(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. Connect with a U.S. board-certified doctor by text or video anytime, anywhere. One of the main tests for meniscus tears is the McMurray test. 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. The accuracy of physical diagnostic tests for assessing meniscal lesions of the knee: a meta-analysis. You will start with exercises to improve your range of motion. Cole BJ, Dennis MG, Lee SJ, et al. These injuries have been reported to change joint loading due to failure of the meniscus to convert axial loads into hoop stresses. About OrthoInfoEditorial Board Our ContributorsOur Subspecialty Partners Contact Us, Privacy PolicyTerms & Conditions Linking Policy AAOS Newsroom Find an FAAOS Surgeon. Knee Surg Sports Traumatol Arthrosc 2010;18:5359. 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. J Fam Pract 2001;50:93844. Arthroscopic repair of isolated meniscal tears in patients 18 years and younger. The MRI revealed a vertical flap (oblique) tear of the medial meniscus. For patients requiring meniscectomy, meniscal autograft has been utilised with good outcomes,2931 but is only performed in specialist centres. what is the treatment? The treatment may be conservative or sometimes surgery may be required to treat the fracture. Nonsteroidal anti-inflammatory drugs (NSAIDs). Meniscal tears often occur in young patients who have suffered a twisting injury to the knee. 3 Thornton DD, Rubin DA. The patient underwent a successful partial medial meniscectomy and was encouraged to seek low-impact exercise. 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. A lateral meniscus tear (torn meniscus) is a tear of the semicircular fibrous cartilage discs in the knee. All rights reserved. 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. In brief: meniscal tears. Symptoms. Survivorship analysis and clinical outcome of one hundred cases. We use cookies to ensure that we give you the best experience on our website. A medial meniscus tear on the inside of the knee is more common. Clin Sports Med 2010;29:81106. An experimental study in dogs. Orthopedics 2009;32:8. Arthroscopic treatment is typically required for adequate symptom relief in patients with displaced meniscal flap tears. A torn meniscus often can be identified during a physical exam. The menisci help to transmit weight from one bone to another and play an important role in knee stability. Steroid injection. AJR 2003; 180:93-97. By the time people reach their twenties or thirties, intrasubstance changes of the meniscus tissue are common. Imaging tests X-rays. These are paraphrased. There is no resting pain. 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. Successful outcome and patient satisfaction after medial meniscal root repair are established initially upon appropriate diagnosis and patient selection. 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. Tears are noted by how they look, as well as where the tear occurs in the meniscus. Lateral meniscus is intact. Although all bucket handle tears are repair candidates,16 the bucket handle tear is an example of when the more severe appearing tear is actually better for the patient. The medial meniscus is C-shaped, while the lateral meniscus is more . How to Treat Posterior Horn Medial Meniscus Tear. To learn more, please visit our. This website also contains material copyrighted by third parties. These meniscus tears are displaced into the tibia or femoral recesses and can be often difficult to diagnose intraoperatively. These tears can be challenging to recognize on MRI,9 but are important to diagnose since they are often highly symptomatic due to a reactive synovitis. Nonoperative treatments are an important part of the management of all patients, regardless of whether surgery is being considered. Inferiorly displaced flap tears of the medial meniscus: MR appearance and clinical significance. This type of tear has an unusual pattern. They include: Meniscal tears are categorised as traumatic or non-traumatic (degenerative) on the basis . 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. 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. New surgical advances allow surgeons to repair these tears. It has been shown the peak tibiofemoral contact pressure after a total meniscectomy is equal to a posterior medial meniscal root tear. Most likely, your doctor will recommend that you rest, use pain relievers, and. 9 Lecase LK, Helms CA, Kosarek FJ, Garret WE. Bring someone with you to help you ask questions and remember what your provider tells you. This is the most common type of meniscus tear. Operative Arthroscopy, 3rd Edition, 2002, Lippincott Williams and Wilkins. An MRI scan assesses the soft tissues in your knee joint, including the menisci, cartilage, tendons, and ligaments. With regard to tear morphology, the classic ideal candidate for meniscal repair is the peripheral longitudinal tear. 3rd Edition. 12 McGinty JB, Burkhart SS, Jackson RW, et al. Helms CA, Laorr A, Cannon WD, Jr. Surgery is typically the only option and works to trim the damaged portion of the meniscus. Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. RICE. Harrison BK, Abell BE, Gibson TW. 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. Most commonly it is impossible to fully extend the knee; more accurately described as stiffness (termed 'pseudo locking') due either to a small effusion (requiring increased force to bend the tense joint capsule) or to pain inhibition as the femoral condyle compresses the torn meniscus. In cases where a torn meniscus has locked the knee, walking will be affected. 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. Perhaps the best know of these is the bucket-handle tear. 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. Still, many people with a torn meniscus can walk, stand, sit, and sleep without pain. AnteroLateral Meniscus Tear: This means your lateral meniscus is torn and in a location on the front portion of the knee. 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. Educational text answers on HealthTap are not intended for individual diagnosis, treatment or prescription. 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. This is because this area has rich blood supply and blood cells can regenerate meniscus tissue or help it heal after surgical repair. Because there is no supply, there is little capacity for these tears to heal on their own. How is Oblique Fracture Treated? I have an oblique tear of the posterior horn and body of the medial meniscus extending to the inferior articular surface. How can I tell if I have an oblique fracture? Thessaly test: The clinician holds the patient's outstretched hands for support, while the patient stands flat-footed with their knee flexed to 20 degrees and rotates their body and knee three times, internally and externally. Am J Sports Med 2008;36:12839. Not the symmetrical shape of the lateral meniscus (red outline) and the asymmetry of the medial meniscus (blue outline), where the posterior horn (asterisk) is significantly larger than the anterior horn. J Bone Joint Surg Am 2005;87:71524. 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. This presents with a combination of tear patterns. Horizontal tears can be sewn together rather than removing the damaged portion. Before your visit, write down questions you want answered. Solomon L, Warwick D, Nayagam S. Apley's Concise System of Orthopaedics and Fractures. what is the treatment for that? 13 Newman AP, Daniels AU, Burks RT. Meniscus tears simply do not heal on their own, regardless of conservative treatment. 10 DeHaven KE. There are two menisci, a medial one on the "inside" of the knee and a lateral one on the "outside" of the knee. Many tears are repaired with dartlike devices that are inserted and placed across the tear to hold it together. Develop pain gradually along the meniscus and joint line when you put stress on your knees (usually during a repeated activity). These tears often require surgical treatment to restore the proper function of the knee. A barely noticeable tear may resurface years later, triggered by something as simple as tripping over a sidewalk curb. Note: the cartilage deficit more anteriorly on the medial femoral condyle and altered subchondral cortical bone interface, Figure 5. (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. If you have a follow-up appointment, write down the date, time, and purpose for that visit. A meniscal cyst may present with signs and symptoms consistent with typical meniscal pathology. 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. 2nd ed. from the American Academy of Orthopaedic Surgeons, Questions and Answers for Patients Regarding Elective Surgery and COVID-19. Meniscus tears are extremely common knee injuries. Meniscal tear configurations: categorization with MR imaging. Flaps cause mechanical instability - meaning they interrupt the smooth function of the knee joint and will make your knee joint feel unstable. 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. Sounds like it will not get better without arthroscopic surgery. Jarit G, Bosco J. Meniscal repair and reconstruction. Know why a new medicine or treatment is prescribed, and how it will help you. The surgeon then inserts surgical instruments through two or three other small portals to trim or repair the tear. 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. Skeletal Radiology 2004; 33:260-264. There are two in each knee, for a total of four. HealthTap uses cookies to enhance your site experience and for analytics and advertising purposes. (5a) A longitudinal tear of the posterior horn of the medial meniscus is illustrated. Choose a doctor and schedule an appointment. Considered a feature of knee osteoarthritis. If this cartilage tears, the result is pain, stiffness, and swelling. Other established anatomical variants include the transverse meniscal ligaments and the meniscofemoral ligaments, which mimic meniscal tears at their meniscal attachment sites. X-rays. what is the treatment? Detailed review of funding for diagnostic imaging services. Presumptive subarticular stress reactions of the knee: MRI detection and association with meniscal tear patterns. You can tear a meniscus during any activity which involves forcefully twisting or rotating the knee. This is a large horizontal tear of the meniscus. 1) [50], [51], [52].Its reported prevalence in middle-aged (45-55 years) individuals . They may not even be apparent with an arthroscopic examination. Printed from Australian Family Physician - https://www.racgp.org.au/afp/2012/april/meniscal-tear The Australian College of General Practitioners www.racgp.org.au, AJGP: Australian Journal of General Practice, https://www.racgp.org.au/afp/2012/april/meniscal-tear, shock absorption and distributing load throughout the joint, providing nutrition for articular cartilage. The tear can be seen as a white line through the dark body of the meniscus. 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. The best known displaced tear that is amenable to repair is the bucket-handle 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. Figure 1. With proper diagnosis, treatment, and rehabilitation, patients often return to their pre-injury abilities. Complex tears like this are likely to be unstable. In fact, the tear will most likely get bigger leading to additional damage if not taken care of soon. Conservative management of the patient with a meniscal tear. If the tear cant be repaired, occasionally the meniscus can be surgically trimmed. AJSM 2003; 31:216-220. 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. The device is small and contains a light and a camera, which transmits images from inside the knee onto a monitor. 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. It is caused by direct impact in contact sports or twisting. Without nutrients from blood, tears in this "white" zone with limited blood flow cannot heal. When small, conservative therapy or simply rasping the meniscus may result in healing of these tear types. Oblique tears give rise to flaps which are mechanical unstable and associated with mechanical symptoms. 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. 6 Knee Surg Sports Traumatol Arthrosc 2011 Aug 11. Medial meniscal root tears are more frequently diagnosed in patients who are older than 40 years, are overweight and cannot recall an inciting event. 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. Types of meniscus tears:(Left) Bucket handle tear. Other nonsurgical treatment. With the realization that even partial meniscectomy leads to accelerated osteoarthritis,2 surgeons have increasingly turned to meniscal repair. Pain, especially when twisting or rotating your knee. Tears present as severe pain, swelling, and possibly catching, clicking, difficulty on deep knee bending and locking of the knee in partial flexion. 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. . See your ortho for an evaluation. A meniscectomy requires less time for healing approximately 3 to 6 weeks. 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. The most commonly encountered signs are posterior knee pain with deep flexion and joint line tenderness. The vascularity of the peripheral menisci is primarily derived from the Acta Orthop Scand 1982;53:9759. Can a torn meniscus heal by itself? As people age, they are more likely to have degenerative meniscus tears. You might feel a pop when you tear the meniscus.