RICE. 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. w/severe pain? 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. 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. Sources: Chahla and Geeslin report no relevant financial disclosures. 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. There are two menisci, a medial one on the "inside" of the knee and a lateral one on the "outside" of the knee. Non-operative treatment of degenerative posterior root tear of the medial meniscus. If you have a meniscus tear, this movement may cause pain, clicking, or a clunking sensation within the joint. The knee: a comprehensive review. Helms CA, Laorr A, Cannon WD, Jr. https://www.webmd.com/pain-management/knee-pain/meniscus-tear-injury Brain Res Rev 2009;60:187201. summary. 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. 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. Patients describe meniscal tears in a variety of ways. 1165 Dunlawton Ave., Suite 102 Port Orange, FL 32127, Port Orange East & Walk-In Clinic Orthopedics 2009;32:8. 1993;9(1):33-51. Over 2 to 3 days, however, the knee will gradually become more stiff and swollen. New surgical advances allow surgeons to repair these tears. Includes interactive tool to help you decide. Horizontal cleavage, oblique, and complex meniscal tear patterns have traditionally been poor candidates for meniscal repair. The medial meniscus transmits approximately 50% of the total joint load of the knee medial compartment, thus protecting the articular cartilage from excessive force. Athletes, particularly those who play contact sports, are at risk for meniscus tears. If you undergo surgery it will likely be followed by physical therapy to optimize knee strength and stability. The question about meniscus tears and the subsequent MRI in emails we receive are numerous. As recognition of the critical function of the menisci in normal biomechanical function of the knee has grown, attempts at preserving meniscal tissue via repair as opposed to partial meniscectomy have also gained favor. In older patients, referral is appropriate if conservative management fails to improve symptoms. Meniscal repair using an exogenous fibrin clot. Apley test (grinding) test: The patient lies prone, with their knee flexed to 90 degrees and their hip extended. 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. Knee Surg Sports Traumatol Arthrosc 2007;15:393401. AJR 2000; 174:161-164. 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. Complex or degenerative tears are where two or more tear patterns exist. 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. Tears present as severe pain, swelling, and possibly catching, clicking, difficulty on deep knee bending and locking of the knee in partial flexion. A comparative study with a short term follow up. RACGP - Meniscal tear - presentation, diagnosis and management 2023 Cedars-Sinai. The body usually absorbs these over time. 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. 2013. Meniscus Tear of the Knee: Causes, Symptoms, and Diagnosis - Healthline Sometimes conservative treatment doesnt work. Oblique tear of the posterior horn of the medial meniscus 2023 The Orthopedic Clinic. The primary objective is to control the disease process to avoid the complications . If your symptoms persist with nonsurgical treatment, your doctor may suggest arthroscopic surgery. The posterior horn is located on the back half of the meniscus. Nourissat G, Beaufils P, Charrois O, et al. Parrot Beak Tear: MRI Knee Surg Sports Traumatol Arthrosc 2009;17:11026. Choose a doctor and schedule an appointment. 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. This tear pattern was historically unrecognized, although more recently it has been suggested this hidden pathology may account for nearly 80% of the total knee replacements in patients younger than 60 years. Most commonly it is impossible to fully extend the knee; more accurately described as stiffness (termed 'pseudo locking') due either to a small effusion (requiring increased force to bend the tense joint capsule) or to pain inhibition as the femoral condyle compresses the torn meniscus. type 3, vertical longitudinal bucket-handle tears; type 4, complex oblique tears; and type 5, bone avulsion fractures of the root attachments. Posterior Horn Medial Meniscus Tear | Knee Specialist | Minnesota 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. 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. An MRI scan assesses the soft tissues in your knee joint, including the menisci, cartilage, tendons, and ligaments. As orthopaedic surgeons increasingly consider meniscal repair, accurate pre-operative assessment with MR becomes more important, allowing proper planning on the part of both the surgeon and the patient. A meniscus tear is an injury to one of the bands of rubbery cartilage that act as shock absorbers for the knee. If your symptoms do not persist and you have no locking or swelling of the knee, your doctor may recommend nonsurgical treatment. Medial meniscus tears are most frequently addressed with a partial meniscectomy, which involves arthroscopically removing the damaged portion of cartilage. (386) 254-6819, Main Office & Walk-In Clinic 1 article features images from this case Medial meniscal root tears: Fix it or leave it alone - Healio Arnoczky SP, Warren RF, Spivak JM. The arthroscope is inserted near the knee via a tiny incision. 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. 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. 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. (3a) A fat-suppressed proton density-weighted axial image through the knee joint demonstrates the C-shaped menisci. or ? PDF Peripheral Meniscal Tears: How 7 to Diagnose and Repair - Dr. Jorge Chahla Know how you can contact your provider if you have questions. The RICE protocol is effective for most sports-related injuries. 5 Jee WH, McCauley TR, Kim JM, et al. Meniscus Radial Tear | George Gendy MD Larger, unstable tears of this type often cause mechanical symptoms, however, and therefore warrant operative treatment, usually via partial meniscectomy. 2. The medial meniscus is the cushion that is located on the inside part of the knee. Clin J Sport Med 2009;19:912. 16 OShea JJ, Shelbourne KD. Biologics injections, such as platelet-rich plasma (PRP), are currently being studied and may show promise in the future for the treatment of meniscus tears. Successful outcome and patient satisfaction after medial meniscal root repair are established initially upon appropriate diagnosis and patient selection. The ghost sign or absence of an identifiable meniscus anterior to the posterior cruciate ligament is also indicative of a root tear (Figure 2). Biomechanical studies have demonstrated that repair of medial meniscus posterior root tears leads to improved contact mechanics.