This is a large horizontal tear of the meniscus. Lists risks and benefits of surgery for meniscus tear. 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. Meniscus surgery is a common operation to remove or repair a torn meniscus, a piece of cartilage in the knee. Arthroscopy 2006;22:77180. . Acta Orthop Scand 1982;53:9759. One of the main tests for meniscus tears is the McMurray test. Grades 1 and 2 are not considered serious. Oblique tear of the posterior horn and body of the medial meniscus involving inferior articular surface and peripheral meniscal margin. What to Do If Your Orthopaedic Surgery Is Postponed. Most commonly it is impossible to fully extend the knee; more accurately described as stiffness (termed 'pseudo locking') due either to a small effusion (requiring increased force to bend the tense joint capsule) or to pain inhibition as the femoral condyle compresses the torn meniscus. Usually you will be able to leave the hospital the same day. Detailed review of funding for diagnostic imaging services. Barrett GR, Field MH, Treacy SH, Ruff CG. Seldom are they the sign of a problem. With the realization that even partial meniscectomy leads to accelerated osteoarthritis,2 surgeons have increasingly turned to meniscal repair. Arthroscopy. Meniscal tears often occur in young patients who have suffered a twisting injury to the knee. Vincken PW, ter Braak AP, van Erkel AR, et al. Herrlin S, Hallander M, Wange P, Weidenhielm L, Werner S. Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomised trial. Other established anatomical variants include the transverse meniscal ligaments and the meniscofemoral ligaments, which mimic meniscal tears at their meniscal attachment sites. How can I tell if I have an oblique fracture? Harrison BK, Abell BE, Gibson TW. Pathology - a tear that has developed gradually in the meniscus. 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. 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. So the injury as seen in MRI scan means there is an tear in the medial meniscus towards the posterior side, that is towards the back of joint. AJSM 2007; 35:1380-1383. OKeefe R, et al. Because there is no supply, there is little capacity for these tears to heal on their own. The procedure begins with a complete diagnostic arthroscopy using a 30-degree arthroscope. . Rehabilitation of the knee following sports injury. The lateral meniscus has a symmetrical C-shape, whereas the medial meniscus is more crescentic (3a), as the posterior horn of the medial meniscus is always larger than the anterior horn. It is estimated that only 10% of the injuries involving the tear of posterior horn medial meniscus are repairable. AJR Am J Roentgenol 1998;170:5761. A meniscus tear can lead to knee instability, an inability to move the knee normally, and chronic knee pain. Operative Arthroscopy, 3rd Edition, 2002, Lippincott Williams and Wilkins. In this case, a portion may break off, leaving frayed edges. Evaluate the TCO of your PACS download >, 750 Old Hickory Blvd, Suite 1-260Brentwood, TN 37027, Focus on Musculoskeletal and Neurological MRI, The Anterior Meniscofemoral Ligament of the Medial Meniscus, Collateral Ligament Injuries of the Fingers. Primary repair of medial meniscal avulsions: 2 case studies. swelling . Additionally, the large radial tear dramatically undermines the ability of the meniscus to distribute hoop stress. 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- . Br Med Bull 2007;84:523. Sagittal peripheral meniscal images demonstrate the normal anatomical 'bow-tie configuration' (the central meniscal body with the anterior and posterior horns as well circumscribed triangles. Prospective evaluation of allograft meniscus transplantation: a minimum 2-year follow-up. Ligaments: their nature and morphology. Also know what the side effects are. In cases where surgery is required, this time frame increases to somewhere around three to four months. There are two menisci, a medial one on the "inside" of the knee and a lateral one on the "outside" of the knee. Each knee has two C-shaped pieces of cartilage known as menisci. The content of any advertising or promotional material contained within, or mailed with, Australian Family Physician is not necessarily endorsed by the publisher. For potential or actual medical emergencies, immediately call 911 or your local emergency service. Patients describe meniscal tears in a variety of ways. It is possible that your symptoms of pain, etc will improve with time without surgery.But that doesn't mean the tear healed. Successful outcome and patient satisfaction after medial meniscal root repair are established initially upon appropriate diagnosis and patient selection. Meniscal repair surgeries do the best when the meniscal tear extends into the middle 50% of meniscal substance. History, clinical findings, magnetic resonance imaging, and arthroscopic correlation in meniscal lesions. Radial tears, because they are oriented perpendicular to the c-shaped fibers of the meniscus, have a devastating effect upon meniscal function. 3rd Edition. Submission to the Department of Health and Ageing. Lateral meniscus is intact. Verdonk PC, Demurie A, Almqvist KF, Veys EM, Verbruggen G, Verdonk R. Transplantation of viable meniscal allograft. 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. growth factors) on meniscus tissue is being investigated.2 These are currently only being trialled in younger patients7 and the routine use of most of these technologies is some time away. Disclosures: LaPrade reports he is a consultant for and receives royalties from Arthrex, Ossur and Smith & Nephew. Common tears include bucket handle, flap, and radial. I have an oblique tear of the posterior horn and body of the medial meniscus extending to the inferior articular surface. Incisions were made in the dorsal root of the oblique popliteal ligament and the joint capsule . 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. Metcalf MH, Barrett GR. The menisci act as cushions between your shin bone (tibia) and your thigh bone (femur). Procedure. Although some reports have described successful repair of the avascular portion of the meniscus,11 it is generally accepted that meniscal repair is more likely to be successful if it involves or at least communicates with the meniscal red zone, lying within three to four millimeters of the capsular rim.12 A basic principle of meniscal repair is to rasp the tear edges and the parameniscal synovium above and below the meniscus, which is thought to enhance the vascular healing process. Types of meniscus tears:(Left) Bucket handle tear. In case of an open or unstable fracture, the bone may protrude out of the skin surface and be exposed to environmental contaminants. The healing time in children is a little less as the healing process is faster in children than in adults. I have an oblique tear of the posterior horn of the medial meniscus, what is the treatment for that? Perhaps the best know of these is the bucket-handle tear. In the present case, a full-thickness radial tear of the medial meniscus is visualized (Fig 1).An arthroscopic torpedo shaver (Arthrex, Naples, FL, U.S.A.) is used to debride the meniscus tear edges back to a healthy, stable rim (Fig 2).For improved access to the medial meniscus, an 18-gauge spinal . More often, the patient will complain of joint line pain with a minor traumatic event, such as squatting. 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. Psterior horn of medial meniscus Poterior oblique ligament . Horizontal tears can be sewn together rather than removing the damaged portion. Peripheral meniscal tears are among the most common causes of meniscal pathology, particularly occurring in conjunction with anterior cruciate ligament (ACL) injury or deficiency. Although a successful outcome of a meniscal root repair is predicated upon appropriate indications for the repair, not all medial meniscal root tears should be repaired. Strengthening exercises will gradually be added to your rehabilitation plan. 1890 LPGA Blvd., Suite 240 Daytona Beach, FL 32117, Port Orange North & South Horizontal tear posterior horn medial meniscus, Tear of posterior horn of medial meniscus treatment, Horizontal tear posterior horn and body medial meniscus, Body and posterior horn of the medial meniscus, Homeopathy treatment posterior horn medial meniscus. The lateral meniscus is on the outside of the knee. When a meniscus tear occurs, you may hear a popping sound around your knee joint. The posterior horn is located on the back half of the meniscus. Treatment or management protocols for posterior horn menial meniscus tears are quite challenging. In some cases, your doctor may suggest an arthroscopyto examine and possibly treat your knee. 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. 1993;9(1):33-51. Larger, unstable tears of this type often cause mechanical symptoms, however, and therefore warrant operative treatment, usually via partial meniscectomy. 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. It is important to describe your symptoms accurately. If the tear is associated with arthritis it will typically improve over time as the arthritis is treated. Arthroscopic total meniscectomy Occasionally, a large tear of the outer meniscus can best be treated by arthroscopic total meniscectomy, a procedure in which the entire meniscus is removed. A horizontal meniscus tear runs along the circumference of the fibers of the meniscus. Doctors typically provide answers within 24 hours. Meniscus tears are among the most common knee injuries. Because other knee injuries can cause similar symptoms, your doctor may order imaging tests to help confirm the diagnosis. Sports-related meniscus injuries often occur along with other knee injuries, such as anterior cruciate ligament (ACL) tears. Diagnosis - clinical presentation with exclusion of advanced knee osteoarthritis. Includes interactive tool to help you decide. Skeletal Radiology 2004; 33:260-264. 13 Newman AP, Daniels AU, Burks RT. Meniscus tears are extremely common knee injuries. Arthroscopic meniscus repairs typically takes about 40 minutes. 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. Requests for permission to reprint articles must be sent to permissions@racgp.org.au. Disclosures: Blake and Johnson report no relevant financial disclosures. The ghost sign or absence of an identifiable meniscus anterior to the posterior cruciate ligament is also indicative of a root tear (Figure 2). Repair is sometimes attempted even with these tear types, particularly when the patient is young and substantial loss of meniscal tissue would lead to an unacceptable risk of future arthritis.11 Repair of these challenging tear types should only be attempted when the meniscal tissue is of good quality and a stable result is achievable. Both of these factors increase contact forces across the joint, leading to accelerated osteoarthritis and predisposing the patient to the development of subchondral insufficiency fractures.7. As people age, they are more likely to have degenerative meniscus tears. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website.
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