They may not even be apparent with an arthroscopic examination. 4 Hauger O, Frank LR, Boutin RD, et al. 8 Ruff C, Weingardt J, Russ P, Kilcoyne R. MR imaging patterns of displaced meniscus injuries of the knee. If you have a follow-up appointment, write down the date, time, and purpose for that visit. Diagnosis can be suspected clinically with joint line tenderness and a positive Mcmurray's test, and can be confirmed with MRI studies. 1993;9(1):33-51. Henning C, Lynch M, Clark J. Vascularity for healing of meniscus repairs. Arthroscopic meniscus repairs typically takes about 40 minutes. The Thessaly test for detection of meniscal tears: validation of a new physical examination technique for primary care medicine. Performing activities that involve aggressive pivoting and twisting of the knee puts you at a significantly higher risk of tearing your meniscus. 12 Sources By Jonathan Cluett, MD 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. The posterior horn is the thickest and most important for overall function of the knee. w/severe pain? 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. 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. Indications for meniscal root repair are acute, traumatic root tears in patients with nearly normal or normal cartilage (Outerbridge grade 0 to 2) and chronic symptomatic root tears in active patients without significant pre-existing osteoarthritis (OA). Sagittal peripheral meniscal images demonstrate the normal anatomical 'bow-tie configuration' (the central meniscal body with the anterior and posterior horns as well circumscribed triangles. Depending on the cut thickness, axial MRI images may display the root tear (Figure 3). Optimal diagnosis and management is essential to prevent long term sequelae. Meniscus tears can happen during physical activities, but they can also occur from: Sometimes, a torn meniscus can occur due to degenerative changes in the knee, even if there is little to no trauma. Description of Medial Meniscus Tear The medial meniscus is an important shock absorber on the inside (medial) aspect of the knee joint. American Board of Orthopaedic Surgery Practice of the Orthopaedic Surgeon: Part-II, certification examination case mix. This information is provided as an educational service and is not intended to serve as medical advice. During the exam, your doctor will look for signs of tenderness along the joint line. A magnetic resonance imaging (MRI) scan is often used to diagnose meniscal injuries. The skilled interpreter of MR of the knee must do more than simply identify the presence of a meniscal tear. 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. There are numerous types of meniscus tears, including: 1. The medial meniscus is the cushion that is located on the inside part of the knee. Clinical results of meniscus repair in patients 40 years and older. A comparative study with a short term follow up. If you have a meniscus tear, this movement may cause pain, clicking, or a clunking sensation within the joint. Includes interactive tool to help you decide. Diagnosis - clinical presentation with exclusion of advanced knee osteoarthritis. If you undergo surgery it will likely be followed by physical therapy to optimize knee strength and stability. My husband has complex tear of the body and posterior horn of the medial meniscus with flap components, horizontal oblique tear of the body and posterior horn lateral meniscus. I have an oblique tear of the posterior horn of my medial meniscus that extends to the undersurface of the cartilage. 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. It is important to describe your symptoms accurately. a feeling that your knee is catching or locking, usually when it's bent - you may notice it clicking. 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. Garrett WE Jr, Swiontkowski MF, Weinstein JN, et al. Several variations in meniscal tear patterns have been granted specific names that recognize the unique characteristics of the tear. 17 Old Kings Road N., Suite K Palm Coast, FL 32137, East Coast Surgery Center 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. How to treat oblique tear of medial meniscus? Knowing where and how a meniscus was torn helps the doctor determine the best treatment.. 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. A medial meniscus tear on the inside of the knee is more common. Reciprocally, an increased force is also placed on an ACL graft with a deficient medial meniscus. Skeletal Radiol 2007;36:14551. The meniscus is a C-shaped cartilage disk that is found in the knee. Symptoms of a meniscus tear. The vertical flap tear is a displaced type of radial tear that often occurs in the posterior medial meniscus. These are the menisci. Surgery is most likely needed to resolve your problem. type 3, vertical longitudinal bucket-handle tears; type 4, complex oblique tears; and type 5, bone avulsion fractures of the root attachments. Conservative management is important in all patients with acute rest, intensive rehabilitation with physiotherapy and modification of activity. The Thessaly test is the most sensitive and specific clinical test to diagnose meniscal injury. Although rarely taught and poorly utilised, recent validation demonstrated a sensitivity of 90%, and specificity of 98% in detecting meniscal injury.10, If clinically suspicious of meniscal injury, a trial of conservative measures may be considered or confirmation with magnetic resonance imaging (MRI). 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 relationships among MM radial/oblique tears, MM extrusion (MME), and the effect of arthroscopic meniscal repair are not established. The tear results in a vertical signal abnormality on sagittal MR images. Gillquist J, Hamberg P, Lysholm J. Endoscopic partial and total meniscectomy. Missouri: Mosby, 1998. Sports-related meniscus injuries often occur along with other knee injuries, such as anterior cruciate ligament (ACL) tears. Tears that lie within or contact the red zone are also more likely to be amenable to meniscal repair. Barrett GR, Field MH, Treacy SH, Ruff CG. Nicholas Colyvas, MDClinical ProfessorDepartment of Orthopaedic Surgeryorthosurg.ucsf.edu This type of tear is particularly devastating to meniscal function. 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. Radiographs may or may not show medial joint space narrowing. All Rights Reserved. Meniscal root tears are a form of radial tear that involves the central attachment of the meniscus (12a). bucket-handle tear: displaced vertical tear parrot beak tear: oblique radial tear Radiographic features Plain radiograph On plain radiographs, meniscal tears are not visible. Clin Sports Med 2010;29:81106. What to Do If Your Orthopaedic Surgery Is Postponed. https://orthop.washington.edu/patient-care/articles/sports/torn-meniscus.html, Phone Also know what the side effects are. London;1897. Injury, degeneration, or surgical removal of all or part of the meniscus is associated with an increased risk of developing knee osteoarthritis. This type of tear has an unusual pattern. 1 article features images from this case 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. Helms CA, Laorr A, Cannon WD, Jr. The meniscus is broken down into the outer, middle, and inner thirds. 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). Radial Tear B. Horizontal Tear C. Vertical Tear D. Longitudinal Tear E. Oblique Tear. Inferiorly displaced flap tears of the medial meniscus: MR appearance and clinical significance. Prospective evaluation of 1485 meniscal tear patterns in patients with stable knees. Cole BJ, Dennis MG, Lee SJ, et al. 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. Lists risks and benefits of surgery for meniscus tear. A tear can also develop slowly as the meniscus loses resiliency. Semin Roentgenol. 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. There may be some pain. Harrison BK, Abell BE, Gibson TW. What is Meniscus Radial Tear. Likewise, physical exam findings of an effusion, a positive McMurray test and a positive Apley grind test are not usually present. Arthroscopy 2006;22:77180. 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. OKeefe R, et al. (5a) A longitudinal tear of the posterior horn of the medial meniscus is illustrated. In this short surgical video, a degenerative meniscus tear is smoothed down with a motorized shaver during a partial meniscectomy. The meniscus is a thick cartilage structure that sits between the bones of the knee. The clinician applies axial pressure to the foot and rotates the tibia internally and externally. 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. Knee arthroscopy is one of the most commonly performed surgical procedures. More often, the patient will complain of joint line pain with a minor traumatic event, such as squatting. Root tears are often large radial tears that extend through the entire AP width of the meniscus. From January 2018, it was superseded by AJGP: Australian Journal of General Practice, The Royal Australian College of General Practitioners 2021. Flaps cause mechanical instability - meaning they interrupt the smooth function of the knee joint and will make your knee joint feel unstable. A prospective study of the nonoperative treatment of degenerative meniscus tears. 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. A meniscus tear is an injury to one of the bands of rubbery cartilage that act as shock absorbers for the knee. Still, many people with a torn meniscus can walk, stand, sit, and sleep without pain. The amount of pain and first appearance of swelling can give important clues about where and how bad the injury is. In addition, focal chondral lesions occur more commonly with medial than lateral-sided injuries. Disclosures: Blake and Johnson report no relevant financial disclosures. Your meniscus acts like a cushion between your thigh bone (femur) and shin bone (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). Flaps cause mechanical instability - meaning they interrupt the smooth function of the knee joint and will make your knee joint feel unstable. 2023 Cedars-Sinai. 15 Koski JA, Ibarra C, Rodeo SA. 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. It is caused by direct impact in contact sports or twisting. Bring someone with you to help you ask questions and remember what your provider tells you. An MRI is 70 to 90 percent accurate in identifying whether the meniscus has been torn and how badly. 2. Although C, a vertical tear, is commonly used to describe such an appearance, the better answer is D, a longitudinal tear. Explains when surgery is done. Referral is also indicated if the diagnosis is uncertain for review and to access MRI. The RICE protocol is effective for most sports-related injuries. Question options: . Principles and decision making in meniscal surgery. Dr. Warren Strudwick answered Sports Medicine 32 years experience See your doc: Sounds like it will not get better without arthroscopic surgery. In many cases, rehabilitation can be carried out at home, although your doctor may recommend working with a physical therapist. If you have a meniscus tear, this movement may cause pain, clicking, or a clunking sensation within the joint. (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. 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. (14a) A 3D depiction of a flap tear of the posterior body of the medial meniscus illustrates displacement of the upper component of the flap (arrow) from its site of origin. Tell your doctor of any recurrent swelling or of your knee repeatedly giving way. 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. Nonsteroidal anti-inflammatory drugs (NSAIDs). 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. 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. This means that athletes, especially those who participate in contact sports like football, are at a higher risk of sustaining this injury. Types of meniscus tears:(Left) Bucket handle tear. Each knee has two C-shaped pieces of cartilage known as menisci. These imaging pearls improve recognition of meniscal root tears (Figure 2). Most oblique meniscus tears are happen in the posterior third of the medial meniscus. Fat-suppressed proton density-weighted (4a) sagittal and (4b) coronal images reveal a horizontal tear of the posterior horn of the medial meniscus (arrows), extending to the tibial surface. Patients describe meniscal tears in a variety of ways. . The role of preoperative MRI in knee arthroscopy: a retrospective analysis of 2,000 patients. The menisci the medial meniscus and lateral meniscus - are crescent-shaped bands of thick, rubbery cartilage attached to the shinbone (tibia). Full thickness tears are the complete disruption of the fibers of the supraspinatus muscle, and generally require a more aggressive treatment plan and surgery. Patients with ACL tears are also thought to be better candidates for meniscal repair because of the presence of serum-derived growth factors within the hemarthrosis that accompanies ACL tears.15. In cases where surgery is required, this time frame increases to somewhere around three to four months. Lim HC, Bae JH, Wang JH, Seok CW, Kim MK. Metcalf MH, Barrett GR. 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. You may be asked about your physical and athletic goals to help your doctor decide on the best treatment for you. Makris EA, Hadidi P, Athanasiou KA. Without nutrients from blood, tears in this "white" zone with limited blood flow cannot heal. In this case, a portion may break off, leaving frayed edges. 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. 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. Because there is no supply, there is little capacity for these tears to heal on their own. With regard to tear morphology, the classic ideal candidate for meniscal repair is the peripheral longitudinal tear. Can a torn meniscus heal by itself? 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). Tears are typically vertical in young patients and horizontal in the elderly (Figure 5). The meniscus is a piece of rubber-like cartilage in the knee situated within the femur and tibia, or thigh bone and shin bone.
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