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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. A prospective study of the nonoperative treatment of degenerative meniscus tears. 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. A gradient-echo T2*-weighted sagittal image demonstrates a tear within the posterior horn of the medial meniscus (arrow). Oblique tears give rise to flaps which are mechanical unstable and associated with mechanical symptoms. The tear should be eight millimeters or more in length, as shorter peripheral longitudinal tears are less likely to be symptomatic and may heal spontaneously. The medial meniscus is the portion of the cartilage along the inside of the knee joint (closest to the other knee). Proton weighted sagittal image demonstrates an example of a posterior horn medial meniscal horizontal tear (white arrow). Pathology - a tear that has developed gradually in the meniscus. Note: the cartilage deficit more anteriorly on the medial femoral condyle and altered subchondral cortical bone interface, Figure 5. The Royal Australian College of General Practitioners, 100 Wellington Parade, East Melbourne, Victoria 3002, Australia. MR is also able to assess the stability of meniscal tears,6 an important factor, as unstable tears require operative treatment for symptom relief. However, anyone at any age can tear the meniscus. Because other knee injuries can cause similar symptoms, your doctor may order imaging tests to help confirm the diagnosis. One or two other small incisions are made for inserting instruments. 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. J Fam Pract 2001;50:93844. 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. Inferiorly displaced flap tears of the medial meniscus: MR appearance and clinical significance. All rights reserved. Fat-suppressed coronal images demonstrate before and after images following repair of a bucket handle tear. How to treat oblique tear of medial meniscus? All rights reserved. Weakness, grinding, instability or giving way rarely result from meniscal pathology. If you prefer, you can also fill out our appointment request form online now. 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. A tear can also develop slowly as the meniscus loses resiliency. X-rays provide images of dense structures, such as bone. Copyright 1995-2021 by the American Academy of Orthopaedic Surgeons. Meniscus surgery is a common operation to remove or repair a torn meniscus, a piece of cartilage in the knee. In the early days of MR, it was often felt that the role of MR was simply to identify whether a tear was present or not, and treatment of meniscal tears was largely composed of operative resection. 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? 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. Because a torn meniscus is made of cartilage, it won't show up on X-rays. Principles and decision making in meniscal surgery. Clin Sports Med 2010;29:81106. https://orthop.washington.edu/patient-care/articles/sports/torn-meniscus.html, Phone Treatment varies on a case-by-case basis. Surgery is most likely needed to resolve your problem. 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. The medial meniscus is C-shaped, while the lateral meniscus is more . For patients requiring meniscectomy, meniscal autograft has been utilised with good outcomes,2931 but is only performed in specialist centres. There are numerous types of meniscus tears, including: This type of tear is often a sign of degenerative changes in the meniscus tissue. Meniscal ramp lesions can be defined as longitudinal vertical and/or oblique peripheral tears affecting posterior horn of medial meniscus, in a mediolateral direction of less than 2.0 cm, that may lead to meniscocapsular or meniscotibial disruption [ 1 ]. The kneecap (patella) sits in front of the joint to provide some protection. Patients are often aware of movements that aggravate mensical pain, but should also be educated to avoid twisting on a weight bearing, flexed knee. RICE. AJR 2003; 180:93-97. Crawford R, Walley G, Bridgman S, Maffulli N. Magnetic resonance imaging versus arthroscopy in the diagnosis of knee pathology, concentrating on meniscal lesions and ACL tears: a systematic review. Bull NYU Hosp Jt Dis 2010;68:8490. American Board of Orthopaedic Surgery Practice of the Orthopaedic Surgeon: Part-II, certification examination case mix. Historically, medial meniscal root tears have been treated conservatively or by partial meniscectomy. Lufkin R. The MRI manual. I have an oblique tear of the posterior horn medial meniscus with prominent interior medial extrusion. Each knee joint has two crescent-shaped cartilage menisci. (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. How can I tell if I have an oblique fracture? Herrlin S, Hallander M, Wange P, Weidenhielm L, Werner S. Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomised trial. Seldom are they the sign of a problem. Skeletal Radiology 2004; 33:260-264. No bone marrow edema. For these, please consult a doctor (virtually or in person). You might feel a pop when you tear the meniscus. We describe the technique of diagnosis and treatment of a large displaced lateral meniscus flap tear, presenting as a meniscus comma sign. A flap tear is a descriptive term that refers to a situation where the meniscus tears within its midsubstance, usually in a predominantly horizontal pattern, and then the upper or lower component of the torn meniscus becomes displaced from its site of origin (14a).8 These tears are most common at the medial meniscal body, and when displaced, the flap component may migrate into the superior or inferior meniscal gutter (15a,15b). 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. Treatment of meniscal tears includes simple observation, meniscectomy, and meniscal repair. The outer one-third of the meniscus has a rich blood supply. Meniscal injury is common, and the medial meniscus is more frequently injured. The absolute indication for specialist referral is the locked knee loss of joint function necessitates surgical intervention. Tell your doctor of any recurrent swelling or of your knee repeatedly giving way. An MRI scan assesses the soft tissues in your knee joint, including the menisci, cartilage, tendons, and ligaments. This often signals a tear. A meniscus tear can occur when the knee is suddenly twisted while the foot is planted on the ground. There are two in each knee, for a total of four. Includes interactive tool to help you decide. Our preferred repair method utilizes a two-tunnel transtibial pull-out technique. Most oblique meniscus tears are happen in the posterior third of the medial meniscus. Over 2 to 3 days, however, the knee will gradually become more stiff and swollen. Missouri: Mosby, 1998. Pain and/or clicking on compression suggest a meniscal lesion 1,32, Figure 3. These are the horns. Considered a feature of knee osteoarthritis. Lateral meniscus is intact. Radial Tear B. Horizontal Tear C. Vertical Tear D. Longitudinal Tear E. Oblique Tear. Other nonsurgical treatment. The medial meniscus is an important secondary stabilizer of the knee. To learn more, please visit our. Be unable to extend your leg comfortably and may feel better when your knee is bent (flexed). This technique allows for anatomic reduction and fixation of the meniscal root by restoring the joint contact pressure and area similar to the intact state. The skilled interpreter of MR of the knee must do more than simply identify the presence of a meniscal tear. Medial meniscal root tears are radial tears within 1 cm of the meniscal root insertion or an avulsion of the insertion of the meniscus. The medial meniscus is on the innermost side of your knee (the C-shaped curve faces in toward your body, the opposite knee). Flaps cause mechanical instability - meaning they interrupt the smooth function of the knee joint and will make your knee joint feel unstable. 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. Clinical outcomes following isolated lateral meniscal allograft transplantation. On MRI, meniscal tears are evident as a linear signal intensity that extends through the meniscal substance to a free edge17 (Figure 4). swelling . One of the most common knee injuries is a torn meniscus. Clin J Sport Med 2009;19:912. In addition to categorizing meniscal tears based on morphology, care should be taken to describe the exact location of meniscal tears. Those with a meniscus tear are also more likely to develop osteoarthritis in the injured knee. I could not really walk on it. Steroid injection. X-rays. Connect with a U.S. board-certified doctor by text or video anytime, anywhere. Arthroscopy 2010;26:13689. We use cookies to ensure that we give you the best experience on our website. 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. Clinical results of meniscus repair in patients 40 years and older. Scuderi G, Tria A. The posterior horn of the medial meniscus is especially likely to develop tears as we get older. Recovery and rehabilitation take a few weeks. https://www.verywellhealth.com/types-of-meniscus-tears-3862073 J Bone Joint Surg Am 2005;87:71524. The medial meniscus has a firmer capsular attachment than the lateral meniscus. 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. Additional pain may be felt when flexing or twisting the knee. 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. A meniscus tear is an injury to one of the bands of rubbery cartilage that act as shock absorbers for the knee. There are numerous treatments for meniscus tears, but treatment generally begins conservatively depending on the location, type, and size of the tear. Treatment for a meniscus tear will depend on its size, what kind it is, and where it's located within the cartilage. Meniscal repairs are more likely to be successful when performed near the time of injury. can he still play tennis with this injury? There is no resting pain. He/she will probably recommend surgery. Conservative management is important in all patients with acute rest, intensive rehabilitation with physiotherapy and modification of activity. 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. RICE stands for Rest, Ice, Compression, and Elevation. Nicholas Colyvas, MDClinical ProfessorDepartment of Orthopaedic Surgeryorthosurg.ucsf.edu Makris EA, Hadidi P, Athanasiou KA. In many cases, rehabilitation can be carried out at home, although your doctor may recommend working with a physical therapist. Also know what the side effects are. The Royal Australian College of General Practitioners. 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. Horizontal tears can be sewn together rather than removing the damaged portion. A meniscal cyst may present with signs and symptoms consistent with typical meniscal pathology. Depending on the cut thickness, axial MRI images may display the root tear (Figure 3). In addition to the root tear, the MRI often shows chondral loss or fissuring, other areas of meniscal tearing, bone marrow edema or osteophyte formation (Figure 5). Bring someone with you to help you ask questions and remember what your provider tells you. The medial meniscus is an important structure that provides stability, dissipates force and assists to provide normal kinematics of the knee. Usually you will be able to leave the hospital the same day. The device is small and contains a light and a camera, which transmits images from inside the knee onto a monitor. Lim HC, Bae JH, Wang JH, Seok CW, Kim MK. Bernstein J. Henning C, Lynch M, Clark J. Vascularity for healing of meniscus repairs. Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. The vertical flap tear is a displaced type of radial tear that often occurs in the posterior medial meniscus. MRI scans show (left) a normal meniscus and (right) a torn meniscus. 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. All material on this website is protected by copyright. The meniscus is a C-shaped cartilage disk that is found in the knee. 5 Non-Christmas Movies to Watch This Holiday, Best Online Games to Play with your Friends, 12 tips for creating visual content on social media. This website also contains material copyrighted by third parties. A high level of suspicion is required to detect these injuries, and repair is recommended to preserve joint function. This type of tear has an unusual pattern. Vincken PW, ter Braak AP, van Erkel AR, et al. The posterior horn is the thickest and most important for overall function of the knee. 2. Medial and lateral menisci are crescent-shaped fibrocartilage structures that provide joint congruity, stabilization and lubrication and act as shock absorbers for joint preservation. This extrusion should disappear without stress. Tears are noted by how they look, as well as where the tear occurs in the meniscus. Barrett GR, Field MH, Treacy SH, Ruff CG. Guides you through the decision to have surgery for a torn meniscus. Most people can still walk on their injured knee, and many athletes are able to keep playing with a tear. Call us today at (410) 644-1880 or (855) 4MD-BONE (463-2663) to schedule an appointment. A horizontal meniscus tear runs along the circumference of the fibers of the meniscus. The loss of the central attachment of the posterior horn may allow extrusion of the body of the meniscus relative to the joint (13a). Doctors typically provide answers within 24 hours. 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. 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. 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. This pattern of tear requires resection to prevent propagation of the tear as the flap gets caught within the joint during flexion. Surgery is typically the only option and works to trim the damaged portion of the meniscus. or ? Posterior medial meniscal root tears are often times degenerative, but these can also occur with multi-ligament knee injuries in the acute setting. Am J Sports Med 2004;32:67580. Ligaments: their nature and morphology. Think before you speak. The surgeon then inserts surgical instruments through two or three other small portals to trim or repair the tear. Meniscus tears are either degenerative or acute. A meniscectomy requires less time for healing approximately 3 to 6 weeks. The first one is traumatic and the second one is a degenerative meniscal tear. Read before you think. Parrot Beak Tear: MRI Extrusion of the medial meniscus (MM) is associated with knee joint pain in osteoarthritic knees. Repair of such lesions can result in dramatic clinical as well as MR imaging results (17a,17b). 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. McMurray test: The patient lies supine on the bed with the hip and knee both flexed. 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. 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. AJR 1998;170:63-67. 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. Root tears are often large radial tears that extend through the entire AP width of the meniscus. Know what to expect if you do not take the medicine or have the test or procedure. The described meniscal tears will lead to possible necessary total knee replacement. Characterization of the red zone of knee meniscus: MR imaging and histologic correlation. Complex or degenerative tears are where two or more tear patterns exist. The menisci help to transmit weight from one bone to another and play an important role in knee stability. AJSM 2002; 30:589-600. Arthroscopic repair of meniscal tears extending into the avascular zone in patients younger than twenty years of age. No meniscal tears were observed. Patients describe meniscal tears in a variety of ways. Flaps cause mechanical instability - meaning they interrupt the smooth function of the knee joint and will make your knee joint feel unstable. Before your visit, write down questions you want answered. Have swelling, stiffness or tightness in your knee. 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. Knees with a deficient medial meniscus and an ACL tear have an increased anterior tibial translation of about 60% at 90 of flexion. Non-anatomic placement of a PCL reconstruction tibial tunnel is a reported cause of iatrogenic medial meniscal posterior root tears. Dr. Warren Strudwick answered Sports Medicine 32 years experience See your doc: Sounds like it will not get better without arthroscopic surgery. Because there is no supply, there is little capacity for these tears to heal on their own. Medial Meniscus: oblique tear of the posterior portion with a separated and unstable fragment. 2 The risk of osteoarthritis and its progression increase in line with reductions in tibial cartilage coverage. Magnetic resonance imaging as a tool to predict reparability of longitudinal full-thickness meniscus lesions. AJR 2000; 174:161-164. Sources: How to treat an oblique tear of the posterior horn of the medial 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. 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. Knee Surg Sports Traumatol Arthrosc 2010;18:5359. How is Oblique Fracture Treated? The majority of these types of tears do not need surgery. Know the reason for your visit and what you want to happen. Helms CA, Laorr A, Cannon WD, Jr. Conservati For a young person arthroscopic meniscal repair is the best solution. The healing of an Oblique Fracture can take a minimum of four to six weeks to completely heal. Most likely, your doctor will recommend that you rest, use pain relievers, and. Many tears are repaired with dartlike devices that are inserted and placed across the tear to hold it together. Grades 1 and 2 are not considered serious. (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. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website. The lateral meniscus is on the outermost side of your knee, so the tear location is outside-front. You can tear a meniscus during any activity which involves forcefully twisting or rotating the knee. These can occur through either a contact or non-contact injury for example, a pivoting or cutting injury. 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. Apley test (grinding) test: The patient lies prone, with their knee flexed to 90 degrees and their hip extended. Intrasubstance/incomplete tear (top left) This type of tear is often a sign of degenerative changes in the meniscus tissue. 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. The anatomic landmark for repair is anterior to the PCL footprint on the tibia. 2023 The Orthopedic Clinic. Strengthening exercises will gradually be added to your rehabilitation plan. Meniscal injury and repair: clinical status. They will check for tenderness along the joint line where the meniscus sits. Tears present as severe pain, swelling, and possibly catching, clicking, difficulty on deep knee bending and locking of the knee in partial flexion. They are most frequently seen at the posterior horn of the medial meniscus. 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. If you have a follow-up appointment, write down the date, time, and purpose for that visit. This opening pushes the inside edge of your meniscus toward the middle of your knee. The MRI revealed a vertical flap (oblique) tear of the medial meniscus. J Bone J Surg Am 2006;88:6607. The parrot beak shape of an oblique tear (arrow) is readily apparent on (7a) a proton density-weighted axial image of the menisci. Explains two kinds of surgery. Still, many people with a torn meniscus can walk, stand, sit, and sleep without pain. Although C, a vertical tear, is commonly used to describe such an appearance, the better answer is D, a longitudinal tear. (Right) Degenerative tear. 1) [50], [51], [52].Its reported prevalence in middle-aged (45-55 years) individuals . 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. Mri of knee shows "oblique tear posterior horn medial meniscus, lateral patellar plica and minimal synovial knee effusion" will i need surgery? 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. The one towards the back of leg is the posterior horn. 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.