Medial meniscal posterior root tears represent an often unrecognized pathology with potentially devastating long-term effects. Meniscal tears are categorised as traumatic or non-traumatic (degenerative) on the basis . In (17a), the preoperative study, a large displaced "handle" (arrow) from the body of the lateral meniscus is seen near the intercondylar notch. The most common symptoms of a meniscus tear are: After discussing your symptoms and medical history, your doctor will examine your knee. The loss of the central attachment of the posterior horn may allow extrusion of the body of the meniscus relative to the joint (13a). Illustration and photo show a camera and instruments inserted through portals in a knee. J Bone Joint Surg Am 2005;87:71524. 2013. A gradient-echo T2*-weighted sagittal image demonstrates a tear within the posterior horn of the medial meniscus (arrow). Fat-suppressed coronal images demonstrate before and after images following repair of a bucket handle tear. New advances in musculoskeletal pain. Recovery and rehabilitation take a few weeks. If the knee is still painful, or if it locks, your doctor may recommend surgery. If you prefer, you can also fill out our appointment request form online now. Patients with ACL tears are also thought to be better candidates for meniscal repair because of the presence of serum-derived growth factors within the hemarthrosis that accompanies ACL tears.15. The healing time in children is a little less as the healing process is faster in children than in adults. How can I tell if I have an oblique fracture? Reciprocally, an increased force is also placed on an ACL graft with a deficient medial meniscus. 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. As such, it is critical to repair medial meniscal root tears during ACL reconstruction to help stabilize the knee, as well as to decrease stresses that the graft experiences. The first one is traumatic and the second one is a degenerative meniscal tear. Extrusion of the medial meniscus (MM) is associated with knee joint pain in osteoarthritic knees. There are numerous types of meniscus tears, including: This type of tear is often a sign of degenerative changes in the meniscus tissue. How to treat an oblique tear of the posterior horn of the medial meniscus? The medial meniscus transmits approximately 50% of the total joint load of the knee medial compartment, thus protecting the articular cartilage from excessive force. Medial meniscal root tears are more frequently diagnosed in patients who are older than 40 years, are overweight and cannot recall an inciting event. If you undergo surgery it will likely be followed by physical therapy to optimize knee strength and stability. Nonsurgical treatment is an option for elderly patients, those with significant comorbidities and those with advanced OA (Outerbridge grade 3 or 4 chondromalacia of the ipsilateral compartment). Whats the best way to treat an oblique fracture? Non-anatomic placement of a PCL reconstruction tibial tunnel is a reported cause of iatrogenic medial meniscal posterior root tears. 1175 Dunlawton Ave., Suite 101, Port Orange, FL 32127, Palm Coast Be unable to extend your leg comfortably and may feel better when your knee is bent (flexed). 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 healing of an Oblique Fracture can take a minimum of four to six weeks to completely heal. Seldom are they the sign of a problem. bucket-handle tear: displaced vertical tear parrot beak tear: oblique radial tear Radiographic features Plain radiograph On plain radiographs, meniscal tears are not visible. Performing activities that involve aggressive pivoting and twisting of the knee puts you at a significantly higher risk of tearing your meniscus. However, these patients are rare. The relationships among MM radial/oblique tears, MM extrusion (MME), and the effect of arthroscopic meniscal repair are not established. The knee: a comprehensive review. Because these two tear patterns differ greatly in prognosis and treatment approach, vertical is therefore not the preferred descriptor for such meniscal tears, unless paired with the proper category, such as vertical longitudinal. 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. can he still play tennis with this injury? Repair of locked bucket-handle meniscal tears in knees with chronic anterior cruciate ligament deficiency. 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. Proton weighted sagittal image demonstrates an example of a posterior horn medial meniscal horizontal tear (white arrow). Rehabilitation time for a meniscus repair is about 3 to 6 months. 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. In addition to categorizing meniscal tears based on morphology, care should be taken to describe the exact location of meniscal tears. With the realization that even partial meniscectomy leads to accelerated osteoarthritis,2 surgeons have increasingly turned to meniscal repair. Two wedge-shaped pieces of fibrocartilage act as shock absorbers between your femur and tibia. Biomechanical studies have demonstrated that repair of medial meniscus posterior root tears leads to improved contact mechanics. what is the treatment? Severe pain and swelling may occur up to 24 hours afterward. The described meniscal tears will lead to possible necessary total knee replacement. These tears occur within the avascular zone of the meniscus where there is no blood supply. They may not even be apparent with an arthroscopic examination. Conservati For a young person arthroscopic meniscal repair is the best solution. Radiology 2007;242:8593. Peripheral meniscal tears are among the most common causes of meniscal pathology, particularly occurring in conjunction with anterior cruciate ligament (ACL) injury or deficiency. The kneecap (patella) sits in front of the joint to provide some protection. Knee Surg Sports Traumatol Arthrosc 2009;17:11026. or ? They will manipulate your leg into various positions, observe you while you walk, and bend at the knee. 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. Vertical flap (oblique, flap, parrot's beak) tears are unstable tears and occur in younger patients. Those with a meniscus tear are also more likely to develop osteoarthritis in the injured knee. (13a) A coronal image from another patient with a medial meniscal root tear demonstrates associated severe medial subluxation of the meniscal body (arrow). Once the initial healing is complete, your doctor will prescribe rehabilitation exercises. At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. RICE. Following root repair, patients are required to remain non-weight-bearing for 6 weeks. 5 Non-Christmas Movies to Watch This Holiday, Best Online Games to Play with your Friends, 12 tips for creating visual content on social media. The arthroscope is inserted near the knee via a tiny incision. The views expressed by the authors of articles in Australian Family Physician are their own and not necessarily those of the publisher or the editorial staff, and must not be quoted as such. Requests for permission to reprint articles must be sent to permissions@racgp.org.au. Question options: . In this case, a portion may break off, leaving frayed edges. Treatment for a meniscus tear will depend on its size, what kind it is, and where it's located within the cartilage. A meniscal cyst may present with signs and symptoms consistent with typical meniscal pathology. The posterior horn is the thickest and most important for overall function of the knee. 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 menisci of the knee have several important roles: The medial meniscus is 'C' shaped whereas the lateral is a shorter incomplete circle with closer spaced 'horns'. Both of them have 2 causes. Meniscal tears are common sports-related injuries in young athletes and can also present as a degenerative condition in older patients. 1890 LPGA Blvd., Suite 240 Daytona Beach, FL 32117, Port Orange North & South 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. Think before you speak. 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. In this procedure, the surgeon inserts a miniature camera through a small incision (portal) in the knee. Am J Sports Med 2008;36:12839. Great Britain: Hodder Arnold, 2005. Physiotherapy at two visits per week for at least 8 weeks is recommended.20 There is little evidence for strapping of meniscal injuries and this is not currently recommended. The procedure can reduce pain, improve mobility and stability, and get you back to life's activities. Referral is also indicated if the diagnosis is uncertain for review and to access MRI. See this post to learn more about how a meniscus functions . In case of an open or unstable fracture, the bone may protrude out of the skin surface and be exposed to environmental contaminants. In this case, a portion may break off, leaving frayed edges. This most often happens when the tear develops over a period of time. Meniscal repair surgeries do the best when the meniscal tear extends into the middle 50% of meniscal substance. Trauma to medial collateral ligament usually also involves medial meniscus. 3rd Edition. AJR 2003; 180:93-97. (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. (Right) Degenerative tear. Skeletal Radiology 2004; 33:260-264. The tear results in a vertical signal abnormality on sagittal MR images. Knowledge of these classifications and the potential contraindications to meniscal root repair can aid the . This piece of soft tissue often becomes torn, especially in athletes, due to quick movements and sudden trauma. Similarly, tears that are not associated with locking of the knee will typically become less painful over time. Pain is typically medial and activity-related (e.g. AJSM 2007; 35:1380-1383. 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. Reactive synovitis and edema (arrowheads) are readily apparent deep to the tibial collateral ligament on the coronal view. They will check for tenderness along the joint line where the meniscus sits. Flaps cause mechanical instability - meaning they interrupt the smooth function of the knee joint and will make your knee joint feel unstable. Jul 2000;31(3):419-36. what is the treatment for that? Symptomatic treatment with rest, ice, NSAIDs and/or an unloader brace may help alleviate symptoms in some cases. 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. The medial meniscus is on the innermost side of your knee (the C-shaped curve faces in toward your body, the opposite knee). Aging is also a risk factor due to general wear and tear of the knees. 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. Cole BJ, Dennis MG, Lee SJ, et al. Crawford R, Walley G, Bridgman S, Maffulli N. Magnetic resonance imaging versus arthroscopy in the diagnosis of knee pathology, concentrating on meniscal lesions and ACL tears: a systematic review. However, it may also occur in older athletes through gradual degeneration. All material on this website is protected by copyright. Bove SE, Flatters SJ, Inglis JJ, Mantyh PW. The medial meniscus is more frequently torn, partly because of this different shape but also because of its attachment to the medial collateral ligament, whereas the lateral is pulled out of the way of compression between femur and tibia by politeus. RICE stands for Rest, Ice, Compression, and Elevation. The ideal candidate for a medial meniscal root repair is an individual younger than 40 years who presents after an acute, traumatic event with a BMI less than 30 and a MRI that shows a medial meniscal root tear without secondary signs of osteoarthrosis or varus malalignment. These are the menisci. Know the reason for your visit and what you want to happen. Medial meniscal root tears are radial tears within 1 cm of the meniscal root insertion or an avulsion of the insertion of the meniscus. Knowing where and how a meniscus was torn helps the doctor determine the best treatment.. The operative equipment needs and post-operative rehabilitation process markedly differ between meniscal repair and partial meniscectomy. Meniscus tears can vary widely in size and severity. 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. Difficulty straightening your knee fully. Bernstein J. This is because this area has rich blood supply and blood cells can regenerate meniscus tissue or help it heal after surgical repair. 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. Meniscal ramp lesions can be defined as longitudinal vertical and/or oblique peripheral tears affecting posterior horn of medial meniscus, in a mediolateral direction of less than 2.0 cm, that may lead to meniscocapsular or meniscotibial disruption [ 1 ]. 1. MRI scans show (left) a normal meniscus and (right) a torn meniscus. Surgery is typically the only option and works to trim the damaged portion of the meniscus. This is a large horizontal tear of the meniscus. The meniscus is a piece of rubber-like cartilage in the knee situated within the femur and tibia, or thigh bone and shin bone. Symptoms. Surgical treatment is usually reserved for younger patients with a vertical longitudinal tear within the vascularised outer third of the meniscus. 11 Noyes FR, Barber-Westin SD. If the tear cant be repaired, occasionally the meniscus can be surgically trimmed. This pattern of tear requires resection to prevent propagation of the tear as the flap gets caught within the joint during flexion. An MRI is 70 to 90 percent accurate in identifying whether the meniscus has been torn and how badly. Sports-related meniscus injuries often occur along with other knee injuries, such as anterior cruciate ligament (ACL) tears. By the time people reach their twenties or thirties, intrasubstance changes of the meniscus tissue are common. Identification of a meniscal root tear on MRI may be challenging due to the relatively small size of the root. All rights reserved. Complex or degenerative tears are where two or more tear patterns exist. Transtibial pullout repair is a new arthroscopic technique to repair meniscal root tears, . 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. Age of injury peaks at 2029 years.7 Partial meniscectomy (removal of the torn section) is one of the most commonly performed orthopaedic surgical procedures.8. In cases where a torn meniscus has locked the knee, walking will be affected. Know why a new medicine or treatment is prescribed, and how it will help you. This presents with a combination of tear patterns. 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). 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). Submission to the Department of Health and Ageing. It is important to describe your symptoms accurately. Arthroscopic partial meniscectomy The goal of this surgery is to remove a small piece of the torn meniscus in order to get the knee functioning normally. controlling the movements of the knee joint. Lim HC, Bae JH, Wang JH, Seok CW, Kim MK. The goal of meniscal root repair is to restore the joint to a near native function of the meniscus and prevent cartilage degradation associated with nonsurgical treatment or meniscectomy. Tears to the medial meniscal root change the biomechanics and kinematics of the knee, which cause early degeneration of the joint. Meniscus Surgery. Ligaments: their nature and morphology. The oblique meniscomeniscal ligament is but one of several known structures that can mimic meniscal pathology. If your tear is on the outer one-third of the meniscus, it may heal on its own or be repaired surgically. Although the . Can a torn meniscus heal by itself? Optimal diagnosis and management is essential to prevent long term sequelae. Sekiya JK, West RV, Groff YJ, Irrgang JJ, Fu FH, Harner CD. Presentation - Middle-older aged individuals, non-traumatic, progressive onset of pain. Meniscal tear configurations: categorization with MR imaging. For potential or actual medical emergencies, immediately call 911 or your local emergency service. They will also consider the type, size, and location of the injury. When a meniscus tear occurs, you may hear a popping sound around your knee joint. 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. Additionally, the individual will not be able to move the joint due to pain. The MRI revealed a vertical flap (oblique) tear of the medial meniscus. Henning C, Lynch M, Clark J. Vascularity for healing of meniscus repairs. This provides a clear view of the inside of the knee. 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. All rightsreserved. 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. Seldom are they the sign of a problem. Walking can become difficult. Meniscal root tears are a form of radial tear that involves the central attachment of the meniscus (12a). How is Oblique Fracture Treated? If you have a follow-up appointment, write down the date, time, and purpose for that visit. Meniscal tears within the body of the meniscus or at the meniscocapsular junction represent a well-understood and manageable condition encountered in clinical practice. If you continue to use this site we will assume that you are happy with it. Meniscus tears, indicated by MRI, are classified in three grades. I have a oblique grade 3 tear posterior horn of the medial meniscus. Younger and elderly patients typically sustain different types of tears. Likewise, physical exam findings of an effusion, a positive McMurray test and a positive Apley grind test are not usually present. A horizontal meniscus tear runs along the circumference of the fibers of the meniscus. An experimental study in dogs. It is estimated that only 10% of the injuries involving the tear of posterior horn medial meniscus are repairable.