I have an oblique tear of the posterior horn and body of the medial meniscus extending to the inferior articular surface. Tears are typically vertical in young patients and horizontal in the elderly (Figure 5). bucket-handle tear: displaced vertical tear parrot beak tear: oblique radial tear Radiographic features Plain radiograph On plain radiographs, meniscal tears are not visible. If you undergo surgery it will likely be followed by physical therapy to optimize knee strength and stability. Apley test (grinding) test: The patient lies prone, with their knee flexed to 90 degrees and their hip extended. It is possible that your symptoms of pain, etc will improve with time without surgery.But that doesn't mean the tear healed. Vincken PW, ter Braak AP, van Erkel AR, et al. Available at www.health.gov.au/internet/ main/publishing.nsf/Content/MBRT-DI-submissions-018/$FILE/018%20 RACGP%20Submission.pdf [Accessed 15 August 2011]. Prospective evaluation of allograft meniscus transplantation: a minimum 2-year follow-up. Inferiorly displaced flap tears of the medial meniscus: MR appearance and clinical significance. A horizontal meniscus tear runs along the circumference of the fibers of the meniscus. 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. Magnetic resonance imaging (MRI) scans. If the knee is still painful, or if it locks, your doctor may recommend surgery. w/severe pain? The meniscus root attachment aids meniscal function by securing the meniscus in place and allowing for optimal shock-absorbi Lists risks and benefits of surgery for meniscus tear. Performing activities that involve aggressive pivoting and twisting of the knee puts you at a significantly higher risk of tearing your meniscus. Although C, a vertical tear, is commonly used to describe such an appearance, the better answer is D, a longitudinal tear. Principles and decision making in meniscal surgery. Immediate conservative measures include the RICE regimen: Longer term measures include activity modification, nonsteroidal antiinflammatory drugs (NSAIDs) and physiotherapy.4,1921 Nonsteroidal anti-inflammatory drugs are often recommended for 812 weeks,20 although paracetamol can be considered if NSAIDs are contraindicated or poorly tolerated.22 Where available, intensive physiotherapy is very useful and should include range of motion, proprioceptive work and muscle strengthening exercises. In many cases, rehabilitation can be carried out at home, although your doctor may recommend working with a physical therapist. How to treat an oblique tear of the posterior horn of the medial meniscus? Sports-related meniscus injuries often occur along with other knee injuries, such as anterior cruciate ligament (ACL) tears. 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 Dr. Christopher Ferguson and another doctor agree. This makes the medial meniscus less mobile and is one reason why the medial meniscus is more prone to injury.3 In adults, only the periphery of the meniscus remains vascularized. Patients are often aware of movements that aggravate mensical pain, but should also be educated to avoid twisting on a weight bearing, flexed knee. Extrusion of the medial meniscus (MM) is associated with knee joint pain in osteoarthritic knees. An awkward twist when getting up from a chair may be enough to cause a tear in an aging meniscus. There are numerous types of meniscus tears, including: 1. 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. Meniscus tears, indicated by MRI, are classified in three grades. What is Meniscus Radial Tear. Symptoms. It is important to describe your symptoms accurately. This type of tear is particularly devastating to meniscal function. Torn meniscus symptoms Symptoms are usually sudden onset, however, can develop gradually over time. 5 Non-Christmas Movies to Watch This Holiday, Best Online Games to Play with your Friends, 12 tips for creating visual content on social media. Clinical outcomes following isolated lateral meniscal allograft transplantation. All rights reserved. Guides you through the decision to have surgery for a torn meniscus. The question about meniscus tears and the subsequent MRI in emails we receive are numerous. Radial tears, because they are oriented perpendicular to the c-shaped fibers of the meniscus, have a devastating effect upon meniscal function. Dr. Warren Strudwick answered Sports Medicine 32 years experience See your doc: Sounds like it will not get better without arthroscopic surgery. Magnetic resonance imaging of the knee menisci. AJR 2003; 180:93-97. It is important that these root avulsions are anatomically repaired back to the bone. 11 Noyes FR, Barber-Westin SD. Nourissat G, Beaufils P, Charrois O, et al. Bernstein J. It seems that in the above knee, the biology of the medial compartment has gone off the ski slope in a degenerative fashion and reversing that ski slope fall seems to be unproven at this time, particularly in the patient with low functional demands, who is older than 40 years and who has a BMI greater than 30. Types of meniscus tears:(Left) Bucket handle tear. Know what to expect if you do not take the medicine or have the test or procedure. Detailed review of funding for diagnostic imaging services. The ghost sign or absence of an identifiable meniscus anterior to the posterior cruciate ligament is also indicative of a root tear (Figure 2). Submission to the Department of Health and Ageing. M23.322 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. There are two menisci, a medial one on the "inside" of the knee and a lateral one on the "outside" of the knee. The meniscus is broken down into the outer, middle, and inner thirds. We use cookies to ensure that we give you the best experience on our website. They are most frequently seen at the posterior horn of the medial meniscus. Peripheral meniscal tears are located in the most vascular portion of the menisci and comprise 39-72 % [2, 3, 56, 69, 82] of all meniscal tears. In addition to the root tear, the MRI often shows chondral loss or fissuring, other areas of meniscal tearing, bone marrow edema or osteophyte formation (Figure 5). MR is also able to assess the stability of meniscal tears,6 an important factor, as unstable tears require operative treatment for symptom relief. In this short surgical video, a degenerative meniscus tear is smoothed down with a motorized shaver during a partial meniscectomy. Two months later, the post-operative image (17b) reveals a repaired, normal appearing lateral meniscal body (arrow), with resolution of the previously seen displaced fragment. The procedure begins with a complete diagnostic arthroscopy using a 30-degree arthroscope. Radiology 2000; 217:193-200. Locking presents in two ways. Longitudinal tears do not disrupt the circumferential architecture of the meniscus, and thus repair of longitudinal tears leads to a meniscus with relatively normal biomechanical function. Of course, if a displaced meniscal fragment is identified, the tear is by definition unstable. Knee Surg Sports Traumatol Arthrosc 2009;17:11026. Knee Surg Sports Traumatol Arthrosc 2011 Aug 11. Meniscal tear incidence may be as high as six per 1000 population6 with a 2.5 to 4 times male predominance. There is no resting pain. he is 44 y o tennis player. 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. Knee Surg Sports Traumatol Arthrosc 2008;16:4826. 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. . A meniscus tear is an injury to one of the bands of rubbery cartilage that act as shock absorbers for the knee. However, anyone at any age can tear the meniscus. Magnetic resonance imaging can also be effectively used to estimate the vascular zone classification (see Treatment) of tears.18 This is useful for the orthopaedic surgeon to predict meniscal repairability, assisting informed discussion with patients and scheduling appropriate operating theatre time.18 It is essential to remember that just because a tear can be seen on MRI, this does not mandate surgery. It absorbs shock in your knee and keeps it stable. The treatment of these type of tears can be either arthroscopy (surgery through a tiny hole in knee) or conservative. With regard to tear morphology, the classic ideal candidate for meniscal repair is the peripheral longitudinal tear. You may be asked about your physical and athletic goals to help your doctor decide on the best treatment for you. Symptomatic treatment with rest, ice, NSAIDs and/or an unloader brace may help alleviate symptoms in some cases. . This most often happens when the tear develops over a period of time. Note: the cartilage deficit more anteriorly on the medial femoral condyle and altered subchondral cortical bone interface, Figure 5. We have the medial meniscus on the inner side of the knee and the lateral meniscus on the outer side of the knee. 2023 Cedars-Sinai. Metcalf MH, Barrett GR. These tears occur within the avascular zone of the meniscus where there is no blood supply. The operative equipment needs and post-operative rehabilitation process markedly differ between meniscal repair and partial meniscectomy. Makris EA, Hadidi P, Athanasiou KA. Arthroscopic partial meniscectomy The goal of this surgery is to remove a small piece of the torn meniscus in order to get the knee functioning normally. The medial meniscus is on the inner side of the knee joint. Pain, especially when twisting or rotating your knee. 5 Horizontal tears, the most common meniscal tear pattern, lie parallel to the tibial plateau and separate the meniscus into upper and lower parts (4a,4b). (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. This puts tension on a torn meniscus. Barrett GR, Field MH, Treacy SH, Ruff CG. Jul 2000;31(3):419-36. Arthroscopy. Considered a feature of knee osteoarthritis. Fax AJSM 2003; 31:216-220. Bucket-handle tears are actually a form of longitudinal tear in which subsequent displacement of the inner rim of the tear results in a configuration that resembles the handle of a bucket (11a). It presents as a wedge-shaped defect resembling a parrot beak at the free edge of the meniscus as a result of displaced oblique vertical orientation. Another exam finding is palpating the anteromedial joint line, while placing a varus stress on a fully extended knee and feeling for meniscal extrusion. How to Treat Posterior Horn Medial Meniscus Tear. Biomaterials 2011;32:741131. In some cases, your doctor may suggest an arthroscopyto examine and possibly treat your knee. The absolute indication for specialist referral is the locked knee loss of joint function necessitates surgical intervention. 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. https://www.webmd.com/pain-management/knee-pain/meniscus-tear-injury A meniscus tear is an injury to one of the bands of rubbery cartilage that act as shock absorbers for the knee. Meniscal repairs are more likely to be successful when performed near the time of injury. True locking is less common, and suggests a bucket-handle tear, with the torn fragment preventing full extension. This "C" shaped cartilage helps disperse impact and displace force exerted upon the knee while walking, running, and other mild to high-energy and impact motions. The amount of pain and first appearance of swelling can give important clues about where and how bad the injury is. The medial meniscus has a firmer capsular attachment than the lateral meniscus. These are often 'bucket-handle tears', in which there is a vertical or oblique tear in the posterior horn running toward the anterior horn,5 forming a loose section which remains attached anteriorly and posteriorly.1 In older patients, tears are generally due to degeneration associated with ageing and tend to be horizontal tears. The most commonly encountered signs are posterior knee pain with deep flexion and joint line tenderness. Semin Roentgenol. Sometimes, its possible to repair a torn meniscus, especially if you are a young adult. Acute meniscus tears often happen during sports. The medial meniscus is an important structure that provides stability, dissipates force and assists to provide normal kinematics of the knee.