In contrast, displaced tears involve either complete detachment of a piece of meniscus or flipping of a piece of the meniscus that is still attached to the rest of the meniscal body. Each of your knees has two C-shaped pieces of cartilage that act like a cushion between your shinbone and your thighbone. Although the lateral collateral ligament passes closer to the lateral meniscus, it is not attached to it (Figure (Figure1)1) [6]. [QxMD MEDLINE Link]. In addition to pain, you may experience knee instability and a reduced range . [QxMD MEDLINE Link]. A torn meniscus causes pain, swelling and stiffness. A second peak of incidence is observed in persons older than 55 years; this is secondary to a degenerate meniscus being susceptible to injuries with minor trauma. 94 (6):460-73. Rinonapoli G, Carraro A, Delcogliano A. Each knee has two menisci. 2019 Feb 26; [PubMed PMID: 30809722], van de Graaf VA,Willigenburg NW,Poolman RW, Arthroscopic Partial Meniscectomy vs Physical Therapy for Nonobstructive Meniscal Tears-Reply. Kelly JD 4th, Ebrahimpour P. Chondral injury and synovitis after arthroscopic meniscal repair using an outside-in mulberry knot suture technique. The meniscus is the tough, rubbery cartilage that acts as a shock absorber between your shinbone and thighbone. A meniscus tear is one of the most common sports-related injuries and often requires surgery due to pain and dysfunction of the knee [1]. Knee meniscal injuries also occur in individuals who are skeletally immature, but less commonly than in adults. They can happen when a person changes direction suddenly while running, and often occur at the same time as other knee injuries, like an anterior cruciate ligament (ACL) injury. Arch Orthop Trauma Surg. Medial meniscal tears are more common than lateral meniscal tears, possibly due to the relatively decreased mobility of the medial meniscus secondary to its connection to the MCL. Lerer DB, Umans HR, Hu MX, Jones MH. Meniscal injuries usually are associated with pain that results in gait deviation and loss of time from work and/or sport. These implants are deformable and hence lowering the potential of chondral erosion during weight-bearing [15]. Vertical tears are generally the result of an acute trauma, whereas horizontal tears are typically degenerative in nature. Contraction by the popliteus during knee flexion pulls the lateral meniscus posteriorly, avoiding entrapment within the joint space. sharing sensitive information, make sure youre on a federal Wagemakers HP, Heintjes EM, Boks SS, Berger MY, Verhaar JA, Koes BW, Bierma-Zeinstra SM. Internal Medicine, West Suburban Medical Center, Chicago, USA. Each one of your knees has two c-shaped menisci, one on the inside and one on the outside. root tear: typically radial-type tear located at the meniscal root. The medial meniscus may shift a few millimeters, while the less stable lateral meniscus may move at least 1 cm. [14][Level V], Dejour D,Pungitore M,Valluy J,Nover L,Saffarini M,Demey G, Tibial slope and medial meniscectomy significantly influence short-term knee laxity following ACL reconstruction. Costa CR, Morrison WB, Carrino JA. The cells are termed fibrochondrocytes because they appear to be a mixture of fibroblasts and chondrocytes. [QxMD MEDLINE Link]. Inclusion in an NLM database does not imply endorsement of, or agreement with, Tendinitis causes irritation and inflammation of one or more tendons the thick, fibrous tissues that attach muscles to bones. These cells are responsible for the synthesis and maintenance of the extracellular fibrocartilaginous matrix. It absorbs shock in your knee and keeps it stable. Initially, menisci were described as functionless vestigial remnants and were commonly resected [1]. The rubbery wedges of cartilage act like shock absorbers for your knee, providing cushioning for your bones and knee joint. Frellick M. Exercise as Effective as Surgery for Meniscal Tears. 2014 Jul 18. The coronary ligaments connect the peripheral meniscal rim loosely to the tibia. The aim of this procedure is to re-establish the functionality of the knee joints and mitigate degenerative processes that would otherwise result from poor knee biomechanics [14]. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. An APM is more commonly performed because it is minimally invasive, associated with shorter recovery time, and lower morbidity comparatively [14]. [14]. Degenerative changes in the knee after meniscectomy. One is an acute traumatic injury and the other is due to a degenerative process, the accumulation of damage and wear, slowly over time. Magnetic resonance imaging of the postoperative meniscus. Finally, postoperative rehabilitation and gradual return to normal activity are encouraged to optimize outcomes with all of the above surgeries [14]. The joint capsule attaches to the entire periphery of each meniscus but adheres more firmly to the medial meniscus. Healing and repair of tissue are directly related to vascularization with blood supply to the tissue, hence making the white-white zone prone to degenerative lesions [7]. A meniscus tear is an injury to a part of your knee called the meniscus and is a common injury. Arthroscopic suture anchor repair of posterior root attachment injury in medial meniscus: technical note. When a compressive force is applied in the knee joint, a tensile force is transmitted to the menisci. 20 (5):e49-52. Meniscal tears are sometimes related to trauma, but significant trauma is not necessary. [10], The blood supply to the menisci is limited to their peripheries. The diagnosis of meniscal tears requires detailed history-taking, physical examinations, special diagnostic tests, and most likely magnetic resonance imaging (MRI) to confirm the lesion. Bucket-handle tears are fragments of complete longitudinal tears that migrate centrally over the remaining menisci, whereas parrot-beak tears are radial tears with partially detached fragments. Degenerative meniscal tear: Meniscal rupture: Clinically Relevant Anatomy Characteristics/Clinical Presentation The clinical presentation for a traumatic lesion/rupture: Please confirm that you would like to log out of Medscape. 2009 Aug. 33 (4):961-7. Introduction Six decades ago, the discovery that removing the meniscus from the knee jointthen commonly seen as the sole technique for treating sports-related injuriesresulted in the deterioration of articular cartilage and the gradual development of arthritis, radically changed the approach for treating meniscus-related problems [ 1 ]. Instr Course Lect. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. Arthroscopy. [QxMD MEDLINE Link]. Therefore, per current guidelines, APM is no longer the first-line therapy and should be undertaken only in selective patients with non-repairable meniscal tears and those with persistent mechanical symptoms beyond 3 months [14]. What are the symptoms? 2004 May. It involves passively extending the supine patient's knee from a fully flexed position to 90 degrees flexion while maintaining full external or internal rotation. Today, a meniscus tear is a very common injury and its incidenceis increasing in all ages either due to trauma or osteoarthritis. and transmitted securely. World J Orthop. The cartilage absorbs the stress on the knee and acts as a cushion between the three bones that meet at the knee the femur (thigh bone . Iobst CA, Stanitski CL. The modifiable risk factors that increase the risks of developing meniscal tears are a high body mass index, certain occupations, such as squatting, lifting and carrying weights, stairs climbing, and athletes, and those engaging in sports-related activities, including footballers, and those playing rugby. Pain from a torn meniscus is felt at the front or sides of your knee. Symptoms often include pain, swelling, and difficulty in walking. Careers, Unable to load your collection due to an error. An orthopedic nurse can coordinate medical care and therapy, answer patient questions, and note patient progress or lack thereof, keeping the treating clinician abreast of all developments. Joint effusion gradually develops over a few hours. Arnoczky, in 1982, proposed a classification system that categorizes lesions in relation to the meniscal vascular supply, as follows Double transosseous pull out suture technique for transection of posterior horn of medial meniscus. . Treasure Island (FL): StatPearls [Internet]; 2021. 8600 Rockville Pike Several conditions are associated with meniscus tears. Michael Weinik, DO Associate Chairman, Associate Professor, Physical Medicine and Rehabilitation, Temple University Hospital Meniscal repair is now being touted as a viable and effective alternative. The three main issues considered in the rehabilitation of meniscal repairs are knee motion, weight bearing, and return to sports. Injuries occur predominantly in a young and sports-active population. Imaging techniques such as magnetic resonance imaging may be warranted but are no substitute for thorough clinical history and examination. Int Orthop. Tears within the outer 1/3 vascular zone of the menisci are "red-red" tears, whereas those with central margins extending into the inner 2/3 avascular zone are "red-white" tears. However, these are two different conditions. Bradley S Baker, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North AmericaDisclosure: Nothing to disclose. However, the distribution of neural elements has been demonstrated in essentially the same anatomic distribution as the vascular supply. The larger, semilunar medial meniscus is firmly attached in comparison to the loosely attached, rounder lateral meniscus [8]. 49:189-93. 2017 Apr 5. A torn meniscus causes pain, locking, or clicking, and weakness of the knee. The clinical diagnosis of meniscal tear is not easy. 2004 Jul. A sensation of giving way may occur. Collagen strands are organized for the most part along a longitudinal or circumferential bearing. Depending on the type and extent of the meniscal lesion, there may also be symptoms of locking, clicking, catching, intermittent inability to fully extend the knee, or feeling of the knee giving way. [QxMD MEDLINE Link]. An official website of the United States government. Nikolaou VS, Chronopoulos E, Savvidou C, et al. Pekari TB, Wang KC, Cotter EJ, Kusnezov N, Waterman BR. Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline. Arthroscopic pullout repair of a complete radial tear of the tibial attachment site of the medial meniscus posterior horn. Treasure Island (FL): StatPearls [Internet]; 2021. The pain may be felt on the inner or outer side of the knee depending on which tissues or structures are affected. Trends in meniscus repair and meniscectomy in the United States, 2005-2011. Moreover, energy dissipation, or shock absorption, by the menisci is primarily important when it comes to trauma and high impact load over knee joints [9]. Description The meniscus can tear from acute trauma or as the result of degenerative changes that happen over time. Kim YM, Rhee KJ, Lee JK, Hwang DS, Yang JY, Kim SJ. Mordecai SC, Al-Hadithy N, Ware HE, Gupte CM. Cryotherapy and nonsteroidal anti-inflammatory drugs (NSAIDs) play a very important role in the management of nonoperative meniscal injury. [6, 7, 13]. Two pieces of cartilage sit inside your knee, between your thighbone (femur) and shinbone (tibia). Sarjoo M Bhagia, MD Consulting Staff, OrthoCarolina; Voluntary Teaching Faculty, Carolinas Rehabilitation Am J Sports Med. Insall JN, Scott WN, eds. complex tear: a combination of all or some horizontal, vertical, and radial-type tears. [QxMD MEDLINE Link]. This made meniscus surgery one of the most common orthopedic operations with an incidence of 17 procedures per 100,000 in the United States [2]. In addition, the knee may catch or lock. [16] As previously stated, meniscal injuries are rare in children younger than 10 years with morphologically normal menisci. Internal Medicine, Saint James School of Medicine, Park Ridge, USA, 4 A meniscal repair like meniscectomy can also be performed via an open surgical or arthroscopic approach [15]. ]; The epidemiology of meniscus injury. The protocols for rehabilitation of a meniscal injury take into consideration biomechanical principles and the results of the physical examination. Meniscal lubrication occurs from fluid exudation across the surface, much like with articular cartilage. [QxMD MEDLINE Link]. Note. Physical examination should include inspection of the knee for edema, palpation of the joint line, standing and supine range of motion (ROM), muscle strength testing, and special testing. Note. MR imaging has been found to be 93% sensitive and 88% specific for medial meniscal tears, and 79% sensitive and 96% specific for lateral meniscal tears. The joint capsule attaches to the entire periphery of each meniscus but is more firmly attached to the medial meniscus [6]. Additionally, MSCs also exhibit multilineage differentiation and self-renewal capacity, which make them the perfect substrate for regeneration [18]. Meniscus injuries of the knee. PM [PubMed PMID: 30195704], Ferrari MB,Murphy CP,Gomes JLE, Meniscus Repair in Children and Adolescents: A Systematic Review of Treatment Approaches, Meniscal Healing, and Outcomes. 37 (6):1131-4. The femur attempts to spread the menisci anteroposteriorly in extension and mediolaterally in flexion. The operation is continued until the tear is stabilized [15]. [QxMD MEDLINE Link]. The site is secure. Exercises, medicine, and arthroscopy may be used to treat a torn meniscus. 129 (3):387-92. The recent advances in ongoing research studies and clinical trials contribute to the diagnosis and management of the condition. The medial meniscus is on the inner side of the knee joint. Using arthroscopy as the gold standard, MRI is the best mode of imaging to diagnose and characterize meniscal tears. Tissue engineering has been of high interest in the current research with promising therapeutic results. In the knee, menisci are wedges of fibrocartilage that are located between the tibial plateau andfemoral condyle [6]. [QxMD MEDLINE Link]. A physical examination can diagnose a torn meniscus. 3rd ed. Popliteal hiatus is the area between the joint capsule and lateral meniscus that allows the popliteal tendon to pass through. Arthroscopy. [12] : Reports describe techniques for manufacturing a vascular access channel from the peripheral vasculature to improve the chance that tissue in the central region will repair itself. Beaufils P, Pujol N. The effects of high-intensity and low-intensity cycle ergometry in older adults with knee osteoarthritis. Tissue engineering (TE) is an upcoming technology that has the potential for use in the treatment of meniscal tears [18]. Anatomy, Bony Pelvis and Lower Limb, Medial Meniscus. The test is positive when there is clicking/popping and pain in the knee when the knee is rotated [12]. The load now was distributed directly to the articular cartilage. Occupational kneeling and meniscal tears: a magnetic resonance imaging study in floor layers. 10(2):90-5. Arthroscopy. [6, 7] The wedge-shaped meniscus attached to the tibia serves as a secondary stabilizer. Biomechanicsand pathology of the meniscus. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. 2018 Nov; [PubMed PMID: 30480006], Kurzweil PR,Cannon WD,DeHaven KE, Meniscus Repair and Replacement. Background Medial and lateral knee joint menisci serve to transfer load and absorb shock, aid joint stability and provide lubrication. However, the presence of a discoid meniscus, an anatomic variant most often occurring in the lateral meniscus that involves the additional central extension of the meniscus over the tibial articular surface, may predispose someone to tears at a younger age. Instead, meniscal repair has been shown to have better long-term outcomes and is therefore recommended for all tears, especially for young patients with acute traumatic lesions. Radial tears of the posterior horn of the medial meniscus. AJR Am J Roentgenol. However, recent studies have conclusively shown that outcomes after an APM are no better than the outcomes after a sham/placebo surgery. J Orthop Sci. 2018 May 23; [PubMed PMID: 29791926], Rathcke MW,Lind M,Boesen MI,Nissen N,Boesen AP,Mygind-Klavsen B,Hlmich P, [Treatment of meniscal pathology]. A meniscectomy (or meniscal resection) can be done completely or partially via an open or arthroscopic approach [14]. Si te desgarraste el menisco, podran pasar 24 horas o ms hasta que aparezca el dolor y la hinchazn, especialmente si el desgarro es pequeo. The potential for vascular ingrowth is essential for successful meniscal healing and surgical repair. History-taking information about the cause and presentation of the meniscus tears can be identified. 2019 Feb 26; [PubMed PMID: 30806685], Donohue MA,Zhou L,Haley CA, Meniscus Injuries in the Military Athlete. Skeletal Radiol. . Tears contained within the inner 2/3 avascular zone are "white-white" tears. The femur externally rotates on the tibia, and the medial meniscus is pulled forward. [QxMD MEDLINE Link]. 2018 Mar 7. 354:i3740. A sudden twist or repeated squatting can tear the meniscus. Pain is typically reported over the anteromedial or anterolateral joint line. [QxMD MEDLINE Link]. Deficits in open kinetic chain knee flexion/extension strength testing are unlikely. 20:e32-3. Clin Orthop Relat Res. Arthroscopic suture anchor repair versus pullout suture repair in posterior root tear of the medial meniscus: a prospective comparison study. National Library of Medicine Bhan K. Knee joint changes after meniscectomy. On MRI, the abnormal shape of the meniscus and high signal intensity contacting the surface edge can be appreciated (Figure (Figure3)3) [2]. Does Weightlifting Improve Cardiovascular Mortality Risk for Older Aged Adults? Magnetic resonance imaging scan showing a normal meniscus. Michael Weinik, DO is a member of the following medical societies: American Academy of Physical Medicine and RehabilitationDisclosure: Nothing to disclose. https://now.aapmr.org/meniscus-injuries-of-the-knee/, https://www.aafp.org/afp/2000/0415/p2391.html. BMC musculoskeletal disorders. Fairbank TJ. Surgery of the Knee. Patients with peripheral tears of the meniscus occasionally develop effusion rapidly (in minutes), secondary to a tear that is associated with hemarthrosis and is in the vascular outer one third of the meniscus. [QxMD MEDLINE Link]. official website and that any information you provide is encrypted Many patients are. Meniscal injuries are more common in males, which may be a reflection of greater involvement by males in aggressive sporting and manual activities that predispose to rotational injuries of the knee. Meniscal scaffold surgery, on the other hand, uses synthetic biodegradable porous structures to fill meniscal defects [14]. Although not entirely clear, these nerve endings are believed to play a role in sensory feedback and proprioception. Torn meniscus. 2011 Nov 30. Am J Sports Med. 2018 Dec; [PubMed PMID: 30395058], Karia M,Ghaly Y,Al-Hadithy N,Mordecai S,Gupte C, Current concepts in the techniques, indications and outcomes of meniscal repairs. James H Lubowitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North AmericaDisclosure: Received consulting fee from Arthrex for consulting; Received salary from AANA for employment; Received royalty from Arthrex for other. Kim JH, Chung JH, Lee DH, Lee YS, Kim JR, Ryu KJ. Shrive et al presented a model of normal meniscal function. Since then, studies confirmed that the meniscus is an important weight-bearing structure and its absence leads to knee instability and osteoarthritis [1-3]. [QxMD MEDLINE Link]. The patient's clinical presentation with a meniscal tear is variable depending on the mechanism of injury and degree of concomitant tibiofemoral insults. 52 (5):313. PMID: 2406071 Abstract The pathologic description of the menisci is facilitated by grouping the various disorders into etiologic groups. 2018 Mar. Similar in function to the spinal discs that cushion the vertebrae in the spinal column, the meniscus is a piece of rubbery cartilage that acts as a shock absorber in the knee joint. Meniscal tears in children under the age of 10y/o are uncommon. In terms of a scaffold, the most ideal characteristics would be: (i) cell-instructive, allowing proliferation and differentiation of the seeded cells, (ii) architectural mimic of the native meniscus, (iii) resilience to mechanical forces acting on the joint while allowing deposition of ECM, (iv) biocompatibility to prevent an immunogenic reaction, and (v) easily implantable [18]. Dolor, especialmente al torcer o girar la rodilla. Bryce T Wolf, MD Sports Medicine Fellow, Taos Orthopedic InstituteDisclosure: Nothing to disclose. J Rheumatol. Increasing incidence of medial meniscal tears in nonoperatively treated anterior cruciate ligament insufficiency patients documented by serial magnetic resonance imaging studies. An interruption in the attachment of the joint capsule to the lateral meniscus, forming the popliteal hiatus, allows the popliteus tendon to pass through to its femoral attachment site. All content published within Cureus is intended only for educational, research and reference purposes. The recovery is often prolonged, but overall most patients achieve a satisfactory outcome with full use of the knee. Medscape Education. 2018 Feb 2. [QxMD MEDLINE Link]. Yoo JC, Ahn JH, Lee SH, et al. In joints with intact menisci, the force was applied through the menisci and articular cartilage; however, a lesion in the peripheral rim disrupted the normal mechanics of the menisci and allowed spreading when a load was applied. Kise NJ, Risberg MA, Stensrud S, Ranstam J, Engebretsen L, Roos EM. The .gov means its official. [8][9][10], Initial treatment of the acutely painful, edematous knee in which meniscal tear is suspected should consist of the RICE principles for acute soft tissue injury (rest, ice, compression, and elevation). Flap tears are partially detached fragments of horizontal tears. Allaire R, Muriuki M, Gilbertson L, Harner CD. These tearsare best managed by an interprofessional team that includes the emergency department physician, nurse practitioner, orthopedic surgeon, physical therapist, and radiologist. [QxMD MEDLINE Link]. 2(5604):525-7. In this approach, the sutures are passed from inside the knee to an extra-capsular area through the extra-articular incision and a knot is then secured over the joint capsule [14].
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