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 medial meniscus is the portion of the cartilage along the inside of the knee joint (closest to the other knee). Lufkin R. The MRI manual. Your doctor will bend your knee, then straighten and rotate it. Complex tears like this are likely to be unstable. 2 The risk of osteoarthritis and its progression increase in line with reductions in tibial cartilage coverage. Depending on the cut thickness, axial MRI images may display the root tear (Figure 3). These tears often occur in association with ACL tears, but even if found in isolation, are highly likely to be clinically relevant, as the displaced meniscal fragment frequently results in knee locking. Sounds like it will not get better without arthroscopic surgery. No bone marrow edema. An experimental study in dogs. There is a history of sudden inability to fully extend the knee, with a rotational flexion/extension 'trick' required to regain full extension. 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. 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. (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. 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). 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. Ercin E, Kaya I, Sungur I, Demirbas E, Ugras AA, Cetinus EM. meniscal tear / avulsion off tibial plateau CIRCUMFERENTIAL FIBERS basicall equivalent to a total meniscetyomy - try to repair these at all cost! The procedure begins with a complete diagnostic arthroscopy using a 30-degree arthroscope. MR is also able to assess the stability of meniscal tears,6 an important factor, as unstable tears require operative treatment for symptom relief. Steroid injection. Clinical outcomes following isolated lateral meniscal allograft transplantation. The Thessaly test is the most sensitive and specific clinical test to diagnose meniscal injury. 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. Know why a new medicine or treatment is prescribed, and how it will help you. 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. Acute meniscus tears often happen during sports. 5 Jee WH, McCauley TR, Kim JM, et al. Primary repair of medial meniscal avulsions: 2 case studies. 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. Radiology 2007;242:8593. 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. You will start with exercises to improve your range of motion. Complex degenerative tear. The question about meniscus tears and the subsequent MRI in emails we receive are numerous. 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. Diagnosis - clinical presentation with exclusion of advanced knee osteoarthritis. Tears to the medial meniscal root change the biomechanics and kinematics of the knee, which cause early degeneration of the joint. Presumptive subarticular stress reactions of the knee: MRI detection and association with meniscal tear patterns. The absent bow tie sign in bucket-handle tears of the menisci in the knee. I have an oblique tear of the posterior horn of the medial meniscus, what is the treatment for that? 3rd Edition. 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. Grades 1 and 2 are not considered serious. 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. Larger, unstable tears of this type often cause mechanical symptoms, however, and therefore warrant operative treatment, usually via partial meniscectomy. Any tears appear as white lines. By the time people reach their twenties or thirties, intrasubstance changes of the meniscus tissue are common. Perhaps the best know of these is the bucket-handle tear. Great Britain: Hodder Arnold, 2005. The loss of the central attachment of the posterior horn may allow extrusion of the body of the meniscus relative to the joint (13a). 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? 2010. The MRI revealed a vertical flap (oblique) tear of the medial meniscus. 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. Each knee has two C-shaped pieces of cartilage known as menisci. can he still play tennis with this injury? This provides a clear view of the inside of the knee. The medial meniscus has a firmer capsular attachment than the lateral meniscus. Apley test (grinding) test: The patient lies prone, with their knee flexed to 90 degrees and their hip extended. Meniscal repair is a more difficult surgical technique and requires a motivated, diligent patient in order to be successful. This extrusion should disappear without stress. Tears of the posterior medial meniscal root have shown to disrupt the normal motion of the knee, resulting in degenerative arthritis. Always follow your healthcare professional's instructions. 10 DeHaven KE. The posterior horn it the back portion of the menisci at the end of the curve, where it tapers . Conservati For a young person arthroscopic meniscal repair is the best solution. Adjunctive measures to promote vascularity and healing at the repair sites are also recommended. or ? 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. A meniscus tear can occur when the knee is suddenly twisted while the foot is planted on the ground. These are the horns. The first one is traumatic and the second one is a degenerative meniscal tear. Meniscal tears are common sports-related injuries in young athletes and can also present as a degenerative condition in older patients. Your doctor will hold your heel while you lie on your back and, with your leg bent, straighten your leg with his or her other hand on the outside of your knee as he or she rotates your foot inward. Surgery is typically the only option and works to trim the damaged portion of the meniscus. 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. Dr. Warren Strudwick answered Sports Medicine 32 years experience See your doc: Sounds like it will not get better without arthroscopic surgery. Scholten RJ, Deville WL, Opstelten W, Bijl D, van der Plas CG, Bouter LM. The medial meniscus transmits approximately 50% of the total joint load of the knee medial compartment, thus protecting the articular cartilage from excessive force. Each knee joint has two crescent-shaped cartilage menisci. Knee Surg Sports Traumatol Arthrosc 2007;15:393401. 12 Sources By Jonathan Cluett, MD Arthroscopic repair An arthroscope is inserted into the knee to see the tear. Meniscus Repair. This is because this area has rich blood supply and blood cells can regenerate meniscus tissue or help it heal after surgical repair. During the exam, your doctor will look for signs of tenderness along the joint line. Arthroscopy 2006;22:77180. How is Oblique Fracture Treated? Recovery and rehabilitation take a few weeks. The menisci help to transmit weight from one bone to another and play an important role in knee stability. OKeefe R, et al. If you have a meniscus tear, this movement may cause pain, clicking, or a clunking sensation within the joint. For these, please consult a doctor (virtually or in person). Pain is typically medial and activity-related (e.g. 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 may be categorized into five common configurations, including horizontal, longitudinal, radial, oblique (parrot-beak), and complex. Meniscal tears are the most common lesions followed by the meniscal cyst. HealthTap uses cookies to enhance your site experience and for analytics and advertising purposes. Prospective evaluation of 1485 meniscal tear patterns in patients with stable knees. Following root repair, patients are required to remain non-weight-bearing for 6 weeks. By using our website, you consent to our use of cookies. Arthroscopy. If the tear is associated with arthritis it will typically improve over time as the arthritis is treated. Knee arthroscopy is one of the most commonly performed surgical procedures. 1890 LPGA Blvd., Suite 240 Daytona Beach, FL 32117, Port Orange North & South 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. Trauma to medial collateral ligament usually also involves medial meniscus. 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. Coronal proton weighted MRI of horizontal tear of lateral meniscus (white arrow) with complicating ganglion (black arrow) at the lateral margin of the meniscus, Australian Family Physician was the peer-reviewed, scholarly journal of The Royal Australian College of General Practitioners (RACGP) from 1971 to 2017. This information is provided as an educational service and is not intended to serve as medical advice. Peripheral meniscal tears are among the most common causes of meniscal pathology, particularly occurring in conjunction with anterior cruciate ligament (ACL) injury or deficiency. Difficulty straightening your knee fully. 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. Still, many people with a torn meniscus can walk, stand, sit, and sleep without pain. In case of an open or unstable fracture, the bone may protrude out of the skin surface and be exposed to environmental contaminants. From January 2018, it was superseded by AJGP: Australian Journal of General Practice, The Royal Australian College of General Practitioners 2021. https://www.verywellhealth.com/types-of-meniscus-tears-3862073 Treatment or management protocols for posterior horn menial meniscus tears are quite challenging. This information is not intended as a substitute for professional medical care. 1871 LPGA Blvd., Daytona Beach, FL 32117. The Royal Australian College of General Practitioners, 100 Wellington Parade, East Melbourne, Victoria 3002, Australia. Meniscal tears are categorised as traumatic or non-traumatic (degenerative) on the basis . When small, conservative therapy or simply rasping the meniscus may result in healing of these tear types. These can occur through either a contact or non-contact injury for example, a pivoting or cutting injury. One of the most common knee injuries is a torn meniscus. There may be some pain. The identification of the meniscus comma sign . Progressive weight-bearing begins at 6 weeks, with full weight-bearing at 8 weeks. The medial meniscus is an important secondary stabilizer of the knee. Incisions were made in the dorsal root of the oblique popliteal ligament and the joint capsule . The procedure can reduce pain, improve mobility and stability, and get you back to life's activities. A longitudinal tear is an example of this kind of tear. The joint is fairly flexible only the last 10-15 degrees is painful, but the pain on walking constant and vulnerable to . Meniscal tears often occur in young patients who have suffered a twisting injury to the knee. Bove SE, Flatters SJ, Inglis JJ, Mantyh PW. The typical meniscal pain profile comprises well localised joint-line pain (with medial pain generally being indicative of a medial tear and vice-versa). We have two menisci in either knee. 16 OShea JJ, Shelbourne KD. Medial and lateral menisci are crescent-shaped fibrocartilage structures that provide joint congruity, stabilization and lubrication and act as shock absorbers for joint preservation. Tell your doctor of any recurrent swelling or of your knee repeatedly giving way. Likewise, physical exam findings of an effusion, a positive McMurray test and a positive Apley grind test are not usually present. 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. If you continue to use this site we will assume that you are happy with it. Cole BJ, Dennis MG, Lee SJ, et al. This is a large horizontal tear of the meniscus. A magnetic resonance imaging (MRI) scan is often used to diagnose meniscal injuries. Although the pain improved, the patient could not flex her knee joint deeply. X-rays. A recent study demonstrated 46% of patients with degenerative meniscal tears elected not to have surgery after 4 weeks of nonoperative treatment, and their functional improvement matched patients in the operative group.21 Another study of degenerative tears demonstrated that supervised exercise caused the same reduction in knee pain and the same increase in function and satisfaction as partial meniscectomy plus exercise.23 As degenerative tears are more common in elderly patients, this group is more likely to respond to conservative treatment. These tendons have poor blood supply and will not heal themselves. Meniscal injury is common, and the medial meniscus is more frequently injured. 2023 Cedars-Sinai. Meniscus tears are among the most common knee injuries. Bull NYU Hosp Jt Dis 2010;68:8490. Although an X-ray will not show a meniscus tear, your doctor may order one to look for other causes of knee pain, such as osteoarthritis. This pattern of tear requires resection to prevent propagation of the tear as the flap gets caught within the joint during flexion. Nonsteroidal anti-inflammatory drugs (NSAIDs). Missouri: Mosby, 1998. 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. The oblique meniscomeniscal ligament is but one of several known structures that can mimic meniscal pathology. In this case, a portion may break off, leaving frayed edges. The amount of pain and first appearance of swelling can give important clues about where and how bad the injury is. Location -A tear may be located in the anterior horn, body, or posterior horn.A posterior horn tear is the most common. Pain and/or clicking on compression suggest a meniscal lesion 1,32, Figure 3. X-rays and MRIsallow the doctor to evaluate the bone and soft tissue at the knee. The tear should be eight millimeters or more in length, as shorter peripheral longitudinal tears are less likely to be symptomatic and may heal spontaneously. Skeletal Radiology 2004; 33:260-264. 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. An MRI scan assesses the soft tissues in your knee joint, including the menisci, cartilage, tendons, and ligaments. In this short surgical video, a degenerative meniscus tear is smoothed down with a motorized shaver during a partial meniscectomy. They may not even be apparent with an arthroscopic examination. 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. In (17a), the preoperative study, a large displaced "handle" (arrow) from the body of the lateral meniscus is seen near the intercondylar notch. Afterward, you may experience: pain, especially when the area is touched. 2. 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). 2nd ed. 8 Ruff C, Weingardt J, Russ P, Kilcoyne R. MR imaging patterns of displaced meniscus injuries of the knee. Tears are noted by how they look, as well as where the tear occurs in the meniscus. Injury, degeneration, or surgical removal of all or part of the meniscus is associated with an increased risk of developing knee osteoarthritis. 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. Sometimes, its possible to repair a torn meniscus, especially if you are a young adult. Of course, if a displaced meniscal fragment is identified, the tear is by definition unstable. w/severe pain? They include: Gillquist J, Hamberg P, Lysholm J. Endoscopic partial and total meniscectomy. When a meniscus tear occurs, you may hear a popping sound around your knee joint. 1175 Dunlawton Ave., Suite 101, Port Orange, FL 32127, Palm Coast Medial meniscal root tears are more frequently diagnosed in patients who are older than 40 years, are overweight and cannot recall an inciting event. Question options: . apalia R, Del Buono A, Osti L, Denaro V, Maffulli N. Meniscectomy as a risk factor for knee osteoarthritis: a systematic review. Rimington T, Mallik K, Evans D, Mroczek K, Reider B. The parrot beak shape of an oblique tear (arrow) is readily apparent on (7a) a proton density-weighted axial image of the menisci. Develop pain gradually along the meniscus and joint line when you put stress on your knees (usually during a repeated activity).