Tears that lie within or contact the red zone are also more likely to be amenable to meniscal repair. What Is a Tear of the Anterior Horn of the Lateral Meniscus? I have been diagnosed with a subtle oblique tear involving This pattern of tear requires resection to prevent propagation of the tear as the flap gets caught within the joint during flexion. 4 Hauger O, Frank LR, Boutin RD, et al. Magnetic resonance imaging (MRI) scans. These injuries have been reported to change joint loading due to failure of the meniscus to convert axial loads into hoop stresses. What is Posterior Horn Medial Meniscus Tear: Causes, Symptoms Most people can still walk on their injured knee, and many athletes are able to keep playing with a tear. Know why a new medicine or treatment is prescribed, and how it will help you. 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. Biomechanical studies have demonstrated that repair of medial meniscus posterior root tears leads to improved contact mechanics. See your ortho for an evaluation. Knee Surg Sports Traumatol Arthrosc 2007;15:393401. Acta Orthop Scand 1982;53:9759. (3a) A fat-suppressed proton density-weighted axial image through the knee joint demonstrates the C-shaped menisci. 1871 LPGA Blvd., Daytona Beach, FL 32117. Survivorship analysis and clinical outcome of one hundred cases. Know how you can contact your provider if you have questions. 5 Jee WH, McCauley TR, Kim JM, et al. Following root repair, patients are required to remain non-weight-bearing for 6 weeks. The meniscus root attachment aids meniscal function by securing the meniscus in place and allowing for optimal shock-absorbi These imaging pearls improve recognition of meniscal root tears (Figure 2). Fax By the time people reach their twenties or thirties, intrasubstance changes of the meniscus tissue are common. Does a degenerative meniscus tear need surgery? - Howard J. Luks, MD what is the treatment? Horizontal Meniscus Tears: Surgery or Conservative Care? Meniscal tear incidence may be as high as six per 1000 population6 with a 2.5 to 4 times male predominance. Rehabilitation of the knee following sports injury. Only a small peripheral rim of meniscal tissue (arrowhead) is present at the native site of the lateral meniscus. The most common symptoms of a meniscus tear are: After discussing your symptoms and medical history, your doctor will examine your knee. Medial meniscal root tears are radial tears within 1 cm of the meniscal root insertion or an avulsion of the insertion of the meniscus. OITE 7 Flashcards | Chegg.com If this cartilage tears, the result is pain, stiffness, and swelling. Management of degenerative meniscal tears and the role of surgery If the fracture is stable or closed where the bones do not move out of alignment then simple immobilization with the use of a sling, splint or cast for a few weeks allowing the fracture to heal may be enough. Meniscus tears, indicated by MRI, are classified in three grades. If mechanical symptoms are present in this subset of patients, a partial or subtotal meniscectomy may improve symptoms; although, these tears are not usually associated with traditional meniscal-based mechanical symptoms. The primary objective is to control the disease process to avoid the complications . Torn meniscus - Symptoms and causes - Mayo Clinic 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). Meniscal repair using an exogenous fibrin clot. Jarit G, Bosco J. Meniscal repair and reconstruction. Still, many people with a torn meniscus can walk, stand, sit, and sleep without pain. 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. 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. Singapore: World scientific, 2010. (5a) A longitudinal tear of the posterior horn of the medial meniscus is illustrated. 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. Oblique tears commonly cause flaps and flaps are generally not good. 15 Koski JA, Ibarra C, Rodeo SA. If your doctor suspects a torn meniscus, he or she will perform aphysicalexam. Acute meniscus tears often happen during sports. It is caused by direct impact in contact sports or twisting. Arthroscopic repair of meniscal tears extending into the avascular zone in patients younger than twenty years of age. MR imaging: effectiveness and costs at triage of patients with nonacute knee symptoms. Meniscus surgery is a common operation to remove or repair a torn meniscus, a piece of cartilage in the knee. Explains two kinds of surgery. Meniscal injury and repair: clinical status. Cole BJ, Dennis MG, Lee SJ, et al. 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). Harrison BK, Abell BE, Gibson TW. 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. Tears of the posterior medial meniscal root have shown to disrupt the normal motion of the knee, resulting in degenerative arthritis. Pain, especially when twisting or rotating your knee. A comparative study with a short term follow up. Our preferred repair method utilizes a two-tunnel transtibial pull-out technique. The kneecap (patella) sits in front of the joint to provide some protection. We use cookies to ensure that we give you the best experience on our website. Liodakis E, Hankemeier S, Jagodzinski M, Meller R, Krettek C, Brand J. This leads to decreased contact area and increased contact pressure and ultimately results in joint overloading and degenerative changes in the knee similar to a total meniscectomy state. 13 Newman AP, Daniels AU, Burks RT. A tear can also develop slowly as the meniscus loses resiliency. 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. Tears that are stable, < 1 cm in length, and that do not cause significant . In some cases, your doctor may suggest an arthroscopyto examine and possibly treat your knee. Additionally, the individual will not be able to move the joint due to pain. The procedure can reduce pain, improve mobility and stability, and get you back to life's activities. 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. The parrot beak shape of an oblique tear (arrow) is readily apparent on (7a) a proton density-weighted axial image of the menisci. RACGP - Meniscal tear - presentation, diagnosis and management There will also be skin discoloration and visible deformity at the site of the injury. Referral to an orthopaedic surgeon is important if the diagnosis is uncertain or there is minimal improvement at clinical review. 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. This provides a clear view of the inside of the knee. A medial meniscus tear on the inside of the knee is more common. Medial meniscal posterior root tears represent an often unrecognized pathology with potentially devastating long-term effects. Missouri: Mosby, 1998. Conservative management is important in all patients with acute rest, intensive rehabilitation with physiotherapy and modification of activity. 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. The treatment of these type of tears can be either arthroscopy (surgery through a tiny hole in knee) or conservative. Note: the cartilage deficit more anteriorly on the medial femoral condyle and altered subchondral cortical bone interface, Figure 5. 2. Know why a test or procedure is recommended and what the results could mean. The meniscus is broken down into the outer, middle, and inner thirds. In many cases, rehabilitation can be carried out at home, although your doctor may recommend working with a physical therapist. 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). These are paraphrased. Every care is taken to reproduce articles accurately, but the publisher accepts no responsibility for errors, omissions or inaccuracies contained therein or for the consequences of any action taken by any person as a result of anything contained in this publication. Meniscus tears are among the most common knee injuries. Knee arthroscopy is one of the most commonly performed surgical procedures. You may be asked about your physical and athletic goals to help your doctor decide on the best treatment for you. These tears occur within the avascular zone of the meniscus where there is no blood supply. The role of preoperative MRI in knee arthroscopy: a retrospective analysis of 2,000 patients. Most likely, your doctor will recommend that you rest, use pain relievers, and. 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 . 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. Inferiorly displaced flap tears of the medial meniscus: MR appearance and clinical significance. The meniscus is a piece of C-shaped cartilage that helps cushion the knee. Get the latest news and education delivered to your inbox, Receive an email when new articles are posted on, Please provide your email address to receive an email when new articles are posted on. 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. Meniscal repair surgeries do the best when the meniscal tear extends into the middle 50% of meniscal substance. 6 Types of Meniscus Tears and Locations - Verywell Health 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. This website also contains material copyrighted by third parties. 2013. Posterior Horn Medial Meniscus Tear | Knee Meniscus Tear These tears often require surgical treatment to restore the proper function of the knee. Bull NYU Hosp Jt Dis 2010;68:8490. They act as shock absorbers and stabilize the knee. Chahla and Geeslin report no relevant financial disclosures. Arthroscopy. The anterior horn of the medial meniscus demonstrates half of the normal anatomic 'bow-tie configuration'. You can tear a meniscus during any activity which involves forcefully twisting or rotating the knee. Because the pieces cannot grow back together, symptomatic tears in this zone that do not respond to conservative treatment are usually trimmed surgically. As stated above, the most common cause of Posterior Horn Medial Meniscus Tear can be trauma to the knee which can be sustained due to a sporting injury, a slip and fall, a blunt trauma to the knee, and in majority of the cases natural degeneration of the meniscus due to the work load of the knee. Your meniscus acts like a cushion between your thigh bone (femur) and shin bone (tibia). Feb 1995;11(1):29-36. Non-operative treatment of degenerative posterior root tear of the medial meniscus. Complex tears like this are likely to be unstable. 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. Arthroscopic total meniscectomy Occasionally, a large tear of the outer meniscus can best be treated by arthroscopic total meniscectomy, a procedure in which the entire meniscus is removed. 6 Types of Meniscus Tears - Orthopaedic Associates of Central Maryland Injury, degeneration, or surgical removal of all or part of the meniscus is associated with an increased risk of developing knee osteoarthritis. Knee pain: 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 Read More oblique tear of the posterior horn and body of the medial meniscus involving inferior articular surface and peripheral meniscal margin. controlling the movements of the knee joint. Medial and Lateral Meniscus Tears | Cedars-Sinai It seems that in the above knee, the biology of the medial compartment has gone off the ski slope in a degenerative fashion and reversing that ski slope fall seems to be unproven at this time, particularly in the patient with low functional demands, who is older than 40 years and who has a BMI greater than 30. The meniscus can tear from acute trauma or as the result of degenerative changes that happen over time. It has been shown the peak tibiofemoral contact pressure after a total meniscectomy is equal to a posterior medial meniscal root tear. 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. Radiographs may or may not show medial joint space narrowing. Fat-suppressed coronal images demonstrate before and after images following repair of a bucket handle tear. Presumptive subarticular stress reactions of the knee: MRI detection and association with meniscal tear patterns. Although C, a vertical tear, is commonly used to describe such an appearance, the better answer is D, a longitudinal tear. I have a oblique grade 3 tear posterior horn of the medial meniscus. AJR 2001; 176:771-776. This is because this area has rich blood supply and blood cells can regenerate meniscus tissue or help it heal after surgical repair. In addition, focal chondral lesions occur more commonly with medial than lateral-sided injuries. 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). A meniscus tear can occur when the knee is suddenly twisted while the foot is planted on the ground. It is estimated that only 10% of the injuries involving the tear of posterior horn medial meniscus are repairable. A barely noticeable tear may resurface years later, triggered by something as simple as tripping over a sidewalk curb. Coronal MRI sequences are generally considered the best images for visualization of medial meniscal root tears (Figure 1). Meniscal root tears are a form of radial tear that involves the central attachment of the meniscus (12a). AJR 1998;170:63-67. This tear is usually best seen on the coronal T2-weighted MRI scan (see figure 1), where a fragment of meniscus (black in appearance) is stuck between the medial tibial plateau and the overlying medial collateral ligament.This tear pattern tends to be persistently painful, as the meniscal fragment becomes entrapped between bone and the adjacent soft tissues. To learn more, please visit our. 1 article features images from this case 1075 Mason Ave., Daytona Beach, FL 32117, Twin Lakes The surgery requires a few small incisions and takes about an hour. Optimal diagnosis and management is essential to prevent long term sequelae. Lateral Meniscus Tear - Symptoms, Causes, Treatment & Rehabilitation 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. Meniscal tears are categorised as traumatic or non-traumatic (degenerative) on the basis . Read before you think.