However, these patients are rare. 6 Types of Meniscus Tears and Locations - Verywell Health Radial tears, because they are oriented perpendicular to the c-shaped fibers of the meniscus, have a devastating effect upon meniscal function. 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. Referral to an orthopaedic surgeon is important if the diagnosis is uncertain or there is minimal improvement at clinical review. 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. Radiology 2000; 217:193-200. Recovery and rehabilitation take a few weeks. Verdonk PC, Demurie A, Almqvist KF, Veys EM, Verbruggen G, Verdonk R. Transplantation of viable meniscal allograft. Although a successful outcome of a meniscal root repair is predicated upon appropriate indications for the repair, not all medial meniscal root tears should be repaired. Complex or degenerative tears are where two or more tear patterns exist. 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). What Is a Tear of the Anterior Horn of the Lateral Meniscus? Repair is sometimes attempted even with these tear types, particularly when the patient is young and substantial loss of meniscal tissue would lead to an unacceptable risk of future arthritis.11 Repair of these challenging tear types should only be attempted when the meniscal tissue is of good quality and a stable result is achievable. Surgical treatment is usually reserved for younger patients with a vertical longitudinal tear within the vascularised outer third of the meniscus. M23.322 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. (6a) A radial tear of the body of the lateral meniscus also appears vertical on sagittal MR images (arrow), though in the case of radial tears, the lesion is oriented perpendicular to the c-shaped fibers of the meniscus. 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. In older patients, referral is appropriate if conservative management fails to improve symptoms. Apley test (grinding) test: The patient lies prone, with their knee flexed to 90 degrees and their hip extended. 13 Newman AP, Daniels AU, Burks RT. Magnetic resonance imaging is first line for investigating potential meniscal lesions, but should not replace thorough clinical history and examination. Scuderi G, Tria A. Guides you through the decision to have surgery for a torn meniscus. Meniscus Tear in Knee | Signs, Symptoms, Surgery and Rehab - SportsMD Sounds like it will not get better without arthroscopic surgery. Meniscal injury is common, and the medial meniscus is more frequently injured. 1871 LPGA Blvd., Daytona Beach, FL 32117. Similarly, tears that are not associated with locking of the knee will typically become less painful over time. Medial meniscal posterior root tears represent an often unrecognized pathology with potentially devastating long-term effects. This pattern of tear requires resection to prevent propagation of the tear as the flap gets caught within the joint during flexion. You can tear a meniscus during any activity which involves forcefully twisting or rotating the knee. Your doctor will generally ask you how the injury occurred, how your knee has been feeling since the injury and whether you have had other knee injuries. You will start with exercises to improve your range of motion. 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. In addition to categorizing meniscal tears based on morphology, care should be taken to describe the exact location of meniscal tears. How to Treat Posterior Horn Medial Meniscus Tear. what is the treatment? Performing activities that involve aggressive pivoting and twisting of the knee puts you at a significantly higher risk of tearing your meniscus. Meniscal ramp lesions: an illustrated review - Insights into Imaging All Rights Reserved. The content of any advertising or promotional material contained within, or mailed with, Australian Family Physician is not necessarily endorsed by the publisher. Meniscus surgery is a common operation to remove or repair a torn meniscus, a piece of cartilage in the knee. Sometimes this type of tear can heal on its own but it may require surgery if symptoms dont subside. 7 Yao L, Stanczak J, Boutin RD. 6 Types of Meniscus Tears - Orthopaedic Associates of Central Maryland Meniscus Surgery. 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 . Sekiya JK, West RV, Groff YJ, Irrgang JJ, Fu FH, Harner CD. During weight-bearing activities, the menisci dissipate axial loads and contain hoop stresses. The loss of the central attachment of the posterior horn may allow extrusion of the body of the meniscus relative to the joint (13a). I have a oblique grade 3 tear posterior horn of the medial meniscus. Ercin E, Kaya I, Sungur I, Demirbas E, Ugras AA, Cetinus EM. 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 Dr. Christopher Ferguson and another doctor agree. Meniscal tear configurations: categorization with MR imaging. Regular exercise to restore your knee mobility and strength is necessary. Posterior Horn Meniscus Tears An oblique tear (7a,8a) is often referred to as a parrot-beak tear, as the tear shape resembles a parrots beak. Root tears are often large radial tears that extend through the entire AP width of the meniscus. The vascularity of the peripheral menisci is primarily derived from the I have an oblique horizontal tear posterior horn medial meniscus, what does that mean? Your doctor may inject a corticosteroid medication into your knee joint to help eliminate pain and swelling. See your ortho for an evaluation. Ask if your condition can be treated in other ways. The younger population, particularly males with knee instability, is most commonly affected by this type of tear [56]. These tears often require surgical treatment to restore the proper function of the knee. In (17a), the preoperative study, a large displaced "handle" (arrow) from the body of the lateral meniscus is seen near the intercondylar notch. Non-anatomic placement of a PCL reconstruction tibial tunnel is a reported cause of iatrogenic medial meniscal posterior root tears. These can occur through either a contact or non-contact injury for example, a pivoting or cutting injury. Nonsteroidal anti-inflammatory drugs (NSAIDs). Complex Medial Meniscus Tear: Repair technique - YouTube HealthTap uses cookies to enhance your site experience and for analytics and advertising purposes. Rimington T, Mallik K, Evans D, Mroczek K, Reider B. Strengthening exercises will gradually be added to your rehabilitation plan. oblique ligament, and the . Any tears appear as white lines. Grade 3 is a true meniscus tear and an arthroscope is close to 100 percent accurate in diagnosing this tear. Helms CA, Laorr A, Cannon WD, Jr. Lufkin R. The MRI manual. The absolute indication for specialist referral is the locked knee loss of joint function necessitates surgical intervention. 2010. w/severe pain? A meniscus tear can occur when the knee is suddenly twisted while the foot is planted on the ground. This extrusion should disappear without stress. Inferiorly Displaced Flap Tears of the Medial Meniscus Includes interactive tool to help you decide. While visualization of the meniscal root may be difficult due to MRI slice size, type of MRI and strength of MRI, an extrusion larger than 3 mm highly correlates with a root tear. Oblique tears commonly cause flaps and flaps are generally not good. Perhaps the best know of these is the bucket-handle tear. The relationships among MM radial/oblique tears, MM extrusion (MME), and the effect of arthroscopic meniscal repair are not established. Incisions were made in the dorsal root of the oblique popliteal ligament and the joint capsule . Meniscus tears can happen during physical activities, but they can also occur from: Sometimes, a torn meniscus can occur due to degenerative changes in the knee, even if there is little to no trauma. 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. Of course, if a displaced meniscal fragment is identified, the tear is by definition unstable. However, whether they will respond well to surgery depends on the type of tear, the location, and blood flow in the area where the tear occurred. Makris EA, Hadidi P, Athanasiou KA. I have an oblique tear of the posterior horn of my medial meniscus that extends to the undersurface of the cartilage. During the exam, your doctor will look for signs of tenderness along the joint line. 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. . 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. (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. Principles and decision making in meniscal surgery. 12 Sources By Jonathan Cluett, MD Although all bucket handle tears are repair candidates,16 the bucket handle tear is an example of when the more severe appearing tear is actually better for the patient. When displacement is not evident on MR images, additional criteria that suggest tear instability include the presence of fluid signal intensity within the tear on T2-weighted images, a tear that is greater than 10mm in length, and tears with complex patterns (10a). Although surgical repair has led to improved patient-reported function, there are conflicting reports on the progression of cartilage degeneration. 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. Liodakis E, Hankemeier S, Jagodzinski M, Meller R, Krettek C, Brand J. Arthroscopy 1998;14:8249. Studies have also reported that patients who underwent a repair of the posterior root in the medial meniscus slowed the progression of arthritic changes compared with those who had a meniscectomy; although, this did not completely prevent the arthritic changes. The amount of pain and first appearance of swelling can give important clues about where and how bad the injury is. Submission to the Department of Health and Ageing. Conservati For a young person arthroscopic meniscal repair is the best solution. 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. The identification of the meniscus comma sign . It is important that these root avulsions are anatomically repaired back to the bone. Tears that are stable, < 1 cm in length, and that do not cause significant . In contrast, the inner two-thirds of the meniscus lacks a significant blood supply. Meniscus tears are injuries that occur in the cartilage of the knee. Tears to the medial meniscal root change the biomechanics and kinematics of the knee, which cause early degeneration of the joint. Metcalf MH, Barrett GR. 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 type of tear is particularly devastating to meniscal function. Meniscal root tears are a form of radial tear that involves the central attachment of the meniscus (12a). growth factors) on meniscus tissue is being investigated.2 These are currently only being trialled in younger patients7 and the routine use of most of these technologies is some time away. AAOS OVT - Suture Bridge Fixation for Posterior Cruciate Ligament The RICE protocol is effective for most sports-related injuries. Bove SE, Flatters SJ, Inglis JJ, Mantyh PW. Meniscus tears can vary widely in size and severity. Identification of a meniscal root tear on MRI may be challenging due to the relatively small size of the root. The tear can be seen as a white line through the dark body of the meniscus. Meniscal root tears, less common than meniscal body tears and frequently unrecognized, are a subset of meniscal injuries that often result in significant knee joint disorders. Torn meniscus - Symptoms and causes - Mayo Clinic All rights reserved. Non-operative treatment of degenerative posterior root tear of the medial meniscus. Medial and Lateral Meniscus Tears | Cedars-Sinai On MRI, meniscal tears are evident as a linear signal intensity that extends through the meniscal substance to a free edge17 (Figure 4). Medial meniscal root tears: Fix it or leave it alone Orthopedics Today | Medial and lateral menisci are crescent-shaped fibrocartilage structures that provide joint congruity, stabilization and. J Bone Joint Surg Am 2005;87:71524. From January 2018, it was superseded by AJGP: Australian Journal of General Practice, The Royal Australian College of General Practitioners 2021. 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). Rehabilitation of the knee following sports injury. What to Do If Your Orthopaedic Surgery Is Postponed. When appropriate, tears that appear to involve the periphery, or red zone of the meniscus, should be described as such (9a), thereby alerting the surgeon to the fact that the tear is more amenable to repair. The vertical flap tear is a displaced type of radial tear that often occurs in the posterior medial meniscus. The arthroscope is inserted near the knee via a tiny incision. Know why a new medicine or treatment is prescribed, and how it will help you. Recent kinematic/biomechanical studies have also shown the importance of the medial meniscus to anterior translation of the knee. Meniscus tears are either degenerative or acute. Tears present as severe pain, swelling, and possibly catching, clicking, difficulty on deep knee bending and locking of the knee in partial flexion. AJR 2001; 176:771-776. American Board of Orthopaedic Surgery Practice of the Orthopaedic Surgeon: Part-II, certification examination case mix. 2. J Bone J Surg Am 2006;88:6607. If you have a follow-up appointment, write down the date, time, and purpose for that visit. Rehabilitation time for a meniscus repair is about 3 to 6 months. Medial meniscus tears are most frequently addressed with a partial meniscectomy, which involves arthroscopically removing the damaged portion of cartilage. Both of them have 2 causes. meniscal tear / avulsion off tibial plateau CIRCUMFERENTIAL FIBERS basicall equivalent to a total meniscetyomy - try to repair these at all cost! The anterior horn of the medial meniscus demonstrates half of the normal anatomic 'bow-tie configuration'. The absent bow tie sign in bucket-handle tears of the menisci in the knee. These are the menisci. Meniscus Repair. Medial and lateral menisci are crescent-shaped fibrocartilage structures that provide joint congruity, stabilization and lubrication and act as shock absorbers for joint preservation. The healing of an Oblique Fracture can take a minimum of four to six weeks to completely heal. Because there is no supply, there is little capacity for these tears to heal on their own. summary. Arthroscopic repair An arthroscope is inserted into the knee to see the tear. What is an oblique tear of the meniscus? - Rampfesthudson.com Know the reason for your visit and what you want to happen. New surgical advances allow surgeons to repair these tears. AJSM 2007; 35:1380-1383. RACGP - Meniscal tear - presentation, diagnosis and management can he still play tennis with this injury? Knee Surg Sports Traumatol Arthrosc 2010;18:5359. Patients are often aware of movements that aggravate mensical pain, but should also be educated to avoid twisting on a weight bearing, flexed knee. The McMurray test (shown here) will help your doctor determine if you have a meniscus tear. Following root repair, patients are required to remain non-weight-bearing for 6 weeks. Meniscal tear incidence may be as high as six per 1000 population6 with a 2.5 to 4 times male predominance. 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. Surgery is typically the only option and works to trim the damaged portion of the meniscus. It has been shown the peak tibiofemoral contact pressure after a total meniscectomy is equal to a posterior medial meniscal root tear. Absence of the medial meniscus (entire medial meniscal root tear) places large stresses on the ACL, the primary ligament that prevents anterior translation of the knee. A tear can also develop slowly as the meniscus loses resiliency. Unhappy Triad: Stress is put on medial side of the knee which potentially tears three related structures The primary objective is to control the disease process to avoid the complications . Operative Arthroscopy, 3rd Edition, 2002, Lippincott Williams and Wilkins. Of note, drilling tibial tunnels may improve healing of the meniscus-bone interface due to the presence of progenitor cells and growth factors derived from the bone marrow. Types of meniscus tears:(Left) Bucket handle tear. Two bones meet to form your knee joint: the femur and the tibia. The meniscus can tear from acute trauma or as the result of degenerative changes that happen over time. This is because this area has rich blood supply and blood cells can regenerate meniscus tissue or help it heal after surgical repair. The accuracy of physical diagnostic tests for assessing meniscal lesions of the knee: a meta-analysis. Meniscal tear | Radiology Reference Article | Radiopaedia.org Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website. Meniscal repairs are more likely to be successful when performed near the time of injury. By the time people reach their twenties or thirties, intrasubstance changes of the meniscus tissue are common. If your symptoms do not persist and you have no locking or swelling of the knee, your doctor may recommend nonsurgical treatment. Acute meniscus tears often happen during sports. Reactive synovitis and edema (arrowheads) are readily apparent deep to the tibial collateral ligament on the coronal view.