Your meniscus acts like a cushion between your thigh bone (femur) and shin bone (tibia). In some cases, a meniscal repair may also be possible, though this is dependent on the size and location of the tear. If the test is positive (suggesting a meniscal tear), the patient will feel pain and the clinician will feel and/or hear meniscal movement when the meniscus is compressed between the tibia and femur 32, Figure 2. Conservative management of the patient with a meniscal tear. Meniscus tears simply do not heal on their own, regardless of conservative treatment. Complex tears like this are likely to be unstable. The content of any advertising or promotional material contained within, or mailed with, Australian Family Physician is not necessarily endorsed by the publisher. If you continue to use this site we will assume that you are happy with it. The arthroscope is inserted near the knee via a tiny incision. My husband has complex tear of the body and posterior horn of the medial meniscus with flap components, horizontal oblique tear of the body and posterior horn lateral meniscus. Top answers from doctors based on your search: Created for people with ongoing healthcare needs but benefits everyone. If you have unusual pain and discomfort in your knee, let us help you get back to doing the things you love. Bernstein J. 13 Newman AP, Daniels AU, Burks RT. SPHE425_Quiz_5.docx - Quiz 5 Attempt 1 Written: Aug 6, 2022 In this procedure, the surgeon inserts a miniature camera through a small incision (portal) in the knee. 2 The risk of osteoarthritis and its progression increase in line with reductions in tibial cartilage coverage. 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. Reciprocally, an increased force is also placed on an ACL graft with a deficient medial meniscus. (3a) A fat-suppressed proton density-weighted axial image through the knee joint demonstrates the C-shaped menisci. Radiographs may or may not show medial joint space narrowing. Peripheral Meniscal Tears: How to Diagnose and Repair - ResearchGate Radiology 2000; 217:193-200. Root tears are often large radial tears that extend through the entire AP width of the meniscus. Scholten RJ, Deville WL, Opstelten W, Bijl D, van der Plas CG, Bouter LM. A comparative study with a short term follow up. summary. Meniscus surgery is a common operation to remove or repair a torn meniscus, a piece of cartilage in the knee. Herrlin S, Hallander M, Wange P, Weidenhielm L, Werner S. Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomised trial. Of course, if a displaced meniscal fragment is identified, the tear is by definition unstable. Inferiorly displaced flap tears of the medial meniscus: MR appearance and clinical significance. These tears can be challenging to recognize on MRI,9 but are important to diagnose since they are often highly symptomatic due to a reactive synovitis. You can tear a meniscus during any activity which involves forcefully twisting or rotating the knee. 10 DeHaven KE. A prospective study of the nonoperative treatment of degenerative meniscus tears. Chahla and Geeslin report no relevant financial disclosures. Lufkin R. The MRI manual. All rights reserved. No meniscal tears were observed. The meniscus is a thick cartilage structure that sits between the bones of the knee. 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 ]. 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. In (17a), the preoperative study, a large displaced "handle" (arrow) from the body of the lateral meniscus is seen near the intercondylar notch. swelling . Choose a doctor and schedule an appointment. Meniscal repair is a more difficult surgical technique and requires a motivated, diligent patient in order to be successful. Acta Orthop Scand 1982;53:9759. Depending on the cut thickness, axial MRI images may display the root tear (Figure 3). The anatomic landmark for repair is anterior to the PCL footprint on the tibia. The loss of the central attachment of the posterior horn may allow extrusion of the body of the meniscus relative to the joint (13a). This information is provided as an educational service and is not intended to serve as medical advice. Meniscus Tear of the Knee: Causes, Symptoms, and Diagnosis - Healthline The meniscus is a piece of C-shaped cartilage that helps cushion the knee. Conservative management is important in all patients with acute rest, intensive rehabilitation with physiotherapy and modification of activity. In case of an open or unstable fracture, the bone may protrude out of the skin surface and be exposed to environmental contaminants. I have been diagnosed with a subtle oblique tear involving the posterior horn of the medial meniscus and extends to the inferior articular surface of the meniscus. The medial meniscus transmits approximately 50% of the total joint load of the knee medial compartment, thus protecting the articular cartilage from excessive force. what is the treatment? Rehabilitation time for a meniscus repair is about 3 to 6 months. For potential or actual medical emergencies, immediately call 911 or your local emergency service. The healing of an Oblique Fracture can take a minimum of four to six weeks to completely heal. 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). AJR 2001; 176:771-776. Jarit G, Bosco J. Meniscal repair and reconstruction. Sounds like it will not get better without arthroscopic surgery. To provide the highest quality clinical and technology services to customers and patients, in the spirit of continuous improvement and innovation. Sources: Vertical flap (oblique, flap, parrot's beak) tears are unstable tears and occur in younger patients. Cole BJ, Dennis MG, Lee SJ, et al. Our preferred repair method utilizes a two-tunnel transtibial pull-out technique. This type of tear is particularly devastating to meniscal function. (9a) This irregular tibial surface tear (arrow) clearly lies within the peripheral, red zone, of the meniscus. 4 Hauger O, Frank LR, Boutin RD, et al. and oblique tear . Double posterior cruciate ligament sign | Radiology Reference Article oblique ligament, and the . The primary objective is to control the disease process to avoid the complications . Displaced meniscal tears are by definition unstable, and should be repaired relatively quickly, as displaced meniscal fragments may fibrose and distort, making delayed repair difficult or impossible. Many meniscus tears will not need immediate surgery. Knee pain: 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 Read More oblique tear of the posterior horn and body of the medial meniscus involving inferior articular surface and peripheral meniscal margin. The most commonly encountered signs are posterior knee pain with deep flexion and joint line tenderness. 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. Transtibial pullout repair is a new arthroscopic technique to repair meniscal root tears, . Missouri: Mosby, 1998. Barrett GR, Field MH, Treacy SH, Ruff CG. 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. The knee: a comprehensive review. for a 22 year old severe pain. However, it may also occur in older athletes through gradual degeneration. Because of their importance and the clinical impact of meniscal tears, assessment of the menisci has become the most common indication for MR of the knee. Superior and inferior branches of the medial and lateral geniculate arteries supply the peripheral third of the menisci via the perimeniscal capillary plexus.3,4, Meniscal tears occur due to a shear force between the femur and tibia. Explains two kinds of surgery. 7 Yao L, Stanczak J, Boutin RD. Medial meniscal root tears are radial tears within 1 cm of the meniscal root insertion or an avulsion of the insertion of the meniscus. 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. The posterior horn is the thickest and most important for overall function of the knee. (redirected from Oblique Tear) The most common meniscal tear, a type of radial tear which begins at the free (inner) edge like other radial tears, but then curves into a longitudinal orientationsimilar to longitudinal meniscal tearsas the tear extends toward the meniscal periphery. Posterior Horn Meniscus Tears Several variations in meniscal tear patterns have been granted specific names that recognize the unique characteristics of the tear. J Fam Pract 2001;50:93844. The menisci of the knee have several important roles: The medial meniscus is 'C' shaped whereas the lateral is a shorter incomplete circle with closer spaced 'horns'. In cases where a torn meniscus has locked the knee, walking will be affected. Diagnosis can be suspected clinically with joint line tenderness and a positive Mcmurray's test, and can be confirmed with MRI studies. 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. The operative equipment needs and post-operative rehabilitation process markedly differ between meniscal repair and partial meniscectomy. Prospective evaluation of 1485 meniscal tear patterns in patients with stable knees. 12 McGinty JB, Burkhart SS, Jackson RW, et al. The typical meniscal pain profile comprises well localised joint-line pain (with medial pain generally being indicative of a medial tear and vice-versa). On MRI, meniscal tears are evident as a linear signal intensity that extends through the meniscal substance to a free edge17 (Figure 4). Knee Surg Sports Traumatol Arthrosc 2007;15:393401. The described meniscal tears will lead to possible necessary total knee replacement. McMurray test: The patient lies supine on the bed with the hip and knee both flexed. If you have a follow-up appointment, write down the date, time, and purpose for that visit. Meniscal ramp lesions: an illustrated review - Insights into Imaging Treatment for a meniscus tear will depend on its size, what kind it is, and where it's located within the cartilage. Medial Meniscus: oblique tear of the posterior portion with a separated and unstable fragment. (Right) Flap tear. 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).