Wang et al. 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. When diagnosing a meniscus tear, a doctor will carry out a detailed medical history and a thorough examination of the knee joint. Orthopaedic knee surgeons use Although the ultimate cause is unknown, it is quite common to see a subluxated joint capsule in the symptomatic meniscectomized compartment. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. In a recent study by Tsujii et al., it was shown that after concurrent ACLR and meniscal repair, the lateral extrusion of the LM was correlated with its healing status. Our friendly team is here to answer your questions about knee injuries or any other problems with your bones or joints. Advertising on our site helps support our mission. 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. Most people fully recover from a torn meniscus and can get back to doing their favorite activities without knee pain. ME is found in several knee pathologies and is well correlated with rapid knee OA progression as well as increased morbidity. It is often used with chronic degenerative conditions although some authors also propose this term in the setting of a tear (macerated tear) 2.On imaging, it Without surgery, recovery will take about 6 to 8 weeks, though this can vary. Does a degenerative meniscus tear need surgery? ME is strongly correlated with posterior root tears of the menisci [6]. They may also share some exercises you can do at home. The choice of treatment depends on several factors, including severity of This thinner cartilage can tear more easily. It can lead to pain, swelling, and a sensation of the knee giving way. A hip labral tear is an injury to the labrum, the soft tissue that covers the acetabulum (socket) of the hip. This post goes into considerable detail about managing a knee with arthritis and a complex or degenerative meniscus tear. Your healthcare provider will physically examine your knee, looking for signs of swelling. In some cases, surgery may be recommended to repair a torn meniscus. This post will carry two messages, both equally important. It has been shown from studies that the risk for TKA after ACLR is seven timesgreater than in normal individuals [88]. 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. A more posterolateral placement of the tibial tunnel aperture may induce extrusion of the LM following ACLR. Those that are caused by an injury are often the ones that can be, A meniscectomy is a procedure that repairs a torn meniscus. Clinical significance and management of meniscal extrusion in different knee pathologies: a comprehensive review of the literature and treatment algorithm. Policy. (2016). 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]. Radiographics. Its best to see a doctor for diagnosis of knee pain and a treatment plan. If the tear is too big to repair, your surgeon may remove all or part of the meniscus. Arch Bone Jt Surg 6(4):250259, PubMed Also consult a doctor if you continue to have pain after a course of conservative treatment. 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. Being unable to fully bend or straighten your leg. Current research has directed its focus to meniscotibial ligaments (MTL), which stabilize on the tibial plateau and centralize the meniscus, as an additional potential causative factor for ME. Dawson LJ, et al. Today, in general, doctors recommend conservative treatment, not surgery, when meniscus tears result from degeneration. All authors read and approved the final manuscript. However, arthroscopic debridement and osteotomies around the knee are also being employed in some instances in moderate knee OA before a TKR is required [51, 52]. 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. Acta Med Okayama 70(6):441448, Narazaki S, Furumatsu T, Tanaka T, Fujii M, Miyazawa S, Inoue H et al (2015) Postoperative change in the length and extrusion of the medial meniscus after anterior cruciate ligament reconstruction. 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]. Malays Orthop J 9(2):1720, Article Prepatellar bursitis is a common complaint of people who work on their knees or who engage in activities that risk blows to the knee. How can I strengthen my knee meniscus? 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. Last reviewed by a Cleveland Clinic medical professional on 04/17/2021. Conservative treatment constitutes the first line of therapy in mild or moderate knee OA [46, 47]. Heres what it involves: Treatment usually starts with the RICE method: If recommended by your doctor, use nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, or naproxen to reduce pain and swelling for 8 to 12 weeks. The outer one-third of the meniscus has a blood supply, and so doctors refer to this area as the red zone. During this procedure, your doctor will remove the J Orthop Res Off Publ Orthop Res Soc 24(6):12081217, Wenger A, Englund M, Wirth W, Hudelmaier M, Kwoh K, Eckstein F et al (2012) Relationship of 3D meniscal morphology and position with knee pain in subjects with knee osteoarthritis: a pilot study. 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. 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]. Here's what to expect from. All rights reserved. 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. But you can reduce your risk of a torn meniscus if you: Most people who tear a meniscus can return to full activity. However, several studies showed that partial meniscectomy, particularly when the ME was profound [62, 63], failed to prevent the progression of OA, as it creates a meniscus-deficient state, and leads to significant functional impairment with high rates of arthroplasty [24, 60]. Modern treatment of meniscal tears. That can increase your risk of other knee injuries like an ACL tear or other torn ligament. Kneecap pain. To perform this exercise, a person should follow these steps: An advanced exercise routine may include an exercise that involves partially bending the knee. It can be hard to prevent an accidental injury. Red-red tears are within the red zone, and red-white tears have central margins that extend into the white zone. Root repair is indicated when varus malalignment is minimal (<5), the cartilage wear is not advanced (Outerbridge grade 12) and it can be performed arthroscopically either with a transtibial pullout technique or with suture anchors, each with its respective advantages and disadvantages [58]. X-rays are useful in finding other causes of knee pain, but they will not show a meniscus tear. Correspondence to nonsteroidal anti-inflammatory drugs (NSAIDs), rimed.org/rimedicaljournal/2016/10/2016-10-27-sports-babu.pdf, ncbi.nlm.nih.gov/pmc/articles/PMC5489759/, ncbi.nlm.nih.gov/pmc/articles/PMC6483631/, ncbi.nlm.nih.gov/pmc/articles/PMC5994634/, orthoinfo.aaos.org/en/diseases--conditions/meniscus-tears/, ncbi.nlm.nih.gov/pmc/articles/PMC3418117/, physioworks.com.au/pain-injury/knee-pain/meniscus-tear/, sciencedirect.com/science/article/pii/S1063458418300827, ncbi.nlm.nih.gov/pmc/articles/PMC4095015/, racgp.org.au/afp/2012/april/meniscal-tear/, ncbi.nlm.nih.gov/pmc/articles/PMC5905745/, How to Ease Knee Pain and Sleep Tight Through the Night, The 6 Best Knee Compression Sleeves of 2023, What Your Knee Pain May Indicate Based on Its Location, Prepatellar Bursitis on the Kneecap: Treatment and Recovery from this Injury, ACL Knee Repair Sometimes Leads to Better Outcomes Than Reconstruction. If your injury doesnt improve with RICE, NSAIDs and physical therapy, your healthcare provider may recommend arthroscopic surgery. 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. statement and 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. Arthritis Care Res 68(10):15601566, Article We link primary sources including studies, scientific references, and statistics within each article and also list them in the resources section at the bottom of our articles. 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. Persistent hoop and shear stresses create complex tears in the posterior horn and 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]. 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. Arthritis (a breakdown of cartilage in the joints) can also lead to a meniscus tear. medial meniscal extrusion is associated with Orthop J Sports Med 8(7):2325967120936672, Koga H, Muneta T, Watanabe T, Mochizuki T, Horie M, Nakamura T et al (2016) Two-year outcomes after arthroscopic lateral meniscus centralization. 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. 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. 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. Meniscal extrusion (ME) is a radiological finding, especially in magnetic resonance imaging (MRI) scans, for which there has been growing interest in recent years. J Knee Surg 34(2):178186, Furumatsu T, Kodama Y, Kamatsuki Y, Hino T, Okazaki Y, Ozaki T (2017) Meniscal extrusion progresses shortly after the medial meniscus posterior root tear. Complex meniscal tears usually require surgery. A longitudinal tear is an example of this kind of tear. Provided by the Springer Nature SharedIt content-sharing initiative. The inner two-thirds of the meniscus have only a limited blood supply, which is why doctors call this the white zone. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. showed that the difference in the extrusion of the LM between a healthy knee and a knee with combined injury was not statistically significant. 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. The goal of the anatomic reconstruction of the ACL rupture is to replicate the normal knee anatomy. Magnetic resonance imaging (MRI) is the method of choice for the detection and evaluation of ME (Fig. 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. Part of In a recent meta-analysis, the percentages of medium-term and long-term survival after medial MAT were 85.8% and 52.6%, respectively, whereas after lateral MAT they were 89.2% and 56.6%, respectively [116]. The authors declare that they have no competing interests. Here's what you need to know as well as a chart. Google Scholar, Kim SJ, Choi CH, Chun YM, Kim SH, Lee SK, Jang J et al (2017) Relationship between preoperative extrusion of the medial meniscus and surgical outcomes after partial meniscectomy. Mordecai SC, et al. 2017;25(1):76-84. Theres an inner (medial) meniscus and an outer (lateral) meniscus. The lateral meniscus (LM) is a secondary stabilizer in the knee joint during pivot-shift loading [85]. Last medically reviewed on December 21, 2020. Therefore, they suggested that this type of OA patient, with MME and varus malalignment with a low MPTA, could benefit primarily from an early intervention with high tibial osteotomy (HTO), thus delaying the progression of knee OA. Debieux et al. Can I make a meniscus tear worse if I run on it? Arthroscopy 36(4):11351141, Article 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. Associations. (ACLR+LM tears left in situ) showed narrowing of 0.33mm of the lateral joint space at 3years postoperatively, and Shelbourne et al. Degenerative tears occur mainly in the medial meniscus and are most commonly encountered in older patients without any history of significant trauma [4]. Therefore, nonoperative treatment should be reserved for nonsurgical candidates [61]. Healthline Media does not provide medical advice, diagnosis, or treatment. In a biomechanical study, Paletta et at. J ISAKOS 6(1):3545, Beaufils P, Becker R, Kopf S, Englund M, Verdonk R, Ollivier M et al (2017) Surgical management of degenerative meniscus lesions: the 2016 ESSKA meniscus consensus. The injury also commonly affects older people and those with arthritis in their knees. On imaging, it is often seen as a meniscal loss with the destruction of expected architecture. Arthroscopy 31(4):699706, Lee SM, Bin SI, Kim JM, Lee BS, Park JG (2020) Absolute meniscal extrusion after lateral meniscal allograft transplantation does not progress during long-term follow-up: average of 10.3 years follow-up longitudinal magnetic resonance imaging study. Most transplantations have been performed with the bone-plug technique because previous studies have shown its superiority in load-bearing function, resistance to hoop stresses, similar contact mechanics to endogenous menisci and lower extrusion rates compared with the other techniques [109, 111]. The knee meniscus: Management of traumatic tears and degenerative lesions. Depending on your symptoms, your doctor may recommend a special knee brace or other mechanisms to limit your joint movement and stabilize the knee. Knee Surgery & Related Research Am J Sports Med 45(8):18641871, Novaretti JV, Astur DC, Cavalcante ELB, Kaleka CC, Amaro JT, Cohen M (2020) Preoperative meniscal extrusion predicts unsatisfactory clinical outcomes and progression of osteoarthritis after isolated partial medial meniscectomy: a 5-year follow-up study. Careful preoperative planning for correct sizing and accurate placement of the allograft is critical for preventing ME. Google Scholar, Abat F, Gelber PE, Erquicia JI, Pelfort X, Gonzalez-Lucena G, Monllau JC (2012) Suture-only fixation technique leads to a higher degree of extrusion than bony fixation in meniscal allograft transplantation. Physical therapy can help you recover from a meniscus tear by decreasing pain, strengthening and improving the flexibility in your knee, and increasing its range of Wear athletic shoes that are appropriate for the sport youre doing. An individual should seek guidance from a physical therapist about which exercises to perform to assist their healing. Most of the meniscus pathologies have recently been correlated with meniscal extrusion [3, 6]. WebThere are two general forms of treatment for meniscus tears: conservative, or nonsurgical, and surgical. 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. Meniscus tears can occur from an injury or wear and tear on the joint over time. PLoS ONE 9(3):e92901, Article root tear: typically radial-type tear located at the meniscal root. Clinical significance and management of meniscal extrusion in different knee pathologies: a comprehensive review of the literature and treatment algorithm, https://doi.org/10.1186/s43019-022-00163-1, Anterior cruciate ligament reconstruction (ACLR), https://doi.org/10.1007/s00167-020-06363-0, https://link.springer.com/article/10.1007%2Fs00402-020-03683-1, https://doi.org/10.1186/s43019-019-0019-x, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. 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. Putting ice on your knee for 10 to 15 minutes However, more research with high-quality studies is needed in order to refine the technique and validate its long-term results in reducing ME. A meniscus injury is a tear in one of the menisci within the knee. 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. [76] showed that induction of MTL lesions in cadaveric knees resulted in ME after only a few cycles of loading and that repair of the lesion led to a significant reduction of ME. redness or streaking at the site of the injury, persistent symptoms despite appropriate self-care. Your doctor will bend your knee, then straighten and rotate it. 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. Arthroscopic partial meniscectomy The goal of this Cleveland Clinic is a non-profit academic medical center. Several strategies have been proposed to reduce allograft extrusion. WebYour doctor will remove a piece of the torn meniscus so your knee can function normally. It can happen playing sports, exercising or just doing daily activities. Privacy Knee Surg Sports Traumatol Arthrosc 26(3):781786, Krych AJ, Reardon PJ, Johnson NR, Mohan R, Peter L, Levy BA et al (2017) Non-operative management of medial meniscus posterior horn root tears is associated with worsening arthritis and poor clinical outcome at 5-year follow-up. A hip labral tear can be caused by injury, structural problems, or degenerative issues. To perform this exercise, a person should do the following: An intermediate exercise routine may include straight leg raises. Furthermore, Lee et al. Our website services, content, and products are for informational purposes only. 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. To perform this exercise, a person should do the following: The red zone has a blood supply, and therefore, a meniscus injury in this area may heal on its own. MAT is a potential surgical procedure for young, active patients with symptomatic meniscal insufficiency that does not respond to conservative treatment [102, 103]. How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction. Moreover, extrusion of the LM does not improve after ACLR unless the meniscal tear is repaired [87, 92]. Recovery time can be lengthy with either one. This site should be used for informational purposes only. Knee Surg Sports Traumatol Arthrosc 19(2):214217, Kim YS, Kang KT, Son J, Kwon OR, Choi YJ, Jo SB et al (2015) Graft extrusion related to the position of allograft in lateral meniscal allograft transplantation: biomechanical comparison between parapatellar and transpatellar approaches using finite element analysis. How can you tell whether you have a meniscus tear? Rehabilitation following meniscal repair: A systematic review. Webinferior leaet of the meniscus tear. WebArthroscopic surgery. Antony B, Driban J, Price L et al. PubMed Knee Surg Relat Res. 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. Physical therapy generally leads to a good outcome. Nonsurgical treatment may include interventions such as rest, exercises, and medication. Knee 26(6):12921298, Zhang ZZ, Zhou YF, Luo H, Zhang HZ, Chen Z, Jiang C et al (2020) A novel surgical technique for arthroscopic repair of type II posterior lateral meniscal root tear. It is known that ACL and meniscal function cannot be fully restored even after surgical repair [86, 90]. Astur et al. Surgery versus conservative treatment for meniscus tears has been a medical topic of controversy for many years. Become a Gold Supporter and see no third-party ads. More serious meniscus tears may not heal on their own. Try to rest your knee for a few days and keep pressure off it. During an arthroscopy, a small, lighted, optic tube PubMed Central This value is identified as the optimal cutoff point for a complete PRT of the LM and has 100% sensitivity and 83% specificity [92]. Ice. (2018). if you have sudden pain from a knee injury. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. A novel technique has been developed based on a measurement grid in order to determine the precise aperture of the tibial tunnel. 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]. Core tip:The healing potential of chronic degenerative menisci remains poor. Your provider may recommend knee arthroscopy to better view and accurately diagnose your injury. 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 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. After healing occurs, a doctor will recommend a rehabilitation program of exercises to improve range of motion and strength. [55] verified this hypothesis by performing 66 HTO, where they measured ME with MRI preoperatively and postoperatively, and found that at 6weeks postoperatively, the ME had decreased from a mean of 3.90.6mm to a mean of 0.90.5mm. Medial meniscal extrusion (MME) is measured 5.6mm. Following proper treatment and rehabilitation, people can typically resume their pre-injury activities. When will I be able to get back to full activity? However, it is still controversial whether meniscal pathology leads to osteoarthritis (OA), or vice versa. Conservative treatment constitutes the first line of therapy in mild or moderate knee OA [46, 47]. Usually you will be able to leave the hospital the same day. 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. Winkler. On the other hand, the suture-only technique has its own advantages and is therefore chosen by many surgeons [104, 111]. MK, VSI and GP participated in the study design and helped to draft the manuscript. Sci Rep 15(7):44470, Kijima H, Yamada S, Nozaka K, Saito H, Shimada Y (2015) Relationship between pain and medial meniscal extrusion in knee osteoarthritis. Cite this article. Orthop J Sports Med. Small tears often heal on their own, while others may require arthroscopic surgery. A tear in this "red" zone may heal on its own, or can often be repaired with surgery. Doctors may use additional clinical tests that assess range of motion in the knee from various positions. Makiev, K.G., Vasios, I.S., Georgoulas, P. et al. Meniscus tears can occur at any age. Using the back of a chair for support, stand upright. However, over a long-term period, the degenerative changes in the articular cartilage worsened, especially in the lateral tibial plateau, regardless of the healing status of the meniscus [85, 87, 90]. If your symptoms persist after 3 months or your symptoms become significant, your doctor may recommend surgery to repair the tear. Therefore, proper placement of the posterior horn is critical to the anatomical repair of the meniscus [125,126,127].
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