniscocapsular junction represent a well-understood and manageable condition encountered in clinical practice. AJR 2000; 174:161-164. Arthroscopic treatment is typically required for adequate symptom relief in patients with displaced meniscal flap tears. This is termed the 'red-red zone' (denoting area of vascularity).2,4 repair of the 'red-white zone' (watershed area between vascular and avascular meniscus) is controversial25 with many different surgical techniques.26 tears in the 'white-white zone' (avascular zone) are rarely repaired rather the damaged segment is resected (meniscectomy). If you prefer, you can also fill out our appointment request form online now. 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. American Board of Orthopaedic Surgery Practice of the Orthopaedic Surgeon: Part-II, certification examination case mix. 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. Making a medial meniscal root tear diagnosis is difficult because the typical history of locking, catching or giving way is less likely to be present. 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. In this case, a portion may break off, leaving frayed edges. Know why a test or procedure is recommended and what the results could mean. Ercin E, Kaya I, Sungur I, Demirbas E, Ugras AA, Cetinus EM. It is important to describe your symptoms accurately. Trauma to medial collateral ligament usually also involves medial meniscus. Complex or degenerative tears are where two or more tear patterns exist. 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. Arthroscopy 2006;22:77180. M23.322 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Rimington T, Mallik K, Evans D, Mroczek K, Reider B. Acta Orthop Scand 1982;53:9759. Recent kinematic/biomechanical studies have also shown the importance of the medial meniscus to anterior translation of the knee. Develop pain gradually along the meniscus and joint line when you put stress on your knees (usually during a repeated activity). Before your visit, write down questions you want answered. Radiology 2000; 217:193-200. Optimal diagnosis and management is essential to prevent long term sequelae. Nonsteroidal anti-inflammatory drugs (NSAIDs), Inability to move your knee through its full range of motion. A recent study demonstrated 46% of patients with degenerative meniscal tears elected not to have surgery after 4 weeks of nonoperative treatment, and their functional improvement matched patients in the operative group.21 Another study of degenerative tears demonstrated that supervised exercise caused the same reduction in knee pain and the same increase in function and satisfaction as partial meniscectomy plus exercise.23 As degenerative tears are more common in elderly patients, this group is more likely to respond to conservative treatment. Rehabilitation time for a meniscus repair is about 3 to 6 months. Treatment of meniscal tears includes simple observation, meniscectomy, and meniscal repair. If your MRI indicates a Grade 1 or 2 tear, but your symptoms and physical exam are inconsistent with a tear, surgery may not be needed. Operative Arthroscopy, 3rd Edition, 2002, Lippincott Williams and Wilkins. 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. AJR 2003; 180:93-97. The amount of pain and first appearance of swelling can give important clues about where and how bad the injury is. Ask if your condition can be treated in other ways. MR imaging is reliable in the detection of meniscal tears and identification of meniscal fragmentation and displacement [1, 2, 3, 4].Displaced meniscal fragments are often clinically significant lesions requiring surgical intervention and, therefore, are important to identify. 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. It is caused by direct impact in contact sports or twisting. 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. Sometimes conservative treatment doesnt work. The posterior horn it the back portion of the menisci at the end of the curve, where it tapers . These meniscus tears are displaced into the tibia or femoral recesses and can be often difficult to diagnose intraoperatively. Am J Sports Med 2004;32:67580. Full thickness tears are the complete disruption of the fibers of the supraspinatus muscle, and generally require a more aggressive treatment plan and surgery. Singapore: World scientific, 2010. Repair is sometimes attempted even with these tear types, particularly when the patient is young and substantial loss of meniscal tissue would lead to an unacceptable risk of future arthritis.11 Repair of these challenging tear types should only be attempted when the meniscal tissue is of good quality and a stable result is achievable. Walking can become difficult. Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. This information is provided as an educational service and is not intended to serve as medical advice. The kneecap (patella) sits in front of the joint to provide some protection. Both longitudinal and radial tears may appear vertical on MR images (5a,6a), but longitudinal tears extend parallel to the c-shaped circumference of the meniscus, whereas radial tears lie perpendicular to the meniscal circumference. 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. The surgeon then inserts surgical instruments through two or three other small portals to trim or repair the tear. 1 article features images from this case I have been diagnosed with a subtle oblique tear involving the posterior horn of the medial meniscus and extends to the inferior articular surface of the meniscus. Biomaterials 2011;32:741131. J Bone J Surg Am 2006;88:6607. Your doctor may inject a corticosteroid medication into your knee joint to help eliminate pain and swelling. See this post to learn more about how a meniscus functions . They are most frequently seen at the posterior horn of the medial meniscus. If the tear is associated with arthritis it will typically improve over time as the arthritis is treated. 2000-2022 The StayWell Company, LLC. For potential or actual medical emergencies, immediately call 911 or your local emergency service. I have an oblique tear of the posterior horn of my medial meniscus that extends to the undersurface of the cartilage. 12 McGinty JB, Burkhart SS, Jackson RW, et al. Bove SE, Flatters SJ, Inglis JJ, Mantyh PW. Treatment or management protocols for posterior horn menial meniscus tears are quite challenging. Submission to the Department of Health and Ageing. In older patients, referral is appropriate if conservative management fails to improve symptoms. Knees with a deficient medial meniscus and an ACL tear have an increased anterior tibial translation of about 60% at 90 of flexion. (386) 255-4596 To provide the highest quality clinical and technology services to customers and patients, in the spirit of continuous improvement and innovation. Arthroscopy. Typically, complex tears are not treated with meniscus repair due to their complex nature. Usually you will be able to leave the hospital the same day. Connect with a U.S. board-certified doctor by text or video anytime, anywhere. Of note, drilling tibial tunnels may improve healing of the meniscus-bone interface due to the presence of progenitor cells and growth factors derived from the bone marrow. The meniscus is a C-shaped cartilage disk that is found in the knee. Grade 3 is a true meniscus tear and an arthroscope is close to 100 percent accurate in diagnosing this tear. The meniscus shows up as black on the MRI. Clinical: Most trauma to knee joint is caused by a lateral blow at knee level when foot is planted when knee is slightly flexed. The medial meniscus is an important structure that provides stability, dissipates force and assists to provide normal kinematics of the knee. As people age, they are more likely to have degenerative meniscus tears.
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