Similarly, tears that are not associated with locking of the knee will typically become less painful over time. Seldom are they the sign of a problem. Non-anatomic placement of a PCL reconstruction tibial tunnel is a reported cause of iatrogenic medial meniscal posterior root tears. Meniscal tear configurations: categorization with MR imaging. (12a) A radial tear (arrow) truncates the central attachment/root of the posterior horn of the medial meniscus on this fat suppressed proton density-weighted coronal image. Medial meniscus tears are most frequently addressed with a partial meniscectomy, which involves arthroscopically removing the damaged portion of cartilage. How to treat an oblique tear of the posterior horn of the medial meniscus? Medial and lateral menisci are crescent-shaped fibrocartilage structures that provide joint congruity, stabilization and lubrication and act as shock absorbers for joint preservation. A meniscus can be split in half, ripped around its circumference in the shape of a C or left hanging by a thread to the knee joint. 3rd edn. If you have a follow-up appointment, write down the date, time, and purpose for that visit. Know why a new medicine or treatment is prescribed, and how it will help you. Treatment of meniscal tears includes simple observation, meniscectomy, and meniscal repair. Presumptive subarticular stress reactions of the knee: MRI detection and association with meniscal tear patterns. 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. Progressive weight-bearing begins at 6 weeks, with full weight-bearing at 8 weeks. Medial meniscal root tears are radial tears within 1 cm of the meniscal root insertion or an avulsion of the insertion of the meniscus. Additional pain may be felt when flexing or twisting the knee. The posterior horn is the thickest and most important for overall function of the knee. Other nonsurgical treatment. 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. How can I tell if I have an oblique fracture? For potential or actual medical emergencies, immediately call 911 or your local emergency service. The majority of these types of tears do not need surgery. Tears to the medial meniscal root change the biomechanics and kinematics of the knee, which cause early degeneration of the joint. (Lateral one = ACL, medial one= chondral injury) The tear can be seen as a white line through the dark body of the meniscus. Although the pain improved, the patient could not flex her knee joint deeply. In sports, a meniscus tear usually happens suddenly. 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. Skeletal Radiology 2004; 33:260-264. A longitudinal tear is an example of this kind of tear. Lists risks and benefits of surgery for meniscus tear. 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. It is possible that your symptoms of pain, etc will improve with time without surgery.But that doesn't mean the tear healed. We have two menisci in either knee. 17 Old Kings Road N., Suite K Palm Coast, FL 32137, East Coast Surgery Center Prospective evaluation of allograft meniscus transplantation: a minimum 2-year follow-up. Conservative management is important in all patients with acute rest, intensive rehabilitation with physiotherapy and modification of activity. Horizontal tears can be sewn together rather than removing the damaged portion. The surgery requires a few small incisions and takes about an hour. This type of tear is particularly devastating to meniscal function. This opening pushes the inside edge of your meniscus toward the middle of your knee. The role of preoperative MRI in knee arthroscopy: a retrospective analysis of 2,000 patients. The procedure can reduce pain, improve mobility and stability, and get you back to life's activities. summary. These lie on the inside (medial) and outside (lateral) edges of the top of your tibia (shin bone). The vertical flap tear is a displaced type of radial tear that often occurs in the posterior medial meniscus. a feeling that your knee is catching or locking, usually when it's bent - you may notice it clicking. 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. Krych AJ, McIntosh AL, Voll AE, Stuart MJ, Dahm DL. Because the pieces cannot grow back together, symptomatic tears in this zone that do not respond to conservative treatment are usually trimmed surgically. Disclosures: Blake and Johnson report no relevant financial disclosures. 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. Those with a meniscus tear are also more likely to develop osteoarthritis in the injured knee. Collateral and cruciate ligaments are intact. Lateral meniscus is intact. Although C, a vertical tear, is commonly used to describe such an appearance, the better answer is D, a longitudinal tear. Henning C, Lynch M, Clark J. Vascularity for healing of meniscus repairs. 1 Sutton JB. Most people can still walk on their injured knee, and many athletes are able to keep playing with a tear. 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. Missouri: Mosby, 1998. Following root repair, patients are required to remain non-weight-bearing for 6 weeks. The one towards the back of leg is the posterior horn. Arthroscopic meniscus repairs typically takes about 40 minutes. 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. Arthroscopy 2006;22:77180. Our preferred repair method utilizes a two-tunnel transtibial pull-out technique. However, meniscus tears do not always appear on MRIs. Lufkin R. The MRI manual. Considered a feature of knee osteoarthritis. Sekiya JK, West RV, Groff YJ, Irrgang JJ, Fu FH, Harner CD. 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. The menisci act as cushions between your shin bone (tibia) and your thigh bone (femur). The described meniscal tears will lead to possible necessary total knee replacement. 13 Newman AP, Daniels AU, Burks RT. https://www.verywellhealth.com/types-of-meniscus-tears-3862073 How to Treat Posterior Horn Medial Meniscus Tear. They may not even be apparent with an arthroscopic examination. If you have a meniscus tear, this movement may cause pain, clicking, or a clunking sensation within the joint. Operative Arthroscopy, 3rd Edition, 2002, Lippincott Williams and Wilkins. The healing time in children is a little less as the healing process is faster in children than in adults. The McMurray test (shown here) will help your doctor determine if you have a meniscus tear. I have an oblique tear of the posterior horn and body of the medial meniscus extending to the inferior articular surface. I have an oblique tear of the posterior horn of the medial meniscus, what is the treatment for that? If this cartilage tears, the result is pain, stiffness, and swelling. The meniscus shows up as black on the MRI. Oblique tears give rise to flaps which are mechanical unstable and associated with mechanical symptoms. An MMPH repair in an ACL-deficient knee showed a significant decrease in anterior-posterior tibial translation at all flexion angles except 60 compared with the ACL-deficient/MMPH tear state . https://www.webmd.com/pain-management/knee-pain/meniscus-tear-injury 4 Hauger O, Frank LR, Boutin RD, et al. A meniscectomy requires less time for healing approximately 3 to 6 weeks. If a repair is attempted within meniscal tissue that is questionably vascular or non-vascular, healing enhancement techniques such as the use of fibrin clot and the creation of channels that communicate with the vascular zone may be utilized.10. However, whether they will respond well to surgery depends on the type of tear, the location, and blood flow in the area where the tear occurred. This often signals a tear. Arnoczky SP, Warren RF, Spivak JM. Pain is typically medial and activity-related (e.g. Younger and elderly patients typically sustain different types of tears. This extrusion should disappear without stress. What is Meniscus Radial Tear. The medial meniscus is an important secondary stabilizer of the knee. Referral to an orthopaedic surgeon is important if the diagnosis is uncertain or there is minimal improvement at clinical review. Jarit G, Bosco J. Meniscal repair and reconstruction. 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. Flaps cause mechanical instability - meaning they interrupt the smooth function of the knee joint and will make your knee joint feel unstable. Br Med Bull 2007;84:523. or ? 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). what is the treatment? This information is provided as an educational service and is not intended to serve as medical advice. Athletes, particularly those who play contact sports, are at risk for meniscus tears. One or two other small incisions are made for inserting instruments. Peripheral meniscal tears are located in the most vascular portion of the menisci and comprise 39-72 % [2, 3, 56, 69, 82] of all meniscal tears. An MRI scan assesses the soft tissues in your knee joint, including the menisci, cartilage, tendons, and ligaments. [Epub ahead of print]. Sometimes conservative treatment doesnt work. https://www.verywellhealth.com/types-of-meniscus-tears-3862073, https://www.webmd.com/pain-management/knee-pain/meniscus-tear-injury, https://orthop.washington.edu/patient-care/articles/sports/torn-meniscus.html, A sensation that the knee is locked in place. They will manipulate your leg into various positions, observe you while you walk, and bend at the knee. RICE. Common tears include bucket handle, flap, and radial. Orthopedics 2009;32:8. Although surgical repair has led to improved patient-reported function, there are conflicting reports on the progression of cartilage degeneration. On MRI, meniscal tears are evident as a linear signal intensity that extends through the meniscal substance to a free edge17 (Figure 4). With meniscal repair, weight bearing may be severely limited for up to six weeks following surgery, and protection from heavy stress to the knee extends for up to six months. By the time people reach their twenties or thirties, intrasubstance changes of the meniscus tissue are common. 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. They are most frequently seen at the posterior horn of the medial meniscus. (386) 254-6819, Main Office & Walk-In Clinic All rightsreserved. (Left) Radial tear. There are numerous treatments for meniscus tears, but treatment generally begins conservatively depending on the location, type, and size of the tear. The amount of pain and first appearance of swelling can give important clues about where and how bad the injury is. Requests for permission to reprint articles must be sent to permissions@racgp.org.au. Meniscal repair is a more difficult surgical technique and requires a motivated, diligent patient in order to be successful. Arthroscopy 2010;26:13689. Each knee has two C-shaped pieces of cartilage known as menisci. AJSM 2002; 30:589-600. Sometimes, its possible to repair a torn meniscus, especially if you are a young adult. Acute meniscus tears often happen during sports. The second patient reviewed in this video is an 11-year-old girl who fell while playing tag and hit the front of her left lower leg. When small, conservative therapy or simply rasping the meniscus may result in healing of these tear types. Grade 3 is a true meniscus tear and an arthroscope is close to 100 percent accurate in diagnosing this tear. 7 Yao L, Stanczak J, Boutin RD. Depending on the cut thickness, axial MRI images may display the root tear (Figure 3). Biomechanical studies have demonstrated that repair of medial meniscus posterior root tears leads to improved contact mechanics. Clinical: Most trauma to knee joint is caused by a lateral blow at knee level when foot is planted when knee is slightly flexed. Your meniscus acts like a cushion between your thigh bone (femur) and shin bone (tibia). We have the medial meniscus on the inner side of the knee and the lateral meniscus on the outer side of the knee. With regard to tear morphology, the classic ideal candidate for meniscal repair is the peripheral longitudinal tear. A barely noticeable tear may resurface years later, triggered by something as simple as tripping over a sidewalk curb. 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. The parrot beak shape of an oblique tear (arrow) is readily apparent on (7a) a proton density-weighted axial image of the menisci. apalia R, Del Buono A, Osti L, Denaro V, Maffulli N. Meniscectomy as a risk factor for knee osteoarthritis: a systematic review. Harrison BK, Abell BE, Gibson TW. AJR 2003; 180:93-97. If you are having pain, swelling and catching, then the only reasonable option would be arthroscopic knee surgery. Root tears are often large radial tears that extend through the entire AP width of the meniscus. In addition to categorizing meniscal tears based on morphology, care should be taken to describe the exact location of meniscal tears. 2023 The Orthopedic Clinic. See your ortho for an evaluation. If your symptoms persist with nonsurgical treatment, your doctor may suggest arthroscopic surgery. Many tears are repaired with dartlike devices that are inserted and placed across the tear to hold it together. No bone marrow edema. What is the posterior horn of the medial meniscus? In rare cases secondary signs can be seen, such as a soft tissue swelling next to the meniscus when a meniscal cyst is present 4. The healing of an Oblique Fracture can take a minimum of four to six weeks to completely heal. They will check for tenderness along the joint line where the meniscus sits. AnteroLateral Meniscus Tear: This means your lateral meniscus is torn and in a location on the front portion of the knee. Many meniscus tears will not need immediate surgery. Oblique tears commonly cause flaps and flaps are generally not good. The medial meniscus is on the innermost side of your knee (the C-shaped curve faces in toward your body, the opposite knee). 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. (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. 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? The MRI revealed a vertical flap (oblique) tear of the medial meniscus. These tears often require surgical treatment to restore the proper function of the knee. Location -A tear may be located in the anterior horn, body, or posterior horn.A posterior horn tear is the most common. 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. 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'. Successful outcome and patient satisfaction after medial meniscal root repair are established initially upon appropriate diagnosis and patient selection. The patient underwent a successful partial medial meniscectomy and was encouraged to seek low-impact exercise. The test is positive if symptoms are reproduced on rotation 10. Treatment or management protocols for posterior horn menial meniscus tears are quite challenging. Adjunctive measures to promote vascularity and healing at the repair sites are also recommended. 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. Rosemont, Ill. American Academy of Orthopaedic Surgeons. Full thickness tears are the complete disruption of the fibers of the supraspinatus muscle, and generally require a more aggressive treatment plan and surgery. Most oblique meniscus tears are happen in the posterior third of the medial meniscus. The Royal Australian College of General Practitioners. Meniscus tears are injuries that occur in the cartilage of the knee. New advances in musculoskeletal pain. The medial meniscus transmits approximately 50% of the total joint load of the knee medial compartment, thus protecting the articular cartilage from excessive force. Prospective evaluation of 1485 meniscal tear patterns in patients with stable knees. (13a) A coronal image from another patient with a medial meniscal root tear demonstrates associated severe medial subluxation of the meniscal body (arrow). The Royal Australian College of General Practitioners, 100 Wellington Parade, East Melbourne, Victoria 3002, Australia. By using our website, you consent to our use of cookies. 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. (Right) Degenerative tear. 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. Symptoms of a meniscus tear. Sometimes this type of tear can heal on its own but it may require surgery if symptoms dont subside. 2000-2022 The StayWell Company, LLC. When appropriate, tears that appear to involve the periphery, or red zone of the meniscus, should be described as such (9a), thereby alerting the surgeon to the fact that the tear is more amenable to repair. Fat-suppressed coronal images demonstrate before and after images following repair of a bucket handle tear. At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. These are the horns. 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. Pain and/or clicking on compression suggest a meniscal lesion 1,32, Figure 3. Jul 2000;35(3):217-30. The meniscus is a piece of C-shaped cartilage that helps cushion the knee. Nonoperative treatments are an important part of the management of all patients, regardless of whether surgery is being considered. HealthTap uses cookies to enhance your site experience and for analytics and advertising purposes. A tear in this "red" zone may heal on its own, or can often be repaired with surgery. 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.
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