A person may feel a pop when they tear the meniscus. Alternatively, the surgeon may be able to modify the ACL reconstruction technique to decrease the risk of growth plate injury during surgery. 2017;12(1):e0170710. Furthermore, they performed an open MTL repair in 15 patients with meniscal tear and medial ME through a mini-incision with three interconnecting suture anchors (Fig. (2017). We'll go over how it's done, the recovery timeline, and risks to watch for after the, There are two types of knee locking: a true knee lock and a pseudo knee lock. Tears in this area are typically more likely to heal on their own. Zheng J, Zhai W, Li Q, Jia Q, Lin D. A Special Tear Pattern of Anterior Horn of the Lateral Meniscus: Macerated Tear. VA conceived the idea for the study and supervised the whole study process. However, data on this is limited and shouldnt replace talking with your doctor about your treatment options. This study was exempted from the requirement for local institutional review board approval as it is a narrative review of the literature. Management of the MPRT consists of nonoperative treatment, partial meniscectomy and root repair, and primarily aims to prevent the development of OA [58]. Slowly raise the extended leg 12 inches from the floor and then slowly lower it back. medial meniscal extrusion is associated with If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Am J Sports Med 39(7):14391443, Katagiri H, Miyatake K, Nakagawa Y, Otabe K, Ohara T, Shioda M et al (2019) The effect of a longitudinal tear of the medial meniscus on medial meniscal extrusion in anterior cruciate ligament injury patients. These are nonabsorbent radial tear: perpendicular to both the tibial plateau and the long axis of the meniscus. Theres an inner (medial) meniscus and an outer (lateral) meniscus. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Orthop Traumatol Surg Res 105(7):13951399, Everhart JS, Magnussen RA, Abouljoud MM, Regalado LE, Kaeding CC, Flanigan DC (2020) Meniscus tears accelerate joint space loss and lateral meniscal extrusion increases risk of knee arthroplasty in middle-aged adults. It usually results from twisting your knee suddenly. In fact, MAT supporters claim that it restores the biomechanical properties of the endogenous meniscus, prevents or slows cartilage damage, especially if the MAT is performed immediately, and improves long-term outcomes [17, 110, 111]. Knee Surg Sports Traumatol Arthrosc 28(11):34163425, Stein T, Mehling AP, Welsch F, von Eisenhart-Rothe R, Jger A (2010) Long-term outcome after arthroscopic meniscal repair versus arthroscopic partial meniscectomy for traumatic meniscal tears. Am J Sports Med 49(3):684692, Ichiba A, Makuya K (2012) Radial displacement of the lateral meniscus before and after anterior cruciate ligament reconstruction. Beaufils P, et al. Get useful, helpful and relevant health + wellness information, 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://www.merckmanuals.com/home/injuries-and-poisoning/sprains-and-other-soft-tissue-injuries/knee-sprains-and-related-injuries), (https://www.niams.nih.gov/health-topics/knee-problems#tab-overview), (https://orthoinfo.aaos.org/en/treatment/knee-arthroscopy/), (https://orthoinfo.aaos.org/en/diseases--conditions/meniscus-tears/), (https://www.physio-pedia.com/Meniscal_Repair). Pull both heels into the floor while tightening the muscles on the backs of the thighs. The tear frequently occurs while playing sports. Those that are caused by an injury are often the ones that can be, A meniscectomy is a procedure that repairs a torn meniscus. Wear athletic shoes that are appropriate for the sport youre doing. ME, in the coronary plane, is defined as the maximum distance of the most distal end of the meniscus from the border of the tibial plateau, where the tibial eminences are the most prominent, without taking into account the osteophytes. A tear on the inner two-thirds of the meniscus that wont heal on its own because the area lacks blood flow to stimulate the immune system response. Recovery after a meniscectomy takes 36 weeks, and recovery after a meniscus repair takes 36 months. Konstantinos G. Makiev. Arthroscopy. Some clinical studies on its effectiveness exist, but more research is needed. It also outlines symptoms, diagnosis, and treatment and provides information on when to contact a doctor. Am J Sports Med 48(13):31633169, Bin SI, Nha KW, Cheong JY, Shin YS (2018) Midterm and long-term results of medial versus lateral meniscal allograft transplantation: a meta-analysis. 29(4):295301, Moon HS, Choi CH, Jung M, Lee DY, Hong SP, Kim SH (2020) Early surgical repair of medial meniscus posterior root tear minimizes the progression of meniscal extrusion: 2-year follow-up of clinical and radiographic parameters after arthroscopic transtibial pull-out repair. It can be hard to prevent an accidental injury. This can result from disruption of collagen fibers within the meniscus that provide hoop strength 8.. Physical therapy generally leads to a good outcome. Meniscus Tears, Repair, and Transplantation > Fact Also taking into consideration that residual ME after MPRT repair correlates with worse outcomes regarding both clinical parameters and OA progression [72, 73], a better understanding of the causality of ME is needed in order to appropriately address it. [13] proved biomechanically that ME is possible with intact meniscal roots and that centralization of the meniscus restores the tibiofemoral contact pressures back to normal. They may also share some exercises you can do at home. Kessler CS, et al. Recovery time can be lengthy with either one. In addition, given that the presence of severe ME promotes rapid progression of knee OA [44, 45], the importance of inhibiting this process and delaying the inevitable total knee replacement (TKR) is critical. https://doi.org/10.1002/acr.24394, Wu PT, Shao CJ, Wu KC, Wu TT, Chern TC, Kuo LC et al (2012) Pain in patients with equal radiographic grades of osteoarthritis in both knees: the value of gray scale ultrasound. Despite the advances in surgical techniques and the improved methods for the estimation of the implant size, MAT is successful in only up to 75% of patients [2, 16, 109]. Therefore, nonoperative treatment should be reserved for nonsurgical candidates [61]. statement and In the days following your injury, you should also follow the RICE protocol. Labral Treatment often involves OTC medications, cortisone injections, and physical therapy. ME has no specific clinical finding or sign and it is encountered in many knee pathologies. To perform this exercise, a person should do the following: An intermediate exercise routine may include straight leg raises. An individual should seek guidance from a physical therapist about which exercises to perform to assist their healing. Ann Rheum Dis 64(4):556563, Driban JB, Ward RJ, Eaton CB, Lo GH, Price LL, Lu B et al (2015) Meniscal extrusion or subchondral damage characterize incident accelerated osteoarthritis: data from the osteoarthritis initiative. A true knee lock occurs when something in your knee joint gets stuck and. Orthop J Sports Med. meniscus Diagnosis and management of meniscal injury. Int Orthop 43(11):25492556, Figueroa F, Figueroa D, Calvo R, Vaisman A, Espregueira-Mendes J (2019) Meniscus allograft transplantation: indications, techniques and outcomes. California Privacy Statement, Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. A doctor can do physical and imaging tests, such as an X-ray or MRI, to determine what kind of damage you have and discuss possible treatment options with you. Sometimes, degeneration from arthritis causes a tear, even without a knee injury. A physical therapist will individualize a persons exercise regimen to prevent further injury. (D) After the 2 suture limbs have been tied arthroscopically forming a circumferential compression stitch. ME can occur in knee OA [8, 10], and its presence is significantly correlated with increased articular cartilage loss in the tibiofemoral joint and osteophyte formation [29, 30]. A persons initial exercise routine may include an exercise called hamstring contractions. Your doctor will bend your knee, then straighten and rotate it. During an arthroscopy, a small, lighted, optic tube Studies show that exercise routines can significantly improve knee pain and function. The time of recovery varies depending on: The meniscus is a C-shaped band of cartilage that goes around the knee joint and cushions the junction of your thighbone (femur) and shinbone (tibia). Meniscus tears can occur from an injury or wear and tear on the joint over time. After ACLR, extrusion of the is more frequently seen than that of the LM. Meniscal allograft extrusion causes incongruity with the femoral condyle, and therefore the allograft cannot perform normal load transmission and shock absorption. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 28(4):11771194, Swamy N, Wadhwa V, Bajaj G, Chhabra A, Pandey T (2018) Medial meniscal extrusion: detection, evaluation and clinical implications. Conservative treatment constitutes the first line of therapy in mild or moderate knee OA [46, 47]. Persistent hoop and shear stresses create complex tears in the posterior horn and A tear in this "red" zone may heal on its own, or can often be repaired with surgery. With a surgical treatment approach, exercises are necessary for recovery. First, surgery is rarely necessary for degenerative meniscus tears. Today, in general, doctors recommend conservative treatment, not surgery, when meniscus tears result from degeneration. On imaging, it is often seen as a meniscal loss with the destruction of expected architecture. Arthrosc Tech 8(9):e941e946, Leafblad ND, Smith PA, Stuart MJ, Krych AJ (2021) Arthroscopic centralization of the extruded medial meniscus. J Orthop Res Off Publ Orthop Res Soc 36(7):18941900, Kodama Y, Furumatsu T, Miyazawa S, Fujii M, Tanaka T, Inoue H et al (2017) Location of the tibial tunnel aperture affects extrusion of the lateral meniscus following reconstruction of the anterior cruciate ligament. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. It is often used with chronic degenerative conditions although some authors also propose this term in the setting of a tear (macerated tear)2. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. [74] retrospectively analyzed MRI series with isolated ME without concomitant serious knee pathologies, and found that isolated significant ME (>3mm) was associated with MTL abnormalities. Sudden twisting movements such as pivoting to catch a ball can tear the cartilage. These findings suggest that the tension of the graft and the excessive external rotation of the tibia are also factors that can affect the condition of the MM. https://doi.org/10.1155/2017/6793026, Berthiaume MJ, Raynauld JP, Martel-Pelletier J, Labont F, Beaudoin G, Bloch DA et al (2005) Meniscal tear and extrusion are strongly associated with progression of symptomatic knee osteoarthritis as assessed by quantitative magnetic resonance imaging. Degenerative tears occur mainly in the medial meniscus and are most commonly encountered in older patients without any history of significant trauma [4]. All rights reserved. occasionally a surgery we refer to as an arthroscopy. It has been shown from studies that the risk for TKA after ACLR is seven timesgreater than in normal individuals [88]. We do not endorse non-Cleveland Clinic products or services. Your provider may recommend knee arthroscopy to better view and accurately diagnose your injury. https://doi.org/10.1155/2015/210972, Kijima H, Miyakoshi N, Kasukawa Y, Ishikawa Y, Kinoshita H, Ohuchi K et al (2017) Cut-off value of medial meniscal extrusion for knee pain. Orthop J Sports Med 4(8):2325967116663185, Van Der Straeten C, Byttebier P, Eeckhoudt A, Victor J (2016) Meniscal allograft transplantation does not prevent or delay progression of knee osteoarthritis. Prepatellar bursitis is a common complaint of people who work on their knees or who engage in activities that risk blows to the knee. Correspondence to All authors read and approved the final manuscript. The inner two-thirds of the meniscus, however, lacks a blood supply. If your symptoms persist after 3 months or your symptoms become significant, your doctor may recommend surgery to repair the tear. Google Scholar, Ozeki N, Seil R, Krych AJ, Koga H (2021) Surgical treatment of complex meniscus tear and disease: state of the art. Feeling like your knee might give out beneath you. Torn or Frayed Meniscus: When Surgery May Be J Orthop Surg Hong Kong 28(1):2309499020906745, McCormack DJ, Puttock D, Godsiff SP (2021) Medial compartment osteoarthritis of the knee: a review of surgical options. Osteoarthritis Cartilage 27(11):15781589, Primorac D, Molnar V, Matii V, Hudetz D, Jele , Rod E et al (2021) Comprehensive review of knee osteoarthritis pharmacological treatment and the latest professional societies guidelines. Is the ketogenic diet right for autoimmune conditions? Knee Surgery & Related Research When we talk about the meniscus, only about 30 % of the meniscus has an intact blood supply and is called the red zone. The remaining part of the meniscus does not have a blood supply and thus, once injured or torn, it cannot heal or be treated. So whether ayurvedic, homeopathic or allopathic medication, none of them can really help. Historically, MPRT were treated with partial meniscectomy. Meniscal maceration is a finding sometimes used on MRI imaging to describe the wasting away of the meniscus or cause it to become soft or separated into constituent elements. You may also get imaging tests, such as X-rays or an MRI, to assess the damage. Pharmaceuticals 14(3):205, Raynauld JP, Pelletier JP, Abram F, Dodin P, Delorme P, Martel-Pelletier J (2016) Long-term effects of glucosamine and chondroitin sulfate on the progression of structural changes in knee osteoarthritis: six-year followup data from the osteoarthritis initiative. Meniscal extrusion or subluxation refers to the peripheral meniscal margin extending beyond the external aspect of the tibiofemoral compartment of the knee.. Meniscal tear: Presentation, diagnosis and management. A physical therapist can provide a daily routine of exercises and stretches to improve your muscle strength, flexibility, range of motion, and stability. Therefore, improvements in surgical techniques are necessary [102, 109]. Your doctor may also recommend conservative measures as a first step if the tear is caused by injury to the knee. no financial relationships to ineligible companies to disclose. Thats because you now have less shock absorption in your joint. Two pieces of cartilage sit inside your knee, between your thighbone (femur) and shinbone (tibia). Have swelling that doesnt go away with a few days of RICE and taking NSAIDs. Hold the position for 5 seconds and then relax. Arthroscopic partial meniscectomy The goal of this Conservative treatment for some meniscus tears is well documented as effective. ME depends largely on the severity and type of tear [87, 89, 91]. Younger people, especially athletes, are likely to have a sudden meniscus injury. Goto et al. Posterior Horn Medial Meniscus Tears Howard J. Luks, WebOne of the main tests for meniscus tears is the McMurray test. A critical review of the literature. It has been suggested that a 510% reduction of implant size from the estimated one reduces postoperative extrusion [2, 105, 123]. Doral MN, et al. 2. The medial meniscus covers 5060% of the medial tibial plateau, and the lateral meniscus covers 7080% of the lateral tibial plateau. Arthroscopic total meniscectomy. Over time, the joint can break down. For a simple tear here, doctors may advise a short course of rest and physical therapy to see whether spontaneous healing occurs. Arthrosc Tech 10(1):e43e48, Okazaki Y, Furumatsu T, Miyazawa S, Kodama Y, Kamatsuki Y, Hino T et al (2019) Meniscal repair concurrent with anterior cruciate ligament reconstruction restores posterior shift of the medial meniscus in the knee-flexed position. Knee Surg Sports Traumatol Arthrosc 27(2):361368, Jacob G, An S, Kumar G, Varghese J (2020) Percutaneous arthroscopic assisted knee medial collateral ligament repair. Terms and Conditions, Knee arthroscopy, a minimally invasive procedure, is often used to treat meniscal tears. There is no consensus whether medial or lateral MAT is superior in terms of medium-term (510years) and long-term (>10years) survival. But you can reduce your risk of a torn meniscus if you: Most people who tear a meniscus can return to full activity. Arthrosc Tech 8(5):e495-501, Dean RS, DePhillipo NN, Monson JK, LaPrade RF (2020) Peripheral stabilization suture to address meniscal extrusion in a revision meniscal root repair: surgical technique and rehabilitation protocol. The concurrent ACLR with repair of the menisci has shown good clinical and functional results and less risk of reoperation during the follow-up periods [83, 87]. [39,40,41]. This post will carry two messages, both equally important. This post goes into considerable detail about managing a knee with arthritis and a complex or degenerative meniscus tear. extrusion Knee Surg Sports Traumatol Arthrosc Off J ESSKA 24(9):29232935, Lee SM, Bin SI, Kim JM, Lee BS, Lee CR, Son DW et al (2019) Long-term outcomes of meniscal allograft transplantation with and without extrusion: mean 12.3-year follow-up study. Its best to see a doctor as soon as possible: Untreated meniscus tears can get worse, or pieces of the meniscus can shed into the joint. Knee Surg Relat Res. Arthroscopy 32(7):13371345, Kim NK, Bin SI, Kim JM, Lee CR, Kim JH (2017) Meniscal extrusion does not progress during the midterm follow-up period after lateral meniscal transplantation. Arthroscopy 32(10):20002008, Chernchujit B, Prasetia R (2018) Arthroscopic direct meniscal extrusion reduction: surgical tips to reduce persistent meniscal extrusion in meniscal root repair. Currently, MPRT repair constitutes the treatment of choice, since it restores the hoop tension and the joint kinematics [65], halts the progression of OA and lowers the rate of arthroplasty [66, 67]. Part of Furthermore, supplementary centralization of the meniscus appears to be able to adequately reduce the ME, as it also addresses potential MTL lesions. During the meniscus surgery, a small instrument called an arthroscope, which has a camera at its tip, is inserted into your knee. However, more research with high-quality studies is needed in order to refine the technique and validate its long-term results in reducing ME. There are two main types of arthroscopic surgery for a meniscus tear: partial meniscectomy and meniscus repair. Am J Sports Med 48(11):26922702, Chung KS, Ha JK, Ra HJ, Nam GW, Kim JG (2017) Pullout Fixation of posterior medial meniscus root tears: correlation between meniscus extrusion and midterm clinical results. Finally, meniscal allograft extrusion is also associated with subchondral bone marrow lesions and cysts [2, 115]. If the repaired meniscus failed to heal, lateral extrusion progressed significantly [92].
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