The meniscus is a piece of rubber-like cartilage in the knee situated within the femur and tibia, or thigh bone and shin bone. With the foot as close to the hip as possible, the clinician holds the knee joint (with fingers along the joint line) with one hand, and the other hand rotates the tibia internally and externally while extending and flexing the knee. tears of the medial meniscus were the most common type oftear,comprising40%ofmedialmeniscustears.Further-more, more than 75% of medial meniscal tears in the ACL- . Meniscal repair is a more difficult surgical technique and requires a motivated, diligent patient in order to be successful. [Epub ahead of print]. 2023 Cedars-Sinai. Includes interactive tool to help you decide. Acute meniscus tears often happen during sports. What is Posterior Horn Medial Meniscus Tear: Causes, Symptoms Historically, medial meniscal root tears have been treated conservatively or by partial meniscectomy. Trauma to medial collateral ligament usually also involves medial meniscus. The primary objective is to control the disease process to avoid the complications . 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. https://www.verywellhealth.com/types-of-meniscus-tears-3862073 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. Physiotherapy at two visits per week for at least 8 weeks is recommended.20 There is little evidence for strapping of meniscal injuries and this is not currently recommended. The posterior horn it the back portion of the menisci at the end of the curve, where it tapers . Meniscus tears simply do not heal on their own, regardless of conservative treatment. Full-Thickness Radial Medial Meniscal Tear: Fixation With Inside-Out The absolute indication for specialist referral is the locked knee loss of joint function necessitates surgical intervention. Skeletal Radiol 2007;36:14551. Magnetic resonance imaging is first line for investigating potential meniscal lesions, but should not replace thorough clinical history and examination. 6 By the time people reach their twenties or thirties, intrasubstance changes of the meniscus tissue are common. How can I tell if I have an oblique fracture? The knee meniscus: structure-function, pathophysiology, current repair techniques, and prospects for regeneration. This tear pattern was historically unrecognized, although more recently it has been suggested this hidden pathology may account for nearly 80% of the total knee replacements in patients younger than 60 years. This pattern of tear requires resection to prevent propagation of the tear as the flap gets caught within the joint during flexion. Does a degenerative meniscus tear need surgery? - Howard J. Luks, MD Because a torn meniscus is made of cartilage, it won't show up on X-rays. 1. Surgical treatment is usually reserved for younger patients with a vertical longitudinal tear within the vascularised outer third of the meniscus. https://www.webmd.com/pain-management/knee-pain/meniscus-tear-injury Currently, routine MR images do not reveal signal intensity differences between the red and white zones of the menisci. Likewise, physical exam findings of an effusion, a positive McMurray test and a positive Apley grind test are not usually present. 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. The body usually absorbs these over time. The younger population, particularly males with knee instability, is most commonly affected by this type of tear [56]. Although surgical repair has led to improved patient-reported function, there are conflicting reports on the progression of cartilage degeneration. There are two in each knee, for a total of four. Meniscus Radial Tear | George Gendy MD Clin Orthop Related Res 2010;468:11902. AJR Am J Roentgenol 1998;170:5761. AJR 1998;170:63-67. Meniscal root tears, less common than meniscal body tears and frequently unrecognized, are a subset of meniscal injuries that often result in significant knee joint disorders. Double posterior cruciate ligament sign | Radiology Reference Article Perhaps the best know of these is the bucket-handle tear. Explains two kinds of surgery. If you have a meniscus tear, this movement may cause pain, clicking, or a clunking sensation within the joint. 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. Copyright 1995-2021 by the American Academy of Orthopaedic Surgeons. Medial and Lateral Meniscus Tears | Cedars-Sinai Inferiorly displaced flap tears of the medial meniscus: MR appearance and clinical significance. 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. 1 Sutton JB. Knee Surg Sports Traumatol Arthrosc 2007;15:393401. Barrett GR, Field MH, Treacy SH, Ruff CG. Rotator Cuff and Shoulder Conditioning Program. Two bones meet to form your knee joint: the femur and the tibia. Clin J Sport Med 2009;19:912. 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 addition, focal chondral lesions occur more commonly with medial than lateral-sided injuries. (386) 254-6819, Main Office & Walk-In Clinic AJR 2003; 180:93-97. One of the most common knee injuries is a torn meniscus. Makris EA, Hadidi P, Athanasiou KA. Knee Surg Sports Traumatol Arthrosc 2011 Aug 11. Location -A tear may be located in the anterior horn, body, or posterior horn.A posterior horn tear is the most common. Medial meniscal posterior root tears represent an often unrecognized pathology with potentially devastating long-term effects. There are numerous types of meniscus tears, including: 1. Although an X-ray will not show a meniscus tear, your doctor may order one to look for other causes of knee pain, such as osteoarthritis. Arthroscopic Repair of the Medial Meniscus Radial/Oblique Tear Prevents Great Britain: Hodder Arnold, 2005. In some cases, a meniscal repair may also be possible, though this is dependent on the size and location of the tear. There is no resting pain. If you have unusual pain and discomfort in your knee, let us help you get back to doing the things you love. Types of meniscus tears:(Left) Bucket handle tear. The ghost sign or absence of an identifiable meniscus anterior to the posterior cruciate ligament is also indicative of a root tear (Figure 2). Conservati For a young person arthroscopic meniscal repair is the best solution. X-rays. A longitudinal tear is an example of this kind of tear. 6 Vande Berg BC, Poilvache P, Duchateau F. Lesions of the menisci of the knee: value of MR imaging criteria for recognition of unstable lesions. 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. 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. Surgery is most likely needed to resolve your problem. Meniscal Tear Patterns - Radsource A barely noticeable tear may resurface years later, triggered by something as simple as tripping over a sidewalk curb. These tears often require surgical treatment to restore the proper function of the knee. Characterization of the red zone of knee meniscus: MR imaging and histologic correlation. Meniscus Surgery. A tear in this "red" zone may heal on its own, or can often be repaired with surgery. 2010. The RICE protocol is effective for most sports-related injuries. SPHE425_Quiz_5.docx - Quiz 5 Attempt 1 Written: Aug 6, 2022 15 Koski JA, Ibarra C, Rodeo SA. what is the treatment? swelling - this usually happens several hours after you injure your meniscus. 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). A lateral meniscus tear (torn meniscus) is a tear of the semicircular fibrous cartilage discs in the knee. 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. Question options: . Absence of the medial meniscus (entire medial meniscal root tear) places large stresses on the ACL, the primary ligament that prevents anterior translation of the knee. 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. True locking is less common, and suggests a bucket-handle tear, with the torn fragment preventing full extension. AJSM 2007; 35:1380-1383. These lie on the inside (medial) and outside (lateral) edges of the top of your tibia (shin bone). Pathology - a tear that has developed gradually in the meniscus. Recovery and rehabilitation take a few weeks. If the tear is associated with arthritis it will typically improve over time as the arthritis is treated. However, these patients are rare. 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. See your ortho for an evaluation. The tear results in a vertical signal abnormality on sagittal MR images. At The Orthopedic Clinic, we want you to live your life in full motion. Lim HC, Bae JH, Wang JH, Seok CW, Kim MK. Arthroscopic meniscus repairs typically takes about 40 minutes. Arthroscopy 2010;26:13689. Meniscal Tears - Knee & Sports - Orthobullets Bucket Handle Meniscus Tear - Cleveland Clinic: Every Life Deserves 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. If the knee is still painful, or if it locks, your doctor may recommend surgery. 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). Chronic tears may be scarred to the capsule and require release of the meniscocapsular junction to allow anatomic repair. There may be some pain. Meniscus Tears: Causes, Treatment & More - The Orthopedic Clinic Typically, complex tears are not treated with meniscus repair due to their complex nature. Bernstein J. Parrot Beak Tear: MRI We describe the technique of diagnosis and treatment of a large displaced lateral meniscus flap tear, presenting as a meniscus comma sign. Tears present as severe pain, swelling, and possibly catching, clicking, difficulty on deep knee bending and locking of the knee in partial flexion. Radial tears, because they are oriented perpendicular to the c-shaped fibers of the meniscus, have a devastating effect upon meniscal function. (redirected from Oblique Tear) The most common meniscal tear, a type of radial tear which begins at the free (inner) edge like other radial tears, but then curves into a longitudinal orientationsimilar to longitudinal meniscal tearsas the tear extends toward the meniscal periphery.