(16a) Sagittal and (16b) axial proton density weighted images reveal a very large radial tear (arrows) that extends broadly across the entire width of the anterior body of the lateral meniscus. (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. The oblique meniscomeniscal ligament is but one of several known structures that can mimic meniscal pathology. An MRI is 70 to 90 percent accurate in identifying whether the meniscus has been torn and how badly. A prospective study of the nonoperative treatment of degenerative meniscus tears. Radial Tear B. Horizontal Tear C. Vertical Tear D. Longitudinal Tear E. Oblique Tear. The body usually absorbs these over time. Arthroscopy. 1075 Mason Ave., Daytona Beach, FL 32117, Twin Lakes I have a oblique grade 3 tear posterior horn of the medial meniscus. 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. If your doctor suspects a torn meniscus, he or she will perform aphysicalexam. Tears present as severe pain, swelling, and possibly catching, clicking, difficulty on deep knee bending and locking of the knee in partial flexion. In addition to categorizing meniscal tears based on morphology, care should be taken to describe the exact location of meniscal tears. McMurray (Figure 1) and Apley tests (Figure 2) are often positive, although these are specific but not sensitive specificity being 5798% and 8099%, and sensitivity being 1066% and 1658% respectively.2,9 The most useful clinical test for meniscal injury is the Thessaly test, which is demonstrated in Figure 3. for a 22 year old severe pain. 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- . True locking is less common, and suggests a bucket-handle tear, with the torn fragment preventing full extension. Before your visit, write down questions you want answered. meniscal tear / avulsion off tibial plateau CIRCUMFERENTIAL FIBERS basicall equivalent to a total meniscetyomy - try to repair these at all cost! Meniscus tears can vary widely in size and severity. Tears are noted by how they look, as well as where the tear occurs in the meniscus. Treatment or management protocols for posterior horn menial meniscus tears are quite challenging. No bone marrow edema. 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). It is caused by direct impact in contact sports or twisting. Bucket-handle tears are actually a form of longitudinal tear in which subsequent displacement of the inner rim of the tear results in a configuration that resembles the handle of a bucket (11a). Fax 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 ]. They include: With advances in surgical techniques and instrumentation, meniscal root repair is a viable option that can restore the biomechanics and kinematics of the knee (Figure 4). Rimington T, Mallik K, Evans D, Mroczek K, Reider B. Medial meniscus tears are most frequently addressed with a partial meniscectomy, which involves arthroscopically removing the damaged portion of cartilage. A magnetic resonance imaging (MRI) scan is often used to diagnose meniscal injuries. Meniscus tears, indicated by MRI, are classified in three grades. This type of tear is particularly devastating to meniscal function. The Royal Australian College of General Practitioners, 100 Wellington Parade, East Melbourne, Victoria 3002, Australia. The most common symptoms of a meniscus tear are: After discussing your symptoms and medical history, your doctor will examine your knee. More often, the patient will complain of joint line pain with a minor traumatic event, such as squatting. See this post to learn more about how a meniscus functions . type 3, vertical longitudinal bucket-handle tears; type 4, complex oblique tears; and type 5, bone avulsion fractures of the root attachments. Additionally, the individual will not be able to move the joint due to pain. The RICE protocol is effective for most sports-related injuries. 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. (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. 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. Proton weighted sagittal image demonstrates an example of a posterior horn medial meniscal horizontal tear (white arrow). Evaluation of meniscal injury accounts for most requests for MR imaging of the knee at most institutions. Collateral and cruciate ligaments are intact. Repair of locked bucket-handle meniscal tears in knees with chronic anterior cruciate ligament deficiency. These tears occur within the avascular zone of the meniscus where there is no blood supply. During weight-bearing activities, the menisci dissipate axial loads and contain hoop stresses. How is Oblique Fracture Treated? A meniscus can be split in half, ripped around its circumference in the shape of a C or left hanging by a thread to the knee joint. The healing time in children is a little less as the healing process is faster in children than in adults. If you undergo surgery it will likely be followed by physical therapy to optimize knee strength and stability. The medial meniscus has a firmer capsular attachment than the lateral meniscus. Jul 2000;31(3):419-36. Arthroscopy 1998;14:8249. Repair of such lesions can result in dramatic clinical as well as MR imaging results (17a,17b). Call us at(386) 255-4596to schedule an appointment. Without nutrients from blood, tears in this "white" zone with limited blood flow cannot heal. Chahla and Geeslin report no relevant financial disclosures. Characterization of the red zone of knee meniscus: MR imaging and histologic correlation. Cole BJ, Dennis MG, Lee SJ, et al. Your meniscus acts like a cushion between your thigh bone (femur) and shin bone (tibia). 12 Sources By Jonathan Cluett, MD 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). ICD 9 Codes: 717.4 derangement of the lateral meniscus 717.3 derangement of the medial meniscus 836.0 lateral meniscus tear 836.1 medial meniscus tear Case Type / Diagnosis: Functional Anatomy: The menisci are semi lunar shaped cartilages on the medial and lateral sides of the knee joint. 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. This website also contains material copyrighted by third parties. Several variations in meniscal tear patterns have been granted specific names that recognize the unique characteristics of the tear. 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. One of the most common knee injuries is a torn meniscus. Tears to the medial meniscal root change the biomechanics and kinematics of the knee, which cause early degeneration of the joint. (386) 254-6819, Main Office & Walk-In Clinic At The Orthopedic Clinic, we want you to live your life in full motion. Makris EA, Hadidi P, Athanasiou KA. (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. Clinical outcomes following isolated lateral meniscal allograft transplantation. The medial meniscus transmits approximately 50% of the total joint load of the knee medial compartment, thus protecting the articular cartilage from excessive force. In this procedure, the surgeon inserts a miniature camera through a small incision (portal) in the knee. Complex or degenerative tears are where two or more tear patterns exist. Biomaterials 2011;32:741131. Most oblique meniscus tears are happen in the posterior third of the medial meniscus. Non-anatomic placement of a PCL reconstruction tibial tunnel is a reported cause of iatrogenic medial meniscal posterior root tears. Sometimes, its possible to repair a torn meniscus, especially if you are a young adult. Your doctor will bend your knee, then straighten and rotate it. Recovery and rehabilitation take a few weeks. The meniscus is broken down into the outer, middle, and inner thirds. This opening pushes the inside edge of your meniscus toward the middle of your knee. Skeletal Radiology 2004; 33:260-264. Historically, medial meniscal root tears have been treated conservatively or by partial meniscectomy. If you are having pain, swelling and catching, then the only reasonable option would be arthroscopic knee surgery. Both of them have 2 causes. With the realization that even partial meniscectomy leads to accelerated osteoarthritis,2 surgeons have increasingly turned to meniscal repair. These are often 'bucket-handle tears', in which there is a vertical or oblique tear in the posterior horn running toward the anterior horn,5 forming a loose section which remains attached anteriorly and posteriorly.1 In older patients, tears are generally due to degeneration associated with ageing and tend to be horizontal tears. The treatment your doctor recommends will depend on a number of factors, including your age, symptoms, and activity level. Lists risks and benefits of surgery for meniscus tear. Seldom are they the sign of a problem. An oblique tear (7a,8a) is often referred to as a parrot-beak tear, as the tear shape resembles a parrots beak. They act as shock absorbers and stabilize the knee. can he still play tennis with this injury? 2013. The test is positive if symptoms are reproduced on rotation 10. Br Med Bull 2007;84:523. (5a) A longitudinal tear of the posterior horn of the medial meniscus is illustrated. 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. This means that athletes, especially those who participate in contact sports like football, are at a higher risk of sustaining this injury. What to Do If Your Orthopaedic Surgery Is Postponed. 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. If this cartilage tears, the result is pain, stiffness, and swelling. summary. 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. Athletes, particularly those who play contact sports, are at risk for meniscus tears. Meniscus Surgery. This pattern of tear requires resection to prevent propagation of the tear as the flap gets caught within the joint during flexion. Sometimes this type of tear can heal on its own but it may require surgery if symptoms dont subside. There are numerous treatments for meniscus tears, but treatment generally begins conservatively depending on the location, type, and size of the tear. 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.
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