PubMedGoogle Scholar. [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. (2012). 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. Chin Med J (Engl) 132(21):25502558, Goto N, Okazaki K, Akiyama T, Akasaki Y, Mizu-uchi H, Hamai S et al (2019) Alignment factors affecting the medial meniscus extrusion increases the risk of osteoarthritis development. Kneecap pain. Many recent studies have shown that theres no advantage to surgery with this type of tear, and that physical therapy works just as well. The knee meniscus: Management of traumatic tears and degenerative lesions. It is known that ACL and meniscal function cannot be fully restored even after surgical repair [86, 90]. 60 patients were performed arthroscopic meniscus repairs Osteoarthritis Cartilage 13(7):568574, Chan KKW, Sit RWS, Wu RWK, Ngai AHY (2014) Clinical, radiological and ultrasonographic findings related to knee pain in osteoarthritis. Int Orthop 43(11):25492556, Figueroa F, Figueroa D, Calvo R, Vaisman A, Espregueira-Mendes J (2019) Meniscus allograft transplantation: indications, techniques and outcomes. [39,40,41]. However, knowledge regarding the management of ME remains limited. Beaufils P, et al. An intermediate his post talks about the importance of balance training and strengthening-, Muscle mass.. or larger muscles are associated with longevity and better health. Usually you will be able to leave the hospital the same day. 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]. 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. Effectiveness of an Ayurveda treatment approach in knee osteoarthritis A randomized controlled trial. Although the ultimate cause is unknown, it is quite common to see a subluxated joint capsule in the symptomatic meniscectomized compartment. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 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? Your healthcare provider may recommend taking a nonsteroidal anti-inflammatory (NSAID) medicine (such as ibuprofen or aspirin) to relieve pain and reduce swelling. Arthroscopy 36(4):11351141, Article It is associated with either rapidly progressive knee osteoarthritis or early onset of knee osteoarthritis and increased morbidity. Medial meniscus posterior root tear: a comprehensive Work up slowly to more intense exercise activity. If you have surgery to repair a torn meniscus, your knee should be fully recovered after a few months of physical therapy. A tear in this "red" zone may heal on its own, or can often be repaired with surgery. 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. [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. Future research should focus on the role of additional centralization of the meniscus during arthroscopic debridement for the treatment of moderate knee OA. Consequently, partial meniscectomy is only utilized for symptomatic MPRT (catching/locking) when a root repair, due to excessive degenerative changes and poor quality of meniscal tissue, is contraindicated [61, 64]. Terms and Conditions, It can be hard to prevent an accidental injury. 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]. The tear frequently occurs while playing sports. It will also help stabilize your balance and help prevent another knee injury. 2a), and found that postoperative ME was significantly reduced. Generally speaking, the treatment options for meniscus tears include: rest, physical therapy, activity modification, and occasionally a surgery we refer to as an Arthroscopy. Magnetic resonance imaging (MRI) is the method of choice for the detection and evaluation of ME (Fig. We avoid using tertiary references. 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. occasionally a surgery we refer to as an arthroscopy. Knee Surg Relat Res. Conservative treatment is recommended for tears associated with the wear and tear of age. 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]. How can you tell whether you have a meniscus tear? Conservative treatment for some meniscus tears is well documented as effective. Without surgery, recovery will take about 6 to 8 weeks, though this can vary. Exercises Initial routine. At the time the article was last revised Yahya Baba had Knee Surg Sports Traumatol Arthrosc. A true knee lock occurs when something in your knee joint gets stuck and. Pathology. Hart et al. These are nonabsorbent [53], in a retrospective review of 131 patients who had undergone arthroscopic surgery for knee OA and were followed up for 4years, found that in regard to pain relief, arthroscopic surgery was also beneficial in patients with major MME (>3mm). This article outlines two types and their associated symptoms and causes. OrthoInfo from the American Academy of Orthopaedic Surgeons. 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. Therefore, the relative values may be significant [17]. Tsujii et al. 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. 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]. 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]. 3. Treatment of meniscal tears: An evidence based approach. Management of the MPRT consists of nonoperative treatment, partial meniscectomy and root repair, and primarily aims to prevent the development of OA [58]. What is a meniscus injury, and how common is it? You can learn more about how we ensure our content is accurate and current by reading our. Lie on the back, with the unaffected knee bent. A narrative review with focus on relevance for osteoarthritis research. Nevertheless, there is still controversy in the literature regarding the optimal threshold, as a few studies have proposed a value lower than 3mm [9, 10], whereas other researchers suggest that a cutoff value higher than 3mm is optimal [11,12,13]. For a simple tear here, doctors may advise a short course of rest and physical therapy to see whether spontaneous healing occurs. Debieux et al. 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, improvements in surgical techniques are necessary [102, 109]. CAS 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. maceration A persons initial exercise routine may include an exercise called hamstring contractions. (C) After the suture has been passed through the meniscus with free limbs su-perior and inferior to the meniscus tear. Proposed treatment algorithm for meniscal extrusion (ME) in different knee pathologies (OA osteoarthritis, ME meniscal extrusion, HTO high tibial osteotomy, MPRTs meniscal posterior root tears, ACL anterior cruciate ligament reconstruction, LM lateral meniscus, PRT posterior root tear, MAT meniscal allograft transplantation), Krych AJ, Bernard CD, Kennedy NI, Tagliero AJ, Camp CL, Levy BA et al (2020) Medial versus lateral meniscus root tears: is there a difference in injury presentation, treatment decisions, and surgical repair outcomes? 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]. Most authors agree that the transplanted menisci are extruded more frequently than endogenous menisci [15, 102, 105]. A physical therapist will individualize a persons exercise regimen to prevent further injury. During the meniscus surgery, a small instrument called an arthroscope, which has a camera at its tip, is inserted into your knee. There is no consensus whether medial or lateral MAT is superior in terms of medium-term (510years) and long-term (>10years) survival. extrusion Arch Orthop Trauma Surg 132(3):321327, Kamatsuki Y, Furumatsu T, Fujii M, Kodama Y, Miyazawa S, Hino T et al (2018) Complete tear of the lateral meniscus posterior root is associated with meniscal extrusion in anterior cruciate ligament deficient knees. 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. Meniscus Tear Repair Surgery: What To Expect treatment However, it remains unknown whether it is capable of delaying or modifying OA progression, and further research is warranted [32, 48, 49]. Post-ACLR ME is also a concern and should be prevented by repairing concurrent meniscal tears and centralizing the meniscus along with the ACLR. Slowly raise the extended leg 12 inches from the floor and then slowly lower it back. Arthrosc Tech 8(9):e941e946, Leafblad ND, Smith PA, Stuart MJ, Krych AJ (2021) Arthroscopic centralization of the extruded medial meniscus. 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. Krych et al. 1. The inner two-thirds of the meniscus, however, lacks a blood supply. By using this website, you agree to our [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. 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. Perhaps even more important is that once your knee feels better, and it If your symptoms persist after 3 months or your symptoms become significant, your doctor may recommend surgery to repair the tear. 2. Hold the position for 5 seconds and then relax. Osteoarthritis Cartilage 27(11):15781589, Primorac D, Molnar V, Matii V, Hudetz D, Jele , Rod E et al (2021) Comprehensive review of knee osteoarthritis pharmacological treatment and the latest professional societies guidelines. Arthritis Care Res. However, its posterior extrusion progressed significantly regardless of the healing status [90]. Physical therapy generally leads to a good outcome. PubMed Central 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. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Meniscus Tears Why Surgery Isnt Always Necessary, Batters Shoulder : Posterior Labral Tears, Runners require strength too: What to do and when to do it, Lactate, the lactate shuttle, and lactate threshold workouts in polarized training, Zone 2 Heart Rate Training For Longevity and Performance, Pain In The Front Of The Knee: 6 Common Causes, Sometimes our joints just hurt, and its ok not to know why. Pull both heels into the floor while tightening the muscles on the backs of the thighs. 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 The menisci are pads of cartilage in the knee joint. volume34, Articlenumber:35 (2022) Therefore, care should be taken to manage it appropriately and successfully reduce it. Get useful, helpful and relevant health + wellness information, 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://www.merckmanuals.com/home/injuries-and-poisoning/sprains-and-other-soft-tissue-injuries/knee-sprains-and-related-injuries), (https://www.niams.nih.gov/health-topics/knee-problems#tab-overview), (https://orthoinfo.aaos.org/en/treatment/knee-arthroscopy/), (https://orthoinfo.aaos.org/en/diseases--conditions/meniscus-tears/), (https://www.physio-pedia.com/Meniscal_Repair). The knee is a complex synovial joint that can be affected by a range of pathologies: ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. In a biomechanical study, Paletta et at. 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. During this procedure, the surgeon inserts a tiny camera (called an arthroscope) through a small incision into your knee. If your injury doesnt improve with RICE, NSAIDs and physical 6 Types of Meniscus Tears and How Their Treatment Depending on your symptoms, your doctor may recommend a special knee brace or other mechanisms to limit your joint movement and stabilize the knee. 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. First, surgery is rarely necessary for degenerative meniscus tears. Int J Rheum Dis 17(5):536540, PubMed 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. Two pieces of cartilage sit inside your knee, between your thighbone (femur) and shinbone (tibia). 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. 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. Wear athletic shoes that are appropriate for the sport youre doing. Meniscal injury decreases their functional properties, resulting in degeneration of the knee joint [2]. An inappropriate tibial tunnel may also cause extrusion of the LM. 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? Mordecai SC, et al. Your doctor will bend your knee, then straighten and rotate it. J Orthop Surg 24(13):97. Clinical significance and management of meniscal extrusion in different knee pathologies: a comprehensive review of the literature and treatment algorithm. Most people fully recover from a torn meniscus and can get back to doing their favorite activities without knee pain. WebIs knee surgery necessary to repair a torn meniscus? Knee Surg Relat Res. 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. This condition may lead to increased cartilage degeneration, progressive OA and allograft failure, as mentioned in several biomechanical studies [17, 111]. Cant fully bend or straighten your leg without knee pain. PubMed 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. 2023 Healthline Media LLC. Younger people, especially athletes, are likely to have a sudden meniscus injury. Orthop Traumatol Surg Res 105(7):13951399, Everhart JS, Magnussen RA, Abouljoud MM, Regalado LE, Kaeding CC, Flanigan DC (2020) Meniscus tears accelerate joint space loss and lateral meniscal extrusion increases risk of knee arthroplasty in middle-aged adults. Several other techniques of meniscal centralization with suture anchors as well as with transtibial tunnel, with or without prior meniscal release from its capsular attachments, have also been described in technical notes (Fig. Correct estimation of the allograft size is also important. Meniscus Tears - OrthoInfo - AAOS A more posterolateral placement of the tibial tunnel aperture may induce extrusion of the LM following ACLR. Clin Rheumatol 36(11):25572564, Kim JY, Bin SI, Kim JM, Lee BS, Oh SM, Park MH (2019) Tear gap and severity of osteoarthritis are associated with meniscal extrusion in degenerative medial meniscus posterior root tears. Over time, the joint can break down. Meniscal allograft extrusion causes incongruity with the femoral condyle, and therefore the allograft cannot perform normal load transmission and shock absorption. Google Scholar, Ozeki N, Seil R, Krych AJ, Koga H (2021) Surgical treatment of complex meniscus tear and disease: state of the art. Furthermore, supplementary centralization of the meniscus appears to be able to adequately reduce the ME, as it also addresses potential MTL lesions. There are two main types of arthroscopic surgery for a meniscus tear: partial meniscectomy and meniscus repair. Zheng J, Zhai W, Li Q, Jia Q, Lin D. A Special Tear Pattern of Anterior Horn of the Lateral Meniscus: Macerated Tear. Complex tears usually require surgery to trim the damaged part of the meniscus. Treatment usually starts with the RICE method: Rest. Another successful strategy is osteophyte resection. People who tear a meniscus often feel like something has popped in their knee at the time of the injury. Arthritis (a breakdown of cartilage in the joints) can also lead to a meniscus tear. Am J Sports Med 48(2):326333, Patel R, Eltgroth M, Souza RB, Zhang CA, Majumdar S, Link TM et al (2016) Loaded versus unloaded magnetic resonance imaging (MRI) of the knee: Effect on meniscus extrusion in healthy volunteers and patients with osteoarthritis. Therefore, ultrasound (U/S) was recently introduced as a reliable alternative to MRI for the evaluation of ME, which also offers the possibility for dynamically assessing ME in various positions, as well as in a weight-bearing state, in an inexpensive and feasible manner [20,21,22]. WebOne of the main tests for meniscus tears is the McMurray test. Antony B, Driban J, Price L et al. 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? [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. Although it has never been reported, it is worth researching, as it could have a beneficial effect. VA conceived the idea for the study and supervised the whole study process. https://doi.org/10.1177/2325967120913531, Bhatia S, LaPrade CM, Ellman MB, LaPrade RF (2014) Meniscal root tears: significance, diagnosis, and treatment. A torn or strained meniscus is generally treated with rest, ice, over-the-counter anti-inflammatory medicines and physical therapy. Recovery after a meniscectomy takes 36 weeks, and recovery after a meniscus repair takes 36 months. 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. If these measures do not alleviate a persons symptoms, doctors may recommend surgical options, such as a partial meniscectomy or a meniscus repair. 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 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. Straighten the opposite knee using the muscles on the front of the thigh. However, more research with high-quality studies is needed in order to refine the technique and validate its long-term results in reducing ME. 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-. [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.
