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. In many cases, rehabilitation can be carried out at home, although your doctor may recommend working with a physical therapist. what is the treatment? Both of them have 2 causes. Meniscus tears, indicated by MRI, are classified in three grades. Herrlin S, Hallander M, Wange P, Weidenhielm L, Werner S. Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomised trial. Deep leg presses and squats greater than 70 of knee flexion should be avoided for at least 4 months after surgery. Two wedge-shaped pieces of fibrocartilage act as shock absorbers between your femur and tibia. Most oblique meniscus tears are happen in the posterior third of the medial meniscus. Location -A tear may be located in the anterior horn, body, or posterior horn.A posterior horn tear is the most common. 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. Medial and lateral menisci are crescent-shaped fibrocartilage structures that provide joint congruity, stabilization and lubrication and act as shock absorbers for joint preservation. Patients describe meniscal tears in a variety of ways. Sometimes these tears require surgical repair. We describe the technique of diagnosis and treatment of a large displaced lateral meniscus flap tear, presenting as a meniscus comma sign. Symptoms. Nourissat G, Beaufils P, Charrois O, et al. 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 ]. Meniscal tears within the body of the meniscus or at the meniscocapsular junction represent a well-understood and manageable condition encountered in clinical practice. Afterward, you may experience: pain, especially when the area is touched. In addition, focal chondral lesions occur more commonly with medial than lateral-sided injuries. In some cases, your doctor may suggest an arthroscopyto examine and possibly treat your knee. Grades 1 and 2 are not considered serious. Steroid injection. The goal of meniscal root repair is to restore the joint to a near native function of the meniscus and prevent cartilage degradation associated with nonsurgical treatment or meniscectomy. Presumptive subarticular stress reactions of the knee: MRI detection and association with meniscal tear patterns. The Thessaly test is the most sensitive and specific clinical test to diagnose meniscal injury. Meniscal injury is common, and the medial meniscus is more frequently injured. Guides you through the decision to have surgery for a torn meniscus. Radial Tear B. Horizontal Tear C. Vertical Tear D. Longitudinal Tear E. Oblique Tear. Although an X-ray will not show a meniscus tear, your doctor may order one to look for other causes of knee pain, such as osteoarthritis. How can I tell if I have an oblique fracture? Most oblique meniscus tears are happen in the posterior third of the medial meniscus. A loose piece of cartilage can get stuck in the joint, causing the knee to temporarily lock, preventing full extension of the leg. (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. The vascularity of the peripheral menisci is primarily derived from the 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. Other symptoms of a meniscus tear include: pain in your knee, which can vary in severity - the pain might only be mild, severe, or the pain may come and go. There is no resting pain. In sports, a meniscus tear usually happens suddenly. 2023 Cedars-Sinai. Although C, a vertical tear, is commonly used to describe such an appearance, the better answer is D, a longitudinal tear. 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. In this case, a portion may break off, leaving frayed edges. The posterior horn it the back portion of the menisci at the end of the curve, where it tapers . Meniscal tears are categorised as traumatic or non-traumatic (degenerative) on the basis . Liodakis E, Hankemeier S, Jagodzinski M, Meller R, Krettek C, Brand J. Because there is no supply, there is little capacity for these tears to heal on their own. A horizontal meniscus tear runs along the circumference of the fibers of the meniscus. The knee: a comprehensive review. (Right) Degenerative tear. Although rarely taught and poorly utilised, recent validation demonstrated a sensitivity of 90%, and specificity of 98% in detecting meniscal injury.10, If clinically suspicious of meniscal injury, a trial of conservative measures may be considered or confirmation with magnetic resonance imaging (MRI). Medial meniscal root tears are radial tears within 1 cm of the meniscal root insertion or an avulsion of the insertion of the meniscus. The procedure begins with a complete diagnostic arthroscopy using a 30-degree arthroscope. The skilled interpreter of MR of the knee must do more than simply identify the presence of a meniscal tear. Read before you think. from the American Academy of Orthopaedic Surgeons, Questions and Answers for Patients Regarding Elective Surgery and COVID-19. It has been shown the peak tibiofemoral contact pressure after a total meniscectomy is equal to a posterior medial meniscal root tear. Knowledge of these classifications and the potential contraindications to meniscal root repair can aid the . A tear of the anterior horn of the lateral meniscus is damage to the front part of one of the two structures that act as shock absorbers between the thigh bone and the lower leg, explains The Steadman Clinic. Know what to expect if you do not take the medicine or have the test or procedure. An oblique tear (7a,8a) is often referred to as a parrot-beak tear, as the tear shape resembles a parrots beak. Of course, if a displaced meniscal fragment is identified, the tear is by definition unstable. Clinical: Most trauma to knee joint is caused by a lateral blow at knee level when foot is planted when knee is slightly flexed. Clin Sports Med 2010;29:81106. Meniscal repair surgeries do the best when the meniscal tear extends into the middle 50% of meniscal substance. If you have a follow-up appointment, write down the date, time, and purpose for that visit. (3a) A fat-suppressed proton density-weighted axial image through the knee joint demonstrates the C-shaped 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. The medial meniscus is an important structure that provides stability, dissipates force and assists to provide normal kinematics of the knee. A torn meniscus often can be identified during a physical exam. The amount of pain and first appearance of swelling can give important clues about where and how bad the injury is. Arthroscopy 2010;26:13689. 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. This type of tear has an unusual pattern. In circumstances where the flap causes catching in the knee, the flap can simply be removed. If you are having pain, swelling and catching, then the only reasonable option would be arthroscopic knee surgery. Gillquist J, Hamberg P, Lysholm J. Endoscopic partial and total meniscectomy. These tendons have poor blood supply and will not heal themselves. 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. (386) 255-4596 Only a small peripheral rim of meniscal tissue (arrowhead) is present at the native site of the lateral meniscus. Several variations in meniscal tear patterns have been granted specific names that recognize the unique characteristics of the tear. (Left) Radial tear. In the early days of MR, it was often felt that the role of MR was simply to identify whether a tear was present or not, and treatment of meniscal tears was largely composed of operative resection. Semin Roentgenol. Rimington T, Mallik K, Evans D, Mroczek K, Reider B. Lim HC, Bae JH, Wang JH, Seok CW, Kim MK. The tear should be eight millimeters or more in length, as shorter peripheral longitudinal tears are less likely to be symptomatic and may heal spontaneously. 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. 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). 6 Vande Berg BC, Poilvache P, Duchateau F. Lesions of the menisci of the knee: value of MR imaging criteria for recognition of unstable lesions. 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. 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. It is important to describe your symptoms accurately. This often causes the knee to become stuck due to a portion of the meniscus blocking the knees normal motion. Considered a feature of knee osteoarthritis. He/she will probably recommend surgery. Each knee has two C-shaped pieces of cartilage known as menisci. They may not even be apparent with an arthroscopic examination. One of the main tests for meniscus tears is the McMurray test. Meniscal tears may be categorized into five common configurations, including horizontal, longitudinal, radial, oblique (parrot-beak), and complex. Tears present as severe pain, swelling, and possibly catching, clicking, difficulty on deep knee bending and locking of the knee in partial flexion. 2 Jaureguito JW, Elliot JS, Lietner T. The effects of arthroscopic partial lateral meniscectomy in an otherwise normal knee: a retrospective review of functional, clinical, and radiographic results. The views expressed by the authors of articles in Australian Family Physician are their own and not necessarily those of the publisher or the editorial staff, and must not be quoted as such. Adjunctive measures to promote vascularity and healing at the repair sites are also recommended. A magnetic resonance imaging (MRI) scan is often used to diagnose meniscal injuries. Coronal proton weighted MRI of horizontal tear of lateral meniscus (white arrow) with complicating ganglion (black arrow) at the lateral margin of the meniscus, Australian Family Physician was the peer-reviewed, scholarly journal of The Royal Australian College of General Practitioners (RACGP) from 1971 to 2017. Am J Sports Med 2006;34:91927. 1890 LPGA Blvd., Suite 240 Daytona Beach, FL 32117, Port Orange North & South Meniscus tears are either degenerative or acute. It absorbs about 50% of the shock of the medial compartment. Sometimes this type of tear can heal on its own but it may require surgery if symptoms dont subside. These tears occur within the avascular zone of the meniscus where there is no blood supply. A lateral meniscus tear (torn meniscus) is a tear of the semicircular fibrous cartilage discs in the knee. w/severe pain? Reciprocally, an increased force is also placed on an ACL graft with a deficient medial meniscus. Symptoms of a meniscus tear. This most often happens when the tear develops over a period of time. Cole BJ, Dennis MG, Lee SJ, et al. and oblique tear . An awkward twist when getting up from a chair may be enough to cause a tear in an aging meniscus. Your meniscus acts like a cushion between your thigh bone (femur) and shin bone (tibia). OKeefe R, et al. A meniscectomy requires less time for healing approximately 3 to 6 weeks. 1. Meniscal pain occurs during torsional, weight bearing knee movements (classically pivoting on the knee while walking) as a sharp stab lasting several seconds, often followed by a dull ache for several hours. This information is provided as an educational service and is not intended to serve as medical advice. Fat-suppressed coronal images demonstrate before and after images following repair of a bucket handle tear. Posterior medial meniscal root tears are often times degenerative, but these can also occur with multi-ligament knee injuries in the acute setting. RICE. (386) 254-6819, Main Office & Walk-In Clinic If the knee is still painful, or if it locks, your doctor may recommend surgery. For patients requiring meniscectomy, meniscal autograft has been utilised with good outcomes,2931 but is only performed in specialist centres. Call us today at (410) 644-1880 or (855) 4MD-BONE (463-2663) to schedule an appointment. The MRI revealed a vertical flap (oblique) tear of the medial meniscus. We believe that by repairing these tears, the degenerative process may be delayed or halted (Figure 6). Top answers from doctors based on your search: Created for people with ongoing healthcare needs but benefits everyone. 2 The risk of osteoarthritis and its progression increase in line with reductions in tibial cartilage coverage. Before your visit, write down questions you want answered. This is because this area has rich blood supply and blood cells can regenerate meniscus tissue or help it heal after surgical repair. Connect with a U.S. board-certified doctor by text or video anytime, anywhere. Primary repair of medial meniscal avulsions: 2 case studies. 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. Skeletal Radiology 2004; 33:260-264. 1 article features images from this case Crawford R, Walley G, Bridgman S, Maffulli N. Magnetic resonance imaging versus arthroscopy in the diagnosis of knee pathology, concentrating on meniscal lesions and ACL tears: a systematic review. Rosemont, Ill. American Academy of Orthopaedic Surgeons. This puts tension on a torn meniscus. I have an oblique tear of the posterior horn and body of the medial meniscus extending to the inferior articular surface. Aged, worn tissue is more prone to tears. Prospective evaluation of 1485 meniscal tear patterns in patients with stable knees. Arthroscopic repair of meniscal tears extending into the avascular zone in patients younger than twenty years of age. I could not really walk on it. How to treat an oblique tear of the posterior horn of the medial meniscus? The medial meniscus is the portion of the cartilage along the inside of the knee joint (closest to the other knee). These meniscus tears are displaced into the tibia or femoral recesses and can be often difficult to diagnose intraoperatively. Vincken PW, ter Braak AP, van Erkel AR, et al. The body usually absorbs these over time. The menisci are "wedge-shaped" pieces of cartilage that rest between the thigh bone ("femur") and lower leg bone ("tibia") in the knee joint. 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. What is the posterior horn of the medial meniscus? 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. Br Med Bull 2011;2011:89106. Referral to an orthopaedic surgeon is important if the diagnosis is uncertain or there is minimal improvement at clinical review. controlling the movements of the knee joint. Verdonk PC, Demurie A, Almqvist KF, Veys EM, Verbruggen G, Verdonk R. Transplantation of viable meniscal allograft. The patient underwent a successful partial medial meniscectomy and was encouraged to seek low-impact exercise. If mechanical symptoms are present in this subset of patients, a partial or subtotal meniscectomy may improve symptoms; although, these tears are not usually associated with traditional meniscal-based mechanical symptoms. Many meniscus tears will not need immediate surgery. Bull NYU Hosp Jt Dis 2010;68:8490. type 3, vertical longitudinal bucket-handle tears; type 4, complex oblique tears; and type 5, bone avulsion fractures of the root attachments. A high level of suspicion is required to detect these injuries, and repair is recommended to preserve joint function. There is a history of sudden inability to fully extend the knee, with a rotational flexion/extension 'trick' required to regain full extension. A meniscus tear can lead to knee instability, an inability to move the knee normally, and chronic knee pain. Results: Medial meniscus posterior horn longitudinal tears in ACL-deficient knees resulted in a significant increase in anterior-posterior tibial translation at all flexion angles except 90 (P < .05). Educational text answers on HealthTap are not intended for individual diagnosis, treatment or prescription. How to Treat Posterior Horn Medial Meniscus Tear. Arnoczky SP, Warren RF, Spivak JM. Swelling or stiffness. Vertical flap (oblique, flap, parrot's beak) tears are unstable tears and occur in younger patients. Performing activities that involve aggressive pivoting and twisting of the knee puts you at a significantly higher risk of tearing your meniscus. These tears often require surgical treatment to restore the proper function of the knee. The content of any advertising or promotional material contained within, or mailed with, Australian Family Physician is not necessarily endorsed by the publisher. 12 Sources By Jonathan Cluett, MD A meniscus tear is an injury to one of the bands of rubbery cartilage that act as shock absorbers for the knee. Lists risks and benefits of surgery for meniscus tear. AJR 1998;170:63-67. 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. A prospective study of the nonoperative treatment of degenerative meniscus tears. for a 22 year old severe pain. Typically, complex tears are not treated with meniscus repair due to their complex nature. Arthroscopy. The medial meniscus is on the innermost side of your knee (the C-shaped curve faces in toward your body, the opposite knee). This provides a clear view of the inside of the knee. Locking presents in two ways. J Bone Joint Surg Am 2005;87:71524. As people age, they are more likely to have degenerative meniscus tears. Disclosures: Blake and Johnson report no relevant financial disclosures. Younger and elderly patients typically sustain different types of tears. (5a) A longitudinal tear of the posterior horn of the medial meniscus is illustrated. It is caused by direct impact in contact sports or twisting.