Moreover, extrusion of the LM does not improve after ACLR unless the meniscal tear is repaired [87, 92]. Does a degenerative meniscus tear need surgery? OrthoInfo from the American Academy of Orthopaedic Surgeons. 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. J Rheumatol 48(2):270278, Chiba D, Maeda S, Sasaki E, Ota S, Nakaji S, Tsuda E et al (2017) Meniscal extrusion seen on ultrasonography affects the development of radiographic knee osteoarthritis: a 3-year prospective cohort study. However, it remains unknown whether it is capable of delaying or modifying OA progression, and further research is warranted [32, 48, 49]. 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]. It can be hard to prevent an accidental injury. meniscus Kijima et al. Meniscus Tear Recovery Time Without Surgery: What to Arthroscopic total meniscectomy. PLoS ONE 11(5):e0156183, Noyes FR, Barber-Westin SD (2015) A systematic review of the incidence and clinical significance of postoperative meniscus transplant extrusion. Osteophyte removal>2mm at the edge of the lateral tibial plateau can reduce extrusion after lateral MAT [109, 121, 122]. Winkler et al. Meniscal extrusion or subluxation refers to the peripheral meniscal margin extending beyond the external aspect of the tibiofemoral compartment of the knee.. 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. 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. WebHip Labral Tear. David Prado/Stocksy United. Meniscus Tear Repair Surgery: What To Expect 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. Meniscal maceration | Radiology Reference Article Torn Meniscus: Causes, Symptoms, Treatments, Furthermore, Lee et al. [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. WebThe outside one-third of the meniscus has a rich blood supply. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 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. 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? However, to date there is still no well-designed clinical trial available to ascertain the effectiveness of centralization in reducing ME. 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). Meniscal tears are grossly divided into degenerative and traumatic [3]. This site should be used for informational purposes only. Nguyen J, De Smet A, Graf B, Rosas H. MR Imaging-Based Diagnosis and Classification of Meniscal Tears. WebIs knee surgery necessary to repair a torn meniscus? Arthroscopy 30(11):14241429, Merkely G, Ogura T, Ackermann J, Mestriner AB, Minas T, Gomoll AH (2019) Open meniscal allograft transplantation with transosseous suture fixation of the meniscal body significantly decreases meniscal extrusion rate compared with arthroscopic technique. Slowly lower the body, keeping the foot flat. Skeletal Radiol 26(7):424427, Article 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. Recovery time can be lengthy with either one. 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. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 31(9):18081816, Jeon SW, Jung M, Choi CH, Kim SG, Kim SH (2021) Factors related to meniscal extrusion and cartilage lesions in medial meniscus root tears. It has been suggested that a 510% reduction of implant size from the estimated one reduces postoperative extrusion [2, 105, 123]. The menisci serve a number of important functions, such as: According to 2021 research, a meniscus tear is a common injury, affecting 61 out of every 100,000 people in the general population. Healthline Media does not provide medical advice, diagnosis, or treatment. What are signs the injury is getting worse instead of healing? 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. Lie on the back, with the unaffected knee bent. 3). Complex tears usually require surgery to trim the damaged part of the meniscus. Bend the unaffected leg, touching the toe to the floor as necessary for balance. A torn or strained meniscus is generally treated with rest, ice, over-the-counter anti-inflammatory medicines and physical therapy. Last medically reviewed on December 21, 2020. [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. Historically, MPRT were treated with partial meniscectomy. By using this website, you agree to our Mordecai SC, et al. Conservative treatment for some meniscus tears is well documented as effective. Playing contact sports also increases your risk of a meniscus tear. Cleveland Clinic is a non-profit academic medical center. Am J Sports Med 46(5):12431250, Noyes FR, Barber-Westin SD (2016) Long-term survivorship and function of meniscus transplantation. A hip labral tear can be treated nonsurgically, or with surgery in severe cases. PubMed Some clinical studies on its effectiveness exist, but more research is needed. root tear: typically radial-type tear located at the meniscal root. Kneecap pain. An MRI will confirm a suspected diagnosis. Shiraev T, et al. Sonographic evaluation of lateral meniscal extrusion: implementation and validation|SpringerLink [Internet]. Hold the position for 5 seconds and then relax. They then measured the medial meniscal extrusion (MME) with U/S under weight-bearing and reported a cutoff value of MME for knee pain of 4.3mm, with sensitivity of 84% and specificity of 85% [43]. Today, in general, doctors recommend conservative treatment, not surgery, when meniscus tears result from degeneration. Clinical significance and management of meniscal People who play sports (like tennis, soccer, basketball or football) that involve sudden twisting movements are most likely to tear a meniscus. 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. Several strategies have been proposed to reduce allograft extrusion. As you get older, the cartilage in your knees wears down and gets weaker. Goto et al. Have swelling that doesnt go away with a few days of RICE and taking NSAIDs. The menisci are pads of cartilage in the knee joint. How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction. Torn or Frayed Meniscus: When Surgery May Be J Orthop Surg 24(13):97. 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]. Traditional Ayurvedic treatments are widely used in South Asia to reduce swelling, pain, and motion restrictions in meniscus tears and knee osteoarthritis. Most research shows that people do just as well with physical therapy. Future research should focus on the role of additional centralization of the meniscus during arthroscopic debridement for the treatment of moderate knee OA. In some cases, surgery may be recommended to repair a torn meniscus. J Knee Surg. A hip labral tear can be caused by injury, structural problems, or degenerative issues. Those that are caused by an injury are often the ones that can be, A meniscectomy is a procedure that repairs a torn meniscus. Several preoperative and intraoperative factors (Table 3) are associated with the absolute value of allograft extrusion [16, 102, 106, 109, 120]. Cookies policy. 1. ACL Injury: Does It Require Surgery? - OrthoInfo - AAOS Generally speaking, the treatment options for meniscus tears include: rest, physical therapy, activity modification, and occasionally a surgery we refer to as an Zheng J, Zhai W, Li Q, Jia Q, Lin D. A Special Tear Pattern of Anterior Horn of the Lateral Meniscus: Macerated Tear. 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. It permits immediate weight bearing following surgery and provides a full range of motion soon afterward. Wang et al. Pull both heels into the floor while tightening the muscles on the backs of the thighs. Knee arthroscopy, a minimally invasive procedure, is often used to treat meniscal tears. 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. These are nonabsorbent Note that meniscectomy may cause osteoarthritis in the long term. Policy. You may also get imaging tests, such as X-rays or an MRI, to assess the damage. (2016). Small tears often heal on their own, while others may require arthroscopic surgery. Degenerative tears occur mainly in the medial meniscus and are most commonly encountered in older patients without any history of significant trauma [4]. 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. 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-. Magnetic resonance imaging (MRI) is the method of choice for the detection and evaluation of ME (Fig. Tears in this area are typically more likely to heal on their own. Your doctor will likely recommend physical therapy. Knee Surg & Relat Res 34, 35 (2022). 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://www.ncbi.nlm.nih.gov/pmc/articles/PMC7359983/, https://orthoinfo.aaos.org/en/recovery/knee-arthroscopy-exercise-guide/, https://orthoinfo.aaos.org/en/diseases--conditions/meniscus-tears/, https://www.ncbi.nlm.nih.gov/books/NBK431067/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5444079/, New clues to slow aging? Arthroscopic partial meniscectomy The goal of this Eur Radiol 30(7):39964004, Svensson F, Felson DT, Turkiewicz A, Guermazi A, Roemer FW, Neuman P et al (2019) Scrutinizing the cut-off for pathological meniscal body extrusion on knee MRI. Arthritis Care Res 68(10):15601566, Article ME is found in several knee pathologies and is well correlated with rapid knee OA progression as well as increased morbidity. If you have a 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. 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. Core tip:The healing potential of chronic degenerative menisci remains poor. Malays Orthop J 9(2):1720, Article Meniscal tear: Presentation, diagnosis and management. 2a), and found that postoperative ME was significantly reduced. More importantly, it leads to rapid progression of the degenerative process of the knee as well as substantial morbidity and pain [25,26,27,28]. An individual should seek guidance from a physical therapist about which exercises to perform to assist their healing. Lie on the back and bend both knees at a 10-degree angle. Therefore, improvements in surgical techniques are necessary [102, 109]. For a simple tear here, doctors may advise a short course of rest and physical therapy to see whether spontaneous healing occurs. 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. However, its posterior extrusion progressed significantly regardless of the healing status [90]. Osteoarthritis Cartilage 20(12):15071513, Bevers K, Bijlsma JW, Vriezekolk JE, van den Ende CH, den Broeder AA (2014) Ultrasonographic features in symptomatic osteoarthritis of the knee and relation with pain. The choice of treatment depends on several factors, including severity of Radiographics. Medial meniscal extrusion (MME) is measured 5.6mm. JBJS Rev 4(8):e4, Kodama Y, Furumatsu T, Masuda S, Okazaki Y, Kamatsuki Y, Okazaki Y et al (2020) Transtibial fixation for medial meniscus posterior root tear reduces posterior extrusion and physiological translation of the medial meniscus in middle-aged and elderly patients. All rights reserved. WebYour doctor will remove a piece of the torn meniscus so your knee can function normally. After ACLR, extrusion of the is more frequently seen than that of the LM. 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. 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. Meniscus tears can occur at any age. Surgery for degenerative meniscus tears is rarely necessary. Doctors may use additional clinical tests that assess range of motion in the knee from various positions. radial tear: perpendicular to both the tibial plateau and the long axis of the meniscus. volume34, Articlenumber:35 (2022) Arthrosc Tech 8(9):e941e946, Leafblad ND, Smith PA, Stuart MJ, Krych AJ (2021) Arthroscopic centralization of the extruded medial meniscus. PubMedGoogle Scholar. Google Scholar, Malas F, Kara M, Kaymak B, Aknc A, zakar L (2014) Ultrasonographic evaluation in symptomatic knee osteoarthritis: clinical and radiological correlation. This value is identified as the optimal cutoff point for a complete PRT of the LM and has 100% sensitivity and 83% specificity [92]. 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. Sudden twisting movements such as pivoting to catch a ball can tear the cartilage. There is no consensus whether medial or lateral MAT is superior in terms of medium-term (510years) and long-term (>10years) survival. 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. 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. X-rays are useful in finding other causes of knee pain, but they will not show a meniscus tear. 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? Am J Sports Med 42(2):327335, Shelbourne KD, Roberson TA, Gray T (2011) Long-term evaluation of posterior lateral meniscus root tears left in situ at the time of anterior cruciate ligament reconstruction. The rubbery wedges of cartilage act like shock absorbers for your knee, providing cushioning for your bones and knee joint. 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. 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. Depending on the size and location of your meniscus tear, it may heal without surgery. The authors declare that they have no competing interests. To address the problems of patients with meniscectomy, efforts are constantly being made to develop techniques that aim at meniscal regeneration or development of meniscal scaffolds. (2017). If you have surgery to repair a torn meniscus, your knee should be fully recovered after a few months of physical therapy. Knee Surg Sports Traumatol Arthrosc 24(5):14551468, Feucht MJ, Khle J, Bode G, Mehl J, Schmal H, Sdkamp NP et al (2015) Arthroscopic transtibial pullout repair for posterior medial meniscus root tears: a systematic review of clinical, radiographic, and second-look arthroscopic results. Some meniscus tears require surgery to heal the meniscus and restore the knees range of motion. 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. They will test your range of motion. 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]. Most people will need to perform exercises following surgery. [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. Several studies also argue that the presence of ME is predictive of knee OA progression [32,33,34]. A torn meniscus is a very common knee injury. That can increase your risk of other knee injuries like an ACL tear or other torn ligament. A person with a meniscus injury should consult a healthcare professional, such as a physical therapist, before starting an exercise program. 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. 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]. 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. Can I make a meniscus tear worse if I run on it? A novel technique has been developed based on a measurement grid in order to determine the precise aperture of the tibial tunnel. (2018). [42] found that in knees with the same grade of knee OA, extrusion of the medial meniscus was greater in patients who experienced pain in comparison with painless knee OA. 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]. Last medically reviewed on February 8, 2022, The knee is one of the body's more complicated joints and is susceptible to various injuries. 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. Correct estimation of the allograft size is also important. Perhaps even more important is that once your knee feels better, and it 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. Your doctor may also recommend conservative measures as a first step if the tear is caused by injury to the knee. When will I be able to get back to full activity? The inner two-thirds of the meniscus, however, lacks a blood supply. The goal of the anatomic reconstruction of the ACL rupture is to replicate the normal knee anatomy. 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. The early results of MAT are encouraging, as pain relief and improved knee function are reported [15,16,17, 62, 104,105,106,107,108,109]. (2012). Treatment of meniscal tears: An evidence based approach. However, evaluation by absolute value alone may be limited due to differences in implant size, bone and cartilage condition, and individual patient characteristics. During this procedure, the surgeon inserts a tiny camera (called an arthroscope) through a small incision into your knee. Our website services, content, and products are for informational purposes only. Being unable to fully bend or straighten your leg. Torn Meniscus | Meniscus Tear Treatment Options 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.
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