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. Oblique tear of the posterior horn and body of the medial meniscus involving inferior articular surface and peripheral meniscal margin. New surgical advances allow surgeons to repair these tears. Sports-related meniscus injuries often occur along with other knee injuries, such as anterior cruciate ligament (ACL) tears. Apley test (grinding) test: The patient lies prone, with their knee flexed to 90 degrees and their hip extended. Always follow your healthcare professional's instructions. These are the horns. Deep leg presses and squats greater than 70 of knee flexion should be avoided for at least 4 months after surgery. 2 The risk of osteoarthritis and its progression increase in line with reductions in tibial cartilage coverage. A barely noticeable tear may resurface years later, triggered by something as simple as tripping over a sidewalk curb. The device is small and contains a light and a camera, which transmits images from inside the knee onto a monitor. 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. Patients are often aware of movements that aggravate mensical pain, but should also be educated to avoid twisting on a weight bearing, flexed knee. Location -A tear may be located in the anterior horn, body, or posterior horn.A posterior horn tear is the most common. We believe that by repairing these tears, the degenerative process may be delayed or halted (Figure 6). With proper diagnosis, treatment, and rehabilitation, patients often return to their pre-injury abilities. Know the reason for your visit and what you want to happen. Regular exercise to restore your knee mobility and strength is necessary. The healing of an Oblique Fracture can take a minimum of four to six weeks to completely heal. Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other abusable medications. A meniscus tear can lead to knee instability, an inability to move the knee normally, and chronic knee pain. The test is positive if symptoms are reproduced on rotation 10. 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. Not all meniscal tear types, however, are amenable to repair, and thus an accurate description of meniscal tears on MR can have a dramatic impact on preoperative planning. This opening pushes the inside edge of your meniscus toward the middle of your knee. Tears that lie within or contact the red zone are also more likely to be amenable to meniscal repair. The tear can be seen as a white line through the dark body of the meniscus. So the injury as seen in MRI scan means there is an tear in the medial meniscus towards the posterior side, that is towards the back of joint. 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. Coronal MRI sequences are generally considered the best images for visualization of medial meniscal root tears (Figure 1). 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. Helms CA, Laorr A, Cannon WD, Jr. Arthroscopy 2006;22:77180. At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. 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. 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. This information is not intended as a substitute for professional medical care. Nonsteroidal anti-inflammatory drugs (NSAIDs). https://www.webmd.com/pain-management/knee-pain/meniscus-tear-injury There are numerous treatments for meniscus tears, but treatment generally begins conservatively depending on the location, type, and size of the tear. All material on this website is protected by copyright. Knee Surg Sports Traumatol Arthrosc 2009;17:11026. The medial meniscus has a firmer capsular attachment than the lateral meniscus. Magnetic resonance imaging as a tool to predict reparability of longitudinal full-thickness meniscus lesions. 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). Be unable to extend your leg comfortably and may feel better when your knee is bent (flexed). w/severe pain? It is caused by direct impact in contact sports or twisting. You might develop the following signs and symptoms in your knee: A popping sensation. 2nd edn. 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. 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. The loss of the central attachment of the posterior horn may allow extrusion of the body of the meniscus relative to the joint (13a). In some cases, a meniscal repair may also be possible, though this is dependent on the size and location of the tear. They will also consider the type, size, and location of the injury. Available at www.health.gov.au/internet/ main/publishing.nsf/Content/MBRT-DI-submissions-018/$FILE/018%20 RACGP%20Submission.pdf [Accessed 15 August 2011]. Posterior medial meniscal root tears are often times degenerative, but these can also occur with multi-ligament knee injuries in the acute setting. Figure 4. The meniscus root attachment aids meniscal function by securing the meniscus in place and allowing for optimal shock-absorbi In older patients, referral is appropriate if conservative management fails to improve symptoms. Am J Sports Med 2006;34:91927. The absolute indication for specialist referral is the locked knee loss of joint function necessitates surgical intervention. Meniscal tears often occur in young patients who have suffered a twisting injury to the knee. One of the main tests for meniscus tears is the McMurray test. Knowledge of these classifications and the potential contraindications to meniscal root repair can aid the . In cases where surgery is required, this time frame increases to somewhere around three to four months. Nicholas Colyvas, MDClinical ProfessorDepartment of Orthopaedic Surgeryorthosurg.ucsf.edu These meniscus tears are displaced into the tibia or femoral recesses and can be often difficult to diagnose intraoperatively. summary. Tears that are stable, < 1 cm in length, and that do not cause significant . A torn meniscus often can be identified during a physical exam. Radiology 2007;242:8593. Medial meniscal posterior root tears represent an often unrecognized pathology with potentially devastating long-term effects. Survivorship analysis and clinical outcome of one hundred cases. What to Do If Your Orthopaedic Surgery Is Postponed. During the exam, your doctor will look for signs of tenderness along the joint line. All rightsreserved. From January 2018, it was superseded by AJGP: Australian Journal of General Practice, The Royal Australian College of General Practitioners 2021. Afterward, you may experience: pain, especially when the area is touched. Meniscal injury and repair: clinical status. The first one is traumatic and the second one is a degenerative meniscal tear. Characterization of the red zone of knee meniscus: MR imaging and histologic correlation. Arthroscopic repair of meniscal tears extending into the avascular zone in patients younger than twenty years of age. Acta Orthop Scand 1982;53:9759. An experimental study in dogs. If the test is positive (suggesting a meniscal tear), the patient will feel pain and the clinician will feel and/or hear meniscal movement when the meniscus is compressed between the tibia and femur 32, Figure 2. A meniscus tear can occur when the knee is suddenly twisted while the foot is planted on the ground. A magnetic resonance imaging (MRI) scan is often used to diagnose meniscal injuries. 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. Anti-inflammatory drugs such as aspirin, ibuprofen, and naproxen help reduce pain and swelling. 1 article features images from this case 3rd Edition. Figure 1. The medial meniscus is the portion of the cartilage along the inside of the knee joint (closest to the other knee). Reactive synovitis and edema (arrowheads) are readily apparent deep to the tibial collateral ligament on the coronal view. Tears of the posterior medial meniscal root have shown to disrupt the normal motion of the knee, resulting in degenerative arthritis. Meniscal root tears are a form of radial tear that involves the central attachment of the meniscus (12a). 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. 2nd ed. In sports, a meniscus tear usually happens suddenly. 3rd edn. Arthroscopic repair An arthroscope is inserted into the knee to see the tear. An MRI scan assesses the soft tissues in your knee joint, including the menisci, cartilage, tendons, and ligaments. Case Discussion Longitudinal tears, also known as vertical tears, occur perpendicular to the tibial plateau and parallel to the long axis of the meniscus splitting the meniscus into inner and outer parts. Patients describe meniscal tears in a variety of ways. Recovery and rehabilitation take a few weeks. Flaps cause mechanical instability - meaning they interrupt the smooth function of the knee joint and will make your knee joint feel unstable. RICE stands for Rest, Ice, Compression, and Elevation. The meniscus shows up as black on the MRI. AJR 2003; 180:93-97. Oblique tear of the posterior horn and body of the medial meniscus involving inferior articular surface and peripheral meniscal margin. The described meniscal tears will lead to possible necessary total knee replacement. Dr. Warren Strudwick answered Sports Medicine 32 years experience See your doc: Sounds like it will not get better without arthroscopic surgery. Cole BJ, Dennis MG, Lee SJ, et al. These are paraphrased. Orthopedics 2009;32:8. Magnetic resonance imaging of the knee menisci. They are most frequently seen at the posterior horn of the medial meniscus. A meniscus tear is an injury to one of the bands of rubbery cartilage that act as shock absorbers for the knee. Diagnosis can be suspected clinically with joint line tenderness and a positive Mcmurray's test, and can be confirmed with MRI studies. Illustration and photo show a camera and instruments inserted through portals in a knee. 11 Noyes FR, Barber-Westin SD. Fat-suppressed proton density-weighted (4a) sagittal and (4b) coronal images reveal a horizontal tear of the posterior horn of the medial meniscus (arrows), extending to the tibial surface. The medial meniscus is the cushion that is located on the inside part of the 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. MR imaging: effectiveness and costs at triage of patients with nonacute knee symptoms. Psterior horn of medial meniscus Poterior oblique ligament . Athletes, particularly those who play contact sports, are at risk for meniscus tears. A tear can also develop slowly as the meniscus loses resiliency. Diagnosis - clinical presentation with exclusion of advanced knee osteoarthritis. OKeefe R, et al. Makris EA, Hadidi P, Athanasiou KA. The knee meniscus: structure-function, pathophysiology, current repair techniques, and prospects for regeneration. The skilled interpreter of MR of the knee must do more than simply identify the presence of a meniscal tear. Treatment or management protocols for posterior horn menial meniscus tears are quite challenging. A flap tear is a descriptive term that refers to a situation where the meniscus tears within its midsubstance, usually in a predominantly horizontal pattern, and then the upper or lower component of the torn meniscus becomes displaced from its site of origin (14a).8 These tears are most common at the medial meniscal body, and when displaced, the flap component may migrate into the superior or inferior meniscal gutter (15a,15b). Fat-suppressed coronal images demonstrate before and after images following repair of a bucket handle tear. Tell your doctor of any recurrent swelling or of your knee repeatedly giving way. 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. Meniscus surgery is a common operation to remove or repair a torn meniscus, a piece of cartilage in the knee. Gillquist J, Hamberg P, Lysholm J. Endoscopic partial and total meniscectomy. In other words, when the majority of the meniscus forms the handle, that requires tear formation near the meniscal periphery, resulting in a vascular site for operative repair. Whats the best way to treat an oblique fracture? Adjunctive measures to promote vascularity and healing at the repair sites are also recommended. 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. Meniscal tears within the body of the meniscus or at the meniscocapsular junction represent a well-understood and manageable condition encountered in clinical practice. No bone marrow edema. (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. 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. 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. Nourissat G, Beaufils P, Charrois O, et al. AJR 2001; 176:771-776. 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. One or two other small incisions are made for inserting instruments. How is Oblique Fracture Treated? 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. This is because this area has rich blood supply and blood cells can regenerate meniscus tissue or help it heal after surgical repair. This is termed the 'red-red zone' (denoting area of vascularity).2,4 repair of the 'red-white zone' (watershed area between vascular and avascular meniscus) is controversial25 with many different surgical techniques.26 tears in the 'white-white zone' (avascular zone) are rarely repaired rather the damaged segment is resected (meniscectomy). Conservative management of the patient with a meniscal tear. I have an oblique tear of the posterior horn and body of the medial meniscus extending to the inferior articular surface. Meniscal tears may be categorized into five common configurations, including horizontal, longitudinal, radial, oblique (parrot-beak), and complex. A tear of the anterior horn of the lateral meniscus is damage to the front part of one of the two structures that act as shock absorbers between the thigh bone and the lower leg, explains The Steadman Clinic. Knee Surg Sports Traumatol Arthrosc 2010;18:5359. Ask if your condition can be treated in other ways. type 3, vertical longitudinal bucket-handle tears; type 4, complex oblique tears; and type 5, bone avulsion fractures of the root attachments. https://www.verywellhealth.com/types-of-meniscus-tears-3862073 Matthew H. Blake, MD, can be reached at the Kentucky Clinic, 740 Limestone, Suite K415, Lexington, KY 40536; email: Darren L. Johnson, MD, can be reached at the Kentucky Clinic, 740 S Limestone, Suite K415, Lexington, KY 40536; email: Jorge Chahla, MD; Andrew G. Geeslin, MD; and Robert F. LaPrade, MD, PhD, can be reached at Steadman Philippon Research Institute, The Steadman Clinic, 181 West Meadow Dr., Suite 400, Vail, CO 81657; Chahlas email. I have an oblique tear of the posterior horn of my medial meniscus that extends to the undersurface of the cartilage. In (17a), the preoperative study, a large displaced "handle" (arrow) from the body of the lateral meniscus is seen near the intercondylar notch. In the present case, a full-thickness radial tear of the medial meniscus is visualized (Fig 1).An arthroscopic torpedo shaver (Arthrex, Naples, FL, U.S.A.) is used to debride the meniscus tear edges back to a healthy, stable rim (Fig 2).For improved access to the medial meniscus, an 18-gauge spinal . The double posterior cruciate ligament (PCL) sign appears on sagittal MRI images of the knee when a bucket-handle meniscal tear (medial meniscus in 80% of cases) flips towards the center of the joint so that it comes to lie anteroinferior to the posterior cruciate ligament (PCL) mimicking a second smaller ligament.. A double posterior cruciate ligament sign from a torn medial meniscus can . The meniscus is a piece of C-shaped cartilage that helps cushion the knee. Another exam finding is palpating the anteromedial joint line, while placing a varus stress on a fully extended knee and feeling for meniscal extrusion. Tears are noted by how they look, as well as where the tear occurs in the meniscus. They may not even be apparent with an arthroscopic examination. Locking presents in two ways. Magnetic resonance imaging is first line for investigating potential meniscal lesions, but should not replace thorough clinical history and examination. The knee: a comprehensive review. Swelling or stiffness. tears of the medial meniscus were the most common type oftear,comprising40%ofmedialmeniscustears.Further-more, more than 75% of medial meniscal tears in the ACL- . Vertical flap (oblique, flap, parrot's beak) tears are unstable tears and occur in younger patients. Bull NYU Hosp Jt Dis 2010;68:8490. Flaps cause mechanical instability - meaning they interrupt the smooth function of the knee joint and will make your knee joint feel unstable. Perhaps the best know of these is the bucket-handle tear. Normal knee anatomy. It is possible that your symptoms of pain, etc will improve with time without surgery.But that doesn't mean the tear healed. This type of tear has an unusual pattern. Clin Orthop Related Res 2010;468:11902. Many meniscus tears will not need immediate surgery. Oblique tears give rise to flaps which are mechanical unstable and associated with mechanical symptoms. However, these patients are rare. This type of tear is particularly devastating to meniscal function. The parrot beak shape of an oblique tear (arrow) is readily apparent on (7a) a proton density-weighted axial image of the menisci. Explains when surgery is done. X-rays and MRIsallow the doctor to evaluate the bone and soft tissue at the knee. Complex tears like this are likely to be unstable. Henning C, Lynch M, Clark J. Vascularity for healing of meniscus repairs. Two wedge-shaped pieces of fibrocartilage act as shock absorbers between your femur and tibia.