Because there is no supply, there is little capacity for these tears to heal on their own. Clinical outcomes following isolated lateral meniscal allograft transplantation. Although the . 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). Meniscus Tears: Causes, Treatment & More - The Orthopedic Clinic Garrett WE Jr, Swiontkowski MF, Weinstein JN, et al. Medial and Lateral Meniscus Tears | Cedars-Sinai Oblique tear of the posterior horn of the medial meniscus 6 Singapore: World scientific, 2010. If you have a follow-up appointment, write down the date, time, and purpose for that visit. If you have a meniscus tear, this movement may cause pain, clicking, or a clunking sensation within the joint. Meniscal injury and repair: clinical status. Jul 2000;31(3):419-36. Seldom are they the sign of a problem. A medial meniscus tear on the inside of the knee is more common. I have an oblique tear of the posterior horn medial meniscus with prominent interior medial extrusion. Meniscus tears can vary widely in size and severity. 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. Knee Surg Sports Traumatol Arthrosc 2007;15:393401. In some cases, your doctor may suggest an arthroscopyto examine and possibly treat your knee. The vascularity of the peripheral menisci is primarily derived from the RICE stands for Rest, Ice, Compression, and Elevation. The treatment of these type of tears can be either arthroscopy (surgery through a tiny hole in knee) or conservative. Damaged avascular meniscus must be removed.27 However, meniscectomy causes long term osteoarthritis,28 so is only performed when the patient suffers joint locking or mensical pain that is refractory to conservative management. In fact, the tear will most likely get bigger leading to additional damage if not taken care of soon. Be unable to extend your leg comfortably and may feel better when your knee is bent (flexed). 1075 Mason Ave., Daytona Beach, FL 32117, Twin Lakes London;1897. PDF Standard of Care: Meniscal Tears Conservative management of the patient Strengthening exercises will gradually be added to your rehabilitation plan. Always follow your healthcare professional's instructions. 3rd edn. PDF Peripheral Meniscal Tears: How 7 to Diagnose and Repair - Dr. Jorge Chahla AJSM 2002; 30:589-600. For information:Questions and Answers for Patients Regarding Elective Surgery and COVID-19. If you've torn your meniscus, it might take 24 hours or more for pain and swelling to begin, especially if the tear is small. If you have unusual pain and discomfort in your knee, let us help you get back to doing the things you love. Each knee has two C-shaped pieces of cartilage known as menisci. 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). Knee arthroscopy is one of the most commonly performed surgical procedures. These tendons have poor blood supply and will not heal themselves. Metcalf MH, Barrett GR. The younger population, particularly males with knee instability, is most commonly affected by this type of tear [56]. The difference in tear type between these populations is explained by the three-dimensional fibrous structure of the meniscus: horizontal delamination occurs in degenerative injuries, while the fibrous structure is ruptured in a vertical fashion in younger patients. The outer one-third of the meniscus has a rich blood supply. 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 ]. Both longitudinal and radial tears may appear vertical on MR images (5a,6a), but longitudinal tears extend parallel to the c-shaped circumference of the meniscus, whereas radial tears lie perpendicular to the meniscal circumference. These imaging pearls improve recognition of meniscal root tears (Figure 2). De Carlo M, Armstrong B. This pattern of tear requires resection to prevent propagation of the tear as the flap gets caught within the joint during flexion. American Board of Orthopaedic Surgery Practice of the Orthopaedic Surgeon: Part-II, certification examination case mix. As stated above, the most common cause of Posterior Horn Medial Meniscus Tear can be trauma to the knee which can be sustained due to a sporting injury, a slip and fall, a blunt trauma to the knee, and in majority of the cases natural degeneration of the meniscus due to the work load of the knee. Illustration and photo show a camera and instruments inserted through portals in a knee. Meniscus Radial Tear | George Gendy MD Meniscus morphology: Does tear type matter? A narrative review with can he still play tennis with this injury? 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. 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. from the American Academy of Orthopaedic Surgeons, Questions and Answers for Patients Regarding Elective Surgery and COVID-19. In addition to categorizing meniscal tears based on morphology, care should be taken to describe the exact location of meniscal tears. Inferiorly displaced flap tears of the medial meniscus: MR appearance and clinical significance. Nonoperative treatments are an important part of the management of all patients, regardless of whether surgery is being considered. They will check for tenderness along the joint line where the meniscus sits. You may be asked about your physical and athletic goals to help your doctor decide on the best treatment for you. Historically, medial meniscal root tears have been treated conservatively or by partial meniscectomy. 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 . It is possible that your symptoms of pain, etc will improve with time without surgery.But that doesn't mean the tear healed. (9a) This irregular tibial surface tear (arrow) clearly lies within the peripheral, red zone, of the meniscus. 3 Thornton DD, Rubin DA. Currently, routine MR images do not reveal signal intensity differences between the red and white zones of the menisci. 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. Additional pain may be felt when flexing or twisting the knee. Reciprocally, an increased force is also placed on an ACL graft with a deficient medial meniscus. AJSM 2003; 31:216-220. The skilled interpreter of MR of the knee must do more than simply identify the presence of a meniscal tear. For patients whose procedures have not yet been rescheduled:What to Do If Your Orthopaedic Surgery Is Postponed. Includes interactive tool to help you decide. 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. 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 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). If the fracture is stable or closed where the bones do not move out of alignment then simple immobilization with the use of a sling, splint or cast for a few weeks allowing the fracture to heal may be enough. Rosemont, Ill. American Academy of Orthopaedic Surgeons. Helms CA, Laorr A, Cannon WD, Jr. The identification of the meniscus comma sign . 8 Ruff C, Weingardt J, Russ P, Kilcoyne R. MR imaging patterns of displaced meniscus injuries of the knee. Longitudinal (vertical) meniscal tear | Radiology Case | Radiopaedia.org 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. If your MRI indicates a Grade 1 or 2 tear, but your symptoms and physical exam are inconsistent with a tear, surgery may not be needed. Have swelling, stiffness or tightness in your knee. type 3, vertical longitudinal bucket-handle tears; type 4, complex oblique tears; and type 5, bone avulsion fractures of the root attachments. With meniscal repair, weight bearing may be severely limited for up to six weeks following surgery, and protection from heavy stress to the knee extends for up to six months. If your symptoms persist with nonsurgical treatment, your doctor may suggest arthroscopic surgery. Disclosures: LaPrade reports he is a consultant for and receives royalties from Arthrex, Ossur and Smith & Nephew. Surgical treatment is usually reserved for younger patients with a vertical longitudinal tear within the vascularised outer third of the meniscus. Herrlin S, Hallander M, Wange P, Weidenhielm L, Werner S. Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomised trial. If your symptoms do not persist and you have no locking or swelling of the knee, your doctor may recommend nonsurgical treatment. If this cartilage tears, the result is pain, stiffness, and swelling. Makris EA, Hadidi P, Athanasiou KA. Sounds like it will not get better without arthroscopic surgery. 10 DeHaven KE. Treatment varies on a case-by-case basis. Posterior Horn Medial Meniscus Tear | Knee Meniscus Tear Diagnosis - clinical presentation with exclusion of advanced knee osteoarthritis. 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. 5 Jee WH, McCauley TR, Kim JM, et al. I could not really walk on it. Arthroscopy 2006;22:77180. Tears are noted by how they look, as well as where the tear occurs in the meniscus. The most common symptoms of a meniscus tear are: After discussing your symptoms and medical history, your doctor will examine your knee. Pain is typically medial and activity-related (e.g. Most oblique meniscus tears are happen in the posterior third of the medial meniscus. This is because this area has rich blood supply and blood cells can regenerate meniscus tissue or help it heal after surgical repair. Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. Nonoperative treatments are often successful in patients with certain types of tear patients who have no loss of joint function, suffer minimal pain or swelling and are willing to reduce their activities temporarily or in the long term. Torn Cartilage Meniscus - Symptoms, Causes, Treatment & Rehabilitation How can I tell if I have an oblique fracture? Question options: . Missouri: Mosby, 1998. It has been reported that the force experienced by the medial meniscus in the ACL-deficient knee increased by 52% in full extension and by 197% at 60 of flexion under a 134-N load. Vincken PW, ter Braak AP, van Erkel AR, et al. The menisci help to transmit weight from one bone to another and play an important role in knee stability. Medial Meniscus Tear | Knee Specialist | Minnesota Horizontal cleavage, oblique, and complex meniscal tear patterns have traditionally been poor candidates for meniscal repair. The knee: a comprehensive review. Vertical flap (oblique, flap, parrot's beak) tears are unstable tears and occur in younger patients. (13a) A coronal image from another patient with a medial meniscal root tear demonstrates associated severe medial subluxation of the meniscal body (arrow). X-rays and MRIsallow the doctor to evaluate the bone and soft tissue at the knee. 11 Plain radiography is only useful to exclude differentials and computed tomography (CT) is markedly inferior to MRI for meniscal imaging.12 Magnetic resonance imaging is the gold standard, first choice for investigation of suspected meniscal tears.2,1316. 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. Copyright 1995-2021 by the American Academy of Orthopaedic Surgeons. Note: the cartilage deficit more anteriorly on the medial femoral condyle and altered subchondral cortical bone interface, Figure 5. 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. Although C, a vertical tear, is commonly used to describe such an appearance, the better answer is D, a longitudinal tear. 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 .