From January 2018, it was superseded by AJGP: Australian Journal of General Practice, The Royal Australian College of General Practitioners 2021. Torn meniscus symptoms Symptoms are usually sudden onset, however, can develop gradually over time. 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. Arthroscopy. If you are having pain, swelling and catching, then the only reasonable option would be arthroscopic knee surgery. There is a history of sudden inability to fully extend the knee, with a rotational flexion/extension 'trick' required to regain full extension. The medial meniscus is the cushion that is located on the inside part of the knee. The knee meniscus: structure-function, pathophysiology, current repair techniques, and prospects for regeneration. type 3, vertical longitudinal bucket-handle tears; type 4, complex oblique tears; and type 5, bone avulsion fractures of the root attachments. Still, many people with a torn meniscus can walk, stand, sit, and sleep without pain. How to Treat Posterior Horn Medial Meniscus Tear. Normal knee anatomy. Location -A tear may be located in the anterior horn, body, or posterior horn.A posterior horn tear is the most common. Develop pain gradually along the meniscus and joint line when you put stress on your knees (usually during a repeated activity). The question about meniscus tears and the subsequent MRI in emails we receive are numerous. The Thessaly test is the most sensitive and specific clinical test to diagnose meniscal injury. How to treat oblique tear of medial meniscus? Our preferred repair method utilizes a two-tunnel transtibial pull-out technique. Root tears are often large radial tears that extend through the entire AP width of the 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. 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 body usually absorbs these over time. 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. Although the . 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 loss of the central attachment of the posterior horn may allow extrusion of the body of the meniscus relative to the joint (13a). The MRI revealed a vertical flap (oblique) tear of the medial meniscus. Diagnosis can be suspected clinically with joint line tenderness and a positive Mcmurray's test, and can be confirmed with MRI studies. Meniscal tears are the most common lesions followed by the meniscal cyst. If the tear cant be repaired, occasionally the meniscus can be surgically trimmed. 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. 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. A meniscus tear can occur when the knee is suddenly twisted while the foot is planted on the ground. 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. Meniscal repair surgeries do the best when the meniscal tear extends into the middle 50% of meniscal substance. If your symptoms persist with nonsurgical treatment, your doctor may suggest arthroscopic surgery. Clin Orthop Related Res 2010;468:11902. Also know what the side effects are. AJSM 2002; 30:589-600. This pattern of tear requires resection to prevent propagation of the tear as the flap gets caught within the joint during flexion. It is important that these root avulsions are anatomically repaired back to the bone. This puts tension on a torn meniscus. Tears are typically vertical in young patients and horizontal in the elderly (Figure 5). Knee Surg Sports Traumatol Arthrosc 2007;15:393401. We have the medial meniscus on the inner side of the knee and the lateral meniscus on the outer side 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. If your meniscus tear is not severe, your doctor will likely recommend the following treatment: If you have a meniscus tear, physical therapy can help to strengthen the muscles around the knee as well the muscles in your legs which in turn will stabilize and support the knee. Sports-related meniscus injuries often occur along with other knee injuries, such as anterior cruciate ligament (ACL) tears. Before your visit, write down questions you want answered. Grade 3 is a true meniscus tear and an arthroscope is close to 100 percent accurate in diagnosing this tear. The healing time in children is a little less as the healing process is faster in children than in adults. Arthroscopic treatment is typically required for adequate symptom relief in patients with displaced meniscal flap tears. X-rays and MRIsallow the doctor to evaluate the bone and soft tissue at the knee. 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. X-rays. Most likely, your doctor will recommend that you rest, use pain relievers, and. 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. Immediate conservative measures include the RICE regimen: Longer term measures include activity modification, nonsteroidal antiinflammatory drugs (NSAIDs) and physiotherapy.4,1921 Nonsteroidal anti-inflammatory drugs are often recommended for 812 weeks,20 although paracetamol can be considered if NSAIDs are contraindicated or poorly tolerated.22 Where available, intensive physiotherapy is very useful and should include range of motion, proprioceptive work and muscle strengthening exercises. Biomaterials 2011;32:741131. Great Britain: Hodder Arnold, 2005. J Bone Joint Surg Am 2005;87:71524. The menisci are C-shaped fibrocartilages with concave upper surfaces and flat undersides that match their respective interfaces with the femoral condyles and tibial plateau. Oblique tear of the posterior horn and body of the medial meniscus involving inferior articular surface and peripheral meniscal margin. We use cookies to ensure that we give you the best experience on our website. What is Meniscus Radial Tear. In older patients, referral is appropriate if conservative management fails to improve symptoms. Patients are often aware of movements that aggravate mensical pain, but should also be educated to avoid twisting on a weight bearing, flexed knee. For patients requiring meniscectomy, meniscal autograft has been utilised with good outcomes,2931 but is only performed in specialist centres. We have two menisci in either knee. Horizontal tears can be sewn together rather than removing the damaged portion. Anti-inflammatory drugs such as aspirin, ibuprofen, and naproxen help reduce pain and swelling. Oblique tears combine features of radial and longitudinal tears in that they lie perpendicular to the free edge of the meniscus but then curve such that a portion of it lies parallel to the c-shaped fibers of the meniscus. Reactive synovitis and edema (arrowheads) are readily apparent deep to the tibial collateral ligament on the coronal view. w/severe pain? Surgical treatment is usually reserved for younger patients with a vertical longitudinal tear within the vascularised outer third of the meniscus. Evaluation of meniscal injury accounts for most requests for MR imaging of the knee at most institutions. (386) 254-6819, Main Office & Walk-In Clinic They will manipulate your leg into various positions, observe you while you walk, and bend at the knee. The joint is fairly flexible only the last 10-15 degrees is painful, but the pain on walking constant and vulnerable to . 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. Steroid injection. 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). Lists risks and benefits of surgery for meniscus tear. (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. 1175 Dunlawton Ave., Suite 101, Port Orange, FL 32127, Palm Coast 5 Jee WH, McCauley TR, Kim JM, et al. You might develop the following signs and symptoms in your knee: A popping sensation. Meniscus tears, indicated by MRI, are classified in three grades. Meniscal tears within the body of the meniscus or at the meniscocapsular junction represent a well-understood and manageable condition encountered in clinical practice. It is generally divided into 3 separate portions, the anterior horn, the mid-body and the posterior horn. swelling - this usually happens several hours after you injure your meniscus. 2023 Cedars-Sinai. Skeletal Radiology 2004; 33:260-264. Collateral and cruciate ligaments are intact. True locking is less common, and suggests a bucket-handle tear, with the torn fragment preventing full extension. The meniscus is a C-shaped cartilage disk that is found in the knee. 1075 Mason Ave., Daytona Beach, FL 32117, Twin Lakes One of the most common knee injuries is a torn meniscus. The arthroscope is inserted near the knee via a tiny incision. 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. Sources: what is the treatment? Ask if your condition can be treated in other ways. In fact, the tear will most likely get bigger leading to additional damage if not taken care of soon. The ghost sign or absence of an identifiable meniscus anterior to the posterior cruciate ligament is also indicative of a root tear (Figure 2). Research is currently investigating the possibility of implantation of collagen, allogenic and xenogenic cells, embryonic and adult stem cells, or scaffolds derived from polymers, hydrogels, tissues and extracellular matrix,7 and action of biological stimuli (eg. Longitudinal tears do not disrupt the circumferential architecture of the meniscus, and thus repair of longitudinal tears leads to a meniscus with relatively normal biomechanical function. ICD 9 Codes: 717.4 derangement of the lateral meniscus 717.3 derangement of the medial meniscus 836.0 lateral meniscus tear 836.1 medial meniscus tear Case Type / Diagnosis: Functional Anatomy: The menisci are semi lunar shaped cartilages on the medial and lateral sides of the knee joint. Patients describe meniscal tears in a variety of ways. McMurray test: The patient lies supine on the bed with the hip and knee both flexed. Rehabilitation time for a meniscus repair is about 3 to 6 months. 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. Meniscal tear incidence may be as high as six per 1000 population6 with a 2.5 to 4 times male predominance. Henning C, Lynch M, Clark J. Vascularity for healing of meniscus repairs. Liodakis E, Hankemeier S, Jagodzinski M, Meller R, Krettek C, Brand J. Oblique tears give rise to flaps which are mechanical unstable and associated with mechanical symptoms. Sometimes conservative treatment doesnt work. Medial meniscal root tears are more frequently diagnosed in patients who are older than 40 years, are overweight and cannot recall an inciting event. Pain, especially when twisting or rotating your knee. Also write down any new instructions your provider gives you. See your ortho for an evaluation. Afterward, you may experience: pain, especially when the area is touched. The younger population, particularly males with knee instability, is most commonly affected by this type of tear [56]. A magnetic resonance imaging (MRI) scan is often used to diagnose meniscal injuries.