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. Arthritis (a breakdown of cartilage in the joints) can also lead to a meniscus tear. On the other hand, the suture-only technique has its own advantages and is therefore chosen by many surgeons [104, 111]. Treatment with glucosamine, chondroitin sulfate and licofelone has Am J Sports Med 42(10):23292337, Jauregui JJ, Wu ZD, Meredith S, Griffith C, Packer JD, Henn RF (2018) How should we secure our transplanted meniscus? Lie on Intermediate routine. Orthop J Sports Med 8(4):2325967120914568, Tsujii A, Yonetani Y, Kinugasa K, Matsuo T, Yoneda K, Ohori T et al (2021) Outcomes more than 2 years after meniscal repair for longitudinal tears of the lateral meniscus combined with anterior cruciate ligament reconstruction. 2023 Healthline Media UK Ltd, Brighton, UK. Winkler. (2018). A critical review of the literature. According to this technique, a more posterolateral position of the tibial tunnel aperture within the ACL footprint reduces the RTD (reference point to tibial tunnel distance) and increases the extrusion of the LM following ACLR [93]. Although meta-analyses validate the superiority of root repair over partial meniscectomy in terms of clinical outcomes, they also highlight the inability of root repair to successfully reduce ME [68, 69]. Surgery versus conservative treatment for meniscus tears has been a medical topic of controversy for many years. Most authors agree that the transplanted menisci are extruded more frequently than endogenous menisci [15, 102, 105]. 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]. Without nutrients from blood, tears in this "white" zone cannot heal. redness or streaking at the site of the injury, persistent symptoms despite appropriate self-care. WebACL surgery can be delayed until the child is closer to reaching skeletal maturity; however, this comes with a risk of future meniscus or cartilage injury. Getting hit or tackled can make you twist your knee, tearing the cartilage. Severe Meniscus Tear: Treatment Options Part of a Meniscotibial ligament repair with three interconnected suture anchors, b centralization with a transtibial tunnel or c with isolated suture anchors (usually with two or three suture anchors). Shiraev T, et al. Factors that increase the risk of a meniscus tear include: Doctors classify meniscus tears according to their shape and location. Treatment with glucosamine, chondroitin sulfate and licofelone has been found beneficial in patients with knee OA and ME, as it may lead to alleviation of symptoms and reduce cartilage volume loss over time. 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. 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. Here's what you need to know as well as a chart. J Orthop Surg 24(13):97. Management of the MPRT consists of nonoperative treatment, partial meniscectomy and root repair, and primarily aims to prevent the development of OA [58]. The authors did not receive funding for this study. We do not endorse non-Cleveland Clinic products or services. Moreover, instead of a single value, Miller et al. 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. MPRT are defined as an avulsion fracture or a radial lesion occurring within 1cm of the bony tibial attachment [56]. View Yuranga Weerakkody's current disclosures, see full revision history and disclosures, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, Ahlback classification system in assessing osteoarthritis of the knee joint, Kellgren and Lawrence system for classification of osteoarthritis, anterior cruciate ligament mucoid degeneration, MRI grading system for meniscal signal intensity. Alternatively, the surgeon may be able to modify the ACL reconstruction technique to decrease the risk of growth plate injury during surgery. Osteoarthritis Cartilage 25(7):10761083, Naredo E, Cabero F, Palop MJ, Collado P, Cruz A, Crespo M (2005) Ultrasonographic findings in knee osteoarthritis: a comparative study with clinical and radiographic assessment. ME is found in several knee pathologies and is well correlated with rapid knee OA progression as well as increased morbidity. Debieux et al. Recovery after a meniscectomy takes 36 weeks, and recovery after a meniscus repair takes 36 months. The menisci are crescent-shaped, fibrocartilaginous structures that play a crucial role in the load transition and distribution of the contact forces along the tibiofemoral articulation. Cant fully bend or straighten your leg without knee pain. 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. PubMed Knee Surg Sports Traumatol Arthrosc 23(1):290302, Gelber PE, Torres-Claramunt R, Poggioli F, Prez-Prieto D, Monllau JC (2020) Polyurethane Meniscal Scaffold: Does Preoperative Remnant Meniscal Extrusion Have an Influence on Postoperative Extrusion and Knee Function? Am J Sports Med 47(4):815821, Son DW, Bin SI, Kim JM, Lee BS, Lee CR, Park JG et al (2021) Extrusions do not affect degenerative morphologic changes in lateral meniscus allografts during midterm follow-ups. Last reviewed by a Cleveland Clinic medical professional on 04/17/2021. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Many recent studies have shown that theres no advantage to surgery with this type of tear, and that physical therapy works just as well. Some meniscus tears require surgery to heal the meniscus and restore the knees range of motion. A physical therapist will individualize a persons exercise regimen to prevent further injury. https://doi.org/10.1055/s-0040-1710377, Monllau JC, Ibaez M, Masferrer-Pino A, Gelber PE, Erquicia JI, Pelfort X (2017) Lateral capsular fixation: an implant-free technique to prevent meniscal allograft extrusion. If the repaired meniscus failed to heal, lateral extrusion progressed significantly [92]. 2. This is probably why capsulodesis is so effective in minimizing extrusion. Without surgery, recovery will take about 6 to 8 weeks, though this can vary. ME has no specific clinical finding or sign and it is encountered in many knee pathologies. This puts tension on a torn meniscus. It is often used with chronic degenerative conditions although some authors also propose this term in the setting of a tear (macerated tear)2. Can I make a meniscus tear worse if I run on it? See additional information. Meniscal tear | Radiology Reference Article A hip labral tear is an injury to the labrum, the soft tissue that covers the acetabulum (socket) of the hip. AJR Am J Roentgenol 183(1):1723, Muzaffar N, Kirmani O, Ahsan M, Ahmad S (2015) Meniscal extrusion in the knee: should only 3 mm extrusion be considered significant? (2017). 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. 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. 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]. Arthrosc Tech 9(10):e1511e1517, Tsujii A, Yonetani Y, Kinugasa K, Matsuo T, Yoneda K, Ohori T et al (2019) Outcomes more than 2 years after meniscal repair for radial/flap tears of the posterior lateral meniscus combined with anterior cruciate ligament reconstruction. There are two main types of arthroscopic surgery for a meniscus tear: partial meniscectomy and meniscus repair. This thinner cartilage can tear more easily. Reference article, Radiopaedia.org (Accessed on 01 May 2023) https://doi.org/10.53347/rID-70702. Arthrosc Tech 6(2):e269e274, Ahn JH, Kang HW, Yang TY, Lee JY (2016) Multivariate analysis of risk factors of graft extrusion after lateral meniscus allograft transplantation. 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. Tsujii et al. 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. It can happen playing sports, exercising or just doing daily activities. Eur J Radiol Open 20(3):100107, Rowland G, Mar D, McIff T, Nelson J (2016) Evaluation of meniscal extrusion with posterior root disruption and repair using ultrasound. On the contrary, traumatic tears usually involve the lateral meniscus after an acute traumatic episode with concomitant ligamentous injury, especially anterior cruciate ligament tear, in younger patients [5]. Older people are likely to have meniscus damage related to degeneration from wear-and-tear. Home treatment, If you've been sidelined by a common sports injury like an ACL tear, you're likely wondering how long it will take to heal. Knee Surg Sports Traumatol Arthrosc 25(2):383389, Pache S, Aman ZS, Kennedy M, Nakama GY, Moatshe G, Ziegler C et al (2018) Meniscal root tears: current concepts review. Perhaps even more important is that once your knee feels better, and it The menisci can be torn or strained by any rotation or twisting motion that puts stress on the knee. Most of the meniscus pathologies have recently been correlated with meniscal extrusion [3, 6]. Small tears often heal on their own, while others may require arthroscopic surgery. Orthop J Sports Med 9(3):2325967121989678, Koga H, Watanabe T, Horie M, Katagiri H, Otabe K, Ohara T et al (2017) Augmentation of the pullout repair of a medial meniscus posterior root tear by arthroscopic centralization. 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. Diagnosis and management of meniscal injury. That can increase your risk of other knee injuries like an ACL tear or other torn ligament. Terms and Conditions, Eur J Radiol 1(102):115124, Karpinski K, Diermeier T, Willinger L, Imhoff AB, Achtnich A, Petersen W (2019) No dynamic extrusion of the medial meniscus in ultrasound examination in patients with confirmed root tear lesion. Careful preoperative planning for correct sizing and accurate placement of the allograft is critical for preventing ME. Babu J, et al. J Orthop Sci 25(4):640646. The rubbery wedges of cartilage act like shock absorbers for your knee, providing cushioning for your bones and knee joint. It is associated with either rapidly progressive knee osteoarthritis or early onset of knee osteoarthritis and increased morbidity. These tests include: However, these may not have the best accuracy. The menisci play an important role in stabilizing the knee, easing movement of the knee joint, and absorbing shock from walking and other weight bearing activities. Lie on the back, with the unaffected knee bent. Nguyen J, De Smet A, Graf B, Rosas H. MR Imaging-Based Diagnosis and Classification of Meniscal Tears. Moreover, centralization of the allograft can be performed to help stabilize it on the tibial plateau; however, there are not yet sufficient data in the literature to support its benefits. Torn or Frayed Meniscus: When Surgery May Be However, to date there is still no well-designed clinical trial available to ascertain the effectiveness of centralization in reducing ME. meniscus [31] showed that lateral ME was associated with worsening of patellofemoral joint OA features at 2-year follow-up. Your provider may recommend knee arthroscopy to better view and accurately diagnose your injury. Here are tips on how to prepare your room and your body for a good nights sleep, and what to do if your knee pain becomes more severe. Become a Gold Supporter and see no third-party ads. Its best to see a doctor for diagnosis of knee pain and a treatment plan. The knee meniscus: Management of traumatic tears and degenerative lesions. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. A person should make an appointment with a doctor if they experience any of the following: A meniscus injury refers to a tear in one of the menisci within the knee. CARTILAGE 21:1947603520934525, Lee DH, Lee BS, Kim JM, Yang KS, Cha EJ, Park JH et al (2011) Predictors of degenerative medial meniscus extrusion: radial component and knee osteoarthritis. 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]. Hold the position for 5 seconds and then relax. Torn shoulder labrum: Causes, symptoms, and treatment 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. What are signs the injury is getting worse instead of healing? But you can reduce your risk of a torn meniscus if you: Most people who tear a meniscus can return to full activity. PubMed Central For a meniscus tear to heal, it needs three things: Healthy tissue Good blood supply Stability If you are having surgery for a symptomatic torn meniscus, a Meniscus repair involves stitching torn pieces of a meniscus back together. Another promising surgical approach for reducing the ME is the arthroscopic centralization of the extruded meniscus at the point where the capsule adjacent to the meniscus is repaired at the border of the tibial plateau [98, 101]. MPRT should be repaired earlier than 3months after diagnosis. Google Scholar, Magnusson K, Turkiewicz A, Kumm J, Zhang F, Englund M (2020) The relationship between MRI features and knee pain over 6 years in knees without radiographic osteoarthritis at baseline. Persistent hoop and shear stresses create complex tears in the posterior horn and To the best of our knowledge, this is the first study to elaborate on these topics. Degenerative tears occur mainly in the medial meniscus and are most commonly encountered in older patients without any history of significant trauma [4]. Google Scholar, Raynauld JP, Martel-Pelletier J, Bias P, Laufer S, Haraoui B, Choquette D et al (2009) Protective effects of licofelone, a 5-lipoxygenase and cyclo-oxygenase inhibitor, versus naproxen on cartilage loss in knee osteoarthritis: a first multicentre clinical trial using quantitative MRI. Also consult a doctor if you continue to have pain after a course of conservative treatment. Nonsurgical treatment may include interventions such as rest, exercises, and medication. [77] performed arthroscopic centralization of nine extruded lateral menisci with the use of suture anchors, and ME was significantly reduced in 2years of follow-up. Arthrosc Tech 6(4):e1335e1339, Masferrer-Pino A, Monllau JC, Abat F, Gelber PE (2019) Capsular fixation limits graft extrusion in lateral meniscal allograft transplantation. Another successful strategy is osteophyte resection. Most people fully recover from a torn meniscus and can get back to doing their favorite activities without knee pain. Meniscal tears: Current understanding, diagnosis, and management. If you have a And finally, the proper anatomical placement of the allograft is essential. 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. Two pieces of cartilage sit inside your knee, between your thighbone (femur) and shinbone (tibia). occasionally a surgery we refer to as an arthroscopy. Learn about the most common knee injuries from falling, as well as which ones you can treat at home and which ones require medical attention. Experts say choosing between knee repair and knee reconstruction surgery isn't a simple decision. Privacy PolicyThe information on this site is not intended or implied to be medical advice, diagnosis, or treatment. In another study where they examined MRI series both before and after medial MPRT, they showed that MTL disruption and ME predated the MPRT, thus emphasizing the potential role that MTL could play as a causal factor of ME, and even suggesting that disruption of MTL should be addressed alongside MPRT repair in order to reduce ME [75]. Comparative studies between normal knees and knees with ACL rupture demonstrated that the posterior extrusion of the MM during knee flexion is almost the same [83, 94]. CAS Knee Surg Sports Traumatol Arthrosc 28(11):35993605, Krych AJ, LaPrade MD, Hevesi M, Rhodes NG, Johnson AC, Camp CL et al (2020) Investigating the chronology of meniscus root tears: do medial meniscus posterior root tears cause extrusion or the other way around? A hip labral tear can be treated nonsurgically, or with surgery in severe cases. Our friendly team is here to answer your questions about knee injuries or any other problems with your bones or joints. During the meniscus surgery, a small instrument called an arthroscope, which has a camera at its tip, is inserted into your knee. After recovery, your knee will be more stable, and youll be less likely to develop additional knee problems. Conservative treatment for some meniscus tears is well documented as effective. Surgery is a very effective way to repair a torn meniscus. Putting ice on your knee for 10 to 15 minutes Therefore, proper placement of the posterior horn is critical to the anatomical repair of the meniscus [125,126,127]. Wear athletic shoes that are appropriate for the sport youre doing. Meniscus injury: Types, symptoms, treatment, and more WebIs knee surgery necessary to repair a torn meniscus? However, the incidence of severe knee OA is much higher in patients who have been subjected to ACLR than individuals with intact ACL [86, 87]. We avoid using tertiary references. 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. PubMed Central PubMed PLoS ONE 9(3):e92901, Article National Institute of Arthritis and Musculoskeletal and Skin Diseases. Google Scholar, Okada K, Yamaguchi S, Sato Y, Enomoto T, Ogawa Y, Ohtori S et al (2019) Comparison of meniscal extrusion and osteophyte formation at the intercondylar notch as a predictive biomarker for incidence of knee osteoarthritis-Data from the Osteoarthritis Initiative-. 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. 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. Although in mild/moderate knee OA there is still no specific treatment targeting ME, the established conservative and operative treatment modalities seem equally successful in delaying the progression of OA and improving symptoms when ME is also present. 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. However, more research with high-quality studies is needed in order to refine the technique and validate its long-term results in reducing ME. Treatment often involves OTC medications, cortisone injections, and physical therapy. An inappropriate tibial tunnel may also cause extrusion of the LM. Nogueira-Barbosa MH, Gregio-Junior E, Lorenzato MM, Guermazi A, Roemer FW, Chagas-Neto FA et al (2015) Ultrasound assessment of medial meniscal extrusion: a validation study using MRI as reference standard. For these reasons, certain contraindications have been introduced (Table 2) [102, 103, 105,106,107,108,109]. This article outlines two types and their associated symptoms and causes. CAS Degenerative lesions of the knee joint are more commonly present during concurrent ACLR with meniscectomy than with intact or repaired menisci. It should be highlighted that the clinical significance of meniscal allograft extrusion has not yet been clearly elucidated, since it is difficult to draw firm conclusions. We avoid using tertiary references. Recovery time for meniscus tear depends upon the type of surgery performed. The other factors that affect the recovery time are as follows: On an average, it takes about 4 6 weeks of time for the patient to recover completely from the meniscus surgery. Based on these findings, they concluded that the all-inside repair of the radial tear of the LM could help maintain its dynamic behavior, thus reducing the biomechanical stress exerted on the adjacent cartilage [89]. Google Scholar, uczkiewicz P, Daszkiewicz K, Chrcielewski J, Witkowski W, Kuik L (2017) High meniscal slope angle as a risk factor for meniscal allograft extrusion. Meniscus Tear Repair Surgery: What To Expect Knee Surg Sports Traumatol Arthrosc 19(2):222229, Oo WM, Linklater JM, Bennell KL, Pryke D, Yu S, Fu K et al (2021) Are OMERACT knee osteoarthritis ultrasound scores associated with pain severity, other symptoms, and radiographic and magnetic resonance imaging findings? Meniscus tears are a very common knee injury, especially among athletes. Lateral wedge insoles have been found to reduce MME and could also supplement a conservative treatment of knee OA, as they could potentially delay the degenerative process [50]. Google Scholar, Hart HF, Crossley KM, Felson D, Jarraya M, Guermazi A, Roemer F et al (2018) Relation of meniscus pathology to prevalence and worsening of patellofemoral joint osteoarthritis: the multicenter osteoarthritis study. People whose cartilage wears down (due to age or arthritis) can tear a meniscus from a motion as simple as stepping on an uneven surface. The precise location of your knee pain can help you narrow down the potential cause. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 26(12):16331640, Jang SH, Kim JG, Ha JG, Shim JC (2011) Reducing the size of the meniscal allograft decreases the percentage of extrusion after meniscal allograft transplantation. Exercise programs start with an initial routine and then progress to intermediate and advanced routines. To perform this exercise, a person should do the following: An intermediate exercise routine may include straight leg raises. How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction. In this review, we delineate the clinical significance of ME in various knee pathologies, as well as when, why and how it should be managed. 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. If you have surgery to repair a torn meniscus, your knee should be fully recovered after a few months of physical therapy. This post will carry two messages, both equally important. J Orthop Res 38(11):24952504, Roemer FW, Kwoh CK, Hannon MJ, Green SM, Jakicic JM, Boudreau R et al (2012) Risk factors for magnetic resonance imagingdetected patellofemoral and tibiofemoral cartilage loss during a six-month period: the Joints On Glucosamine study. Orthopaedic knee surgeons use Here, find nine gentle exercises that may help strengthen and heal a torn meniscus. National Center for Biotechnology Information Results regarding the correlation of ME with pain in knee OA remain controversial. Nonoperative treatment is associated with poor clinical outcomes, especially in the presence of a large ME [59], and exacerbation of OA with a higher incidence of subsequent arthroplasty over 5years of follow-up [60]. https://doi.org/10.1177/2325967120961368, Paletta GA, Crane DM, Konicek J, Piepenbrink M, Higgins LD, Milner JD et al (2020) Surgical treatment of meniscal extrusion: a biomechanical study on the role of the medial meniscotibial ligaments with early clinical validation. Correspondence to 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. Knee Surg Sports Traumatol Arthrosc 20(1):4861, Kashihara N, Furumatsu T, Kodama Y, Tanaka T, Ozaki T (2016) Concurrent lateral meniscal repair with anterior cruciate ligament reconstruction induces the extrusion of the lateral meniscus: assessments of magnetic resonance images. If your injury doesnt improve with RICE, NSAIDs and physical A torn or strained meniscus is generally treated with rest, ice, over-the-counter anti-inflammatory medicines and physical therapy. Arthroscopy 27(7):914922, Kim JH, Lee S, Ha DH, Lee SM, Jung K, Choi W (2018) The effects of graft shrinkage and extrusion on early clinical outcomes after meniscal allograft transplantation. Mordecai SC, et al. EFORT Open Rev 4(4):115120, Gonzlez-Lucena G, Gelber PE, Pelfort X, Tey M, Monllau JC (2010) Meniscal allograft transplantation without bone blocks: a 5- to 8-year follow-up of 33 patients. Medial Compartment Osteoarthritis Malays Orthop J 9(2):1720, Article For an athlete, playing through knee pain can cause greater problems later.
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