Meniscus (2018). 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. It will also help stabilize your balance and help prevent another knee injury. They will test your range of motion. A torn meniscus is a very common knee injury. Am J Sports Med 47(12):28882894, Delinc P, Ghafil D (2012) Anterior cruciate ligament tears: conservative or surgical treatment? 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]. Knee Surg Sports Traumatol Arthrosc 27(10):33113317, Costa CR, Morrison WB, Carrino JA (2004) Medial meniscus extrusion on knee MRI: is extent associated with severity of degeneration or type of tear? 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. Mordecai SC, et al. WebDamage to the medial meniscus root, for example by a complete radial tear, destroys the ability of the knee to withstand hoop strain, resulting in contact pressure increases and kinematic alterations. MAT is a potential surgical procedure for young, active patients with symptomatic meniscal insufficiency that does not respond to conservative treatment [102, 103]. Cite this article. Most authors agree that the transplanted menisci are extruded more frequently than endogenous menisci [15, 102, 105]. 3). California Privacy Statement, ME depends largely on the severity and type of tear [87, 89, 91]. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Part of Magnetic resonance imaging (MRI) is the method of choice for the detection and evaluation of ME (Fig. Meniscal extrusion or subluxation refers to the peripheral meniscal margin extending beyond the external aspect of the tibiofemoral compartment of the knee.. Several studies also argue that the presence of ME is predictive of knee OA progression [32,33,34]. Ann Rheum Dis 68(6):938947, Ishii Y, Deie M, Fujita N, Kurumadani H, Ishikawa M, Nakamae A et al (2017) Effects of lateral wedge insole application on medial compartment knee osteoarthritis severity evaluated by ultrasound. VA conceived the idea for the study and supervised the whole study process. It also outlines symptoms, diagnosis, and treatment and provides information on when to contact a doctor. A more posterolateral placement of the tibial tunnel aperture may induce extrusion of the LM following ACLR. The knee is the largest and most complex joint in the body, holding together the thigh bone, shin bone, fibula (on the outer side of the shin), and, Torn meniscus is perhaps the most common type of knee injury in which a ligament in the knee becomes lacerated, affecting stability and causing pain, Locked knee refers to an inability to either bend or straighten the knee. Lie on the back and bend both knees at a 10-degree angle. PubMed Central J Knee Surg. Tears in this area are typically more likely to heal on their own. Slowly raise the extended leg 12 inches from the floor and then slowly lower it back. Arthrosc Tech 9(8):e1211e1218, DePhillipo NN, Kennedy MI, Chahla J, LaPrade RF (2019) Type II medial meniscus root repair with peripheral release for addressing meniscal extrusion. 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. 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. The authors declare that they have no competing interests. It usually results from twisting your knee suddenly. Knee Surg Sports Traumatol Arthrosc 27(8):26172623, Astur DC, Novaretti JV, Gomes ML, Rodrigues AG, Kaleka CC, Cavalcante ELB et al (2020) Medial opening wedge high tibial osteotomy decreases medial meniscal extrusion and improves clinical outcomes and return to activity. Doral MN, et al. The medial meniscus covers 5060% of the medial tibial plateau, and the lateral meniscus covers 7080% of the lateral tibial plateau. Therefore, ACL rupture alone cannot cause the posterior extrusion of the MM, and the ACLR alone does not directly cause distinct damage to the MM. 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. WebMedial compartment osteoarthritis is a type of arthritis in your knee. Nonanatomical placement of the meniscal allograft>5mm relative to the endogenous meniscus adversely affects the mechanical contacts of the knee, which may affect the allograft's ability to prevent articular cartilage degeneration [16, 124]. A persons initial exercise routine may include an exercise called hamstring contractions. A Meta-analysis Am J Sports Med 46(9):22852290, Smith NA, Parkinson B, Hutchinson CE, Costa ML, Spalding T (2016) Is meniscal allograft transplantation chondroprotective? Adv Orthop. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Several preoperative and intraoperative factors (Table 3) are associated with the absolute value of allograft extrusion [16, 102, 106, 109, 120]. First, surgery is rarely necessary for degenerative meniscus tears. Eur Radiol 29(5):26162623, Debieux P, Jimenez AE, Novaretti JV, Kaleka CC, Kriscenski DE, Astur DC et al (2020) Medial meniscal extrusion greater than 4 mm reduces medial tibiofemoral compartment contact area: a biomechanical analysis of tibiofemoral contact area and pressures with varying amounts of meniscal extrusion. complex tear: a combination of all or some horizontal, vertical, and radial-type tears. Kneecap pain. Many techniques have been described for meniscal transplantation, but the most commonly used are (a) the suture-only technique, (b) bone-plug technique, (c) keyhole technique and (d) bridge-in-slot technique [102, 104, 111]. Most research shows that people do just as well with physical therapy. In addition, it has been shown that after lateral MAT, the extrusion is correlated with the progression of joint space narrowing (JSN) during long-term follow-up, while after medial MAT, JSN is observed during medium-term follow-up [114]. Therefore, nonoperative treatment should be reserved for nonsurgical candidates [61]. [54] showed that varus alignment factors, and specifically medial proximal tibial angle (MPTA), were significantly related to the extent of MME, especially as the knee OA grade progressed. More serious meniscus tears may not heal on their own. However, it remains unknown whether it is capable of delaying or modifying OA progression, and further research is warranted [32, 48, 49]. Malays Orthop J 9(2):1720, Article Conversely, since tears within the white zone have only a limited blood supply, they do not heal on their own and do not respond to conservative treatment. It is often used with chronic degenerative conditions although some authors also propose this term in the setting of a tear (macerated tear)2. A hip labral tear is an injury to the labrum, the soft tissue that covers the acetabulum (socket) of the hip. Playing contact sports also increases your risk of a meniscus tear. What is the usual treatment for a meniscal tear? Symptomatic meniscal tears are usually treated surgically. If the tear is in an area of the meniscus that has good blood supply, then it will generally be repaired with sutures. But you can reduce your risk of a torn meniscus if you: Most people who tear a meniscus can return to full activity. This puts tension on a torn meniscus. 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. 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. Meniscus tear surgery is very common, with about 850,000 surgeries performed each year in the United States. The primary site of destruction is the soft tissue fibers which couple the deep layers of the ACL to the LM and the LM to the tibial plateau. This is probably why capsulodesis is so effective in minimizing extrusion. On the other hand, the suture-only technique has its own advantages and is therefore chosen by many surgeons [104, 111]. See this post to learn more about how a meniscus functions, As mentioned in my recent post, the majority of posterior horn tears are determined to be degenerative. The choice of treatment depends on several factors, including severity of An MRI scan is the method of choice for confirming a suspected diagnosis. WebItll help increase your range of motion and help your knee get stronger. The ACL is the main restrictor in the anterior tibial translation, while the posterior part of the medial meniscus (MM) acts as a secondary stabilizer [83, 84]. Eur Radiol 22(1):211220, Lee DW, Jang HW, Lee SR, Park JH, Ha JK, Kim JG (2014) Clinical, radiological, and morphological evaluations of posterior horn tears of the lateral meniscus left in situ during anterior cruciate ligament reconstruction. The outer one-third of the meniscus has a blood supply, and so doctors refer to this area as the red zone. J Orthop Res 35(8):16251633, Shefelbine SJ, Ma CB, Lee KY, Schrumpf MA, Patel P, Safran MR et al (2006) MRI analysis of in vivo meniscal and tibiofemoral kinematics in ACL-deficient and normal knees. According to the American Academy of Orthopaedic Surgeons, treatment of a meniscus tear depends on the location of the injury, alongside other factors, including a persons: Below, we outline some potential treatment options. Knee 27(5):15601566, Zheng T, Song G, Li Y, Zhang Z, Ni Q, Cao Y et al (2021) Clinical, radiographic, and arthroscopic outcomes of surgical repair for radial and avulsed lesions on the lateral meniscus posterior root during ACL reconstruction: a systematic review. J Orthop Sci 25(4):640646. To the best of our knowledge, the exact clinical significance of ME after ACLR has not yet been clearly elucidated, although efforts are continuously being made to minimize this phenomenon. [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. The lateral meniscus (LM) is a secondary stabilizer in the knee joint during pivot-shift loading [85]. Conservative treatment is also advised for smaller tears, and stable longitudinal meniscus tears that occur in the outer third of the meniscus, the red zone. This is the area of your meniscus that has some blood supply, which aids healing. The incidence of meniscal tears associated with ACL injury is as high as 79%, with the LM being affected more often than the MM in acute situations [89]. Your provider may recommend knee arthroscopy to better view and accurately diagnose your injury. WebYour doctor will remove a piece of the torn meniscus so your knee can function normally. Knee Surg Sports Traumatol Arthrosc 29(4):11971205, Song JH, Bin SI, Kim JM, Lee BS (2020) Postoperative subchondral bone marrow lesion is associated with graft extrusion after lateral meniscal allograft transplantation. Clin Anat N Y N 28(6):792799, Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA et al (2019) OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Sudden twisting movements such as pivoting to catch a ball can tear the cartilage. Whilst APM is one of the most commonly performed orthopaedic procedures [], meniscal repair is the treatment of choice for the young athlete with an acute meniscal tear [].Meniscal repair is most commonly performed in younger populations aged under 35 years [10, 2127] and aims to preserve the entire meniscus, without excision.The
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