Furthermore, Lee et al. And finally, the proper anatomical placement of the allograft is essential. (D) After the 2 suture limbs have been tied arthroscopically forming a circumferential compression stitch. Scientists use genetic rewiring to increase lifespan of cells, Beyond amyloid and tau: New targets in developing dementia treatments, Napping longer than 30 minutes linked to higher risk of obesity and high blood pressure, Activity 'snacks' could lower blood sugar, complication risk in type 1 diabetes, In Conversation: Investigating the power of music for dementia, Daniel Bubnis, M.S., NASM-CPT, NASE Level II-CSS, stability through preventing the knee from bending and straightening at extreme angles, having an occupation that requires frequent squatting or bending, inability to fully bend and straighten the knee. Goto et al. Being unable to fully bend or straighten your leg. Where possible, doctors will recommend nonsurgical forms of treatment. There is no established optimal surgical technique at present for restoring ME to normal values, and thus there will be a strong need for more effective and refined techniques. Knee arthroscopy, a minimally invasive procedure, is often used to treat meniscal tears. PLoS ONE 9(3):e92901, Article Therefore, the relative values may be significant [17]. Today, in general, doctors recommend conservative treatment, not surgery, when meniscus tears result from degeneration. Straighten the opposite knee using the muscles on the front of the thigh. Meniscal tear | Radiology Reference Article Unable to process the form. Persistent hoop and shear stresses create complex tears in the posterior horn and (2012). The mechanical damage of the meniscus caused by extrusion seems to change the loading-bearing capacity of the tibiofemoral compartments, leading to the destruction of the articular cartilage as well the subchondral bone, ultimately contributing to the development or progression of OA [87, 89, 92]. The diagnostic process starts with a medical history and a thorough examination that may include clinical tests. In the days following your injury, you should also follow the RICE protocol. If you have surgery to remove all or part of your meniscus, you may be at higher risk of developing arthritis down the road. J Orthop Res Off Publ Orthop Res Soc 36(7):18941900, Kodama Y, Furumatsu T, Miyazawa S, Fujii M, Tanaka T, Inoue H et al (2017) Location of the tibial tunnel aperture affects extrusion of the lateral meniscus following reconstruction of the anterior cruciate ligament. 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]. Treatment of meniscal tears: An evidence based approach. One way to reduce postoperative ME is by early intervention, specifically within 3months after the MPRT [70,71,72]. J Orthop Sci 25(4):640646. Furthermore, supplementary centralization of the meniscus appears to be able to adequately reduce the ME, as it also addresses potential MTL lesions. Jones JC, et al. Recovery time can be lengthy with either one. Strengthen the muscles that support and stabilize your knee. 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]. 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. 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-. 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. 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]. Moreover, it has been shown that allograft extrusion does not correlate with clinical outcomes and tends to be stable postoperatively during follow-up [62, 108, 113]. It usually results from twisting your knee suddenly. 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 2b, c) [78,79,80,81,82]. Note that meniscectomy may cause osteoarthritis in the long term. Finally, we provide a proposed treatment algorithm based on the information retrieved from the literature that could help guide clinicians in the management of ME on the aforementioned knee pathologies (Fig. 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. More serious meniscus tears may not heal on their own. Medial meniscal extrusion (MME) is measured 5.6mm. [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. At the time the article was created Yuranga Weerakkody had no recorded disclosures. Am J Sports Med 39(7):14391443, Katagiri H, Miyatake K, Nakagawa Y, Otabe K, Ohara T, Shioda M et al (2019) The effect of a longitudinal tear of the medial meniscus on medial meniscal extrusion in anterior cruciate ligament injury patients. Historically, MPRT were treated with partial meniscectomy. Arthrosc Tech 8(9):e941e946, Leafblad ND, Smith PA, Stuart MJ, Krych AJ (2021) Arthroscopic centralization of the extruded medial meniscus. {"url":"/signup-modal-props.json?lang=us"}, Weerakkody Y, Baba Y, Knipe H, Meniscal maceration. Am J Roentgenol 204(3):584588, Foreman SC, Liu Y, Nevitt MC, Neumann J, Joseph GB, Lane NE et al (2020) Meniscal root tears and extrusion are significantly associated with the development of accelerated knee osteoarthritis: data from the osteoarthritis initiative. Google Scholar, Ozeki N, Seil R, Krych AJ, Koga H (2021) Surgical treatment of complex meniscus tear and disease: state of the art. Arthroscopy 36(4):11351141, Article Other symptoms include: If your torn meniscus doesnt heal properly, your knee wont be as stable as it was before the injury. 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. Those that are caused by an injury are often the ones that can be, A meniscectomy is a procedure that repairs a torn meniscus. The lateral meniscus (LM) is a secondary stabilizer in the knee joint during pivot-shift loading [85]. MPRT should be repaired earlier than 3months after diagnosis. 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. Am J Sports Med 45(1):4249, Krych AJ, Bernard CD, Leland DP, Camp CL, Johnson AC, Finnoff JT et al (2020) Isolated meniscus extrusion associated with meniscotibial ligament abnormality. During this procedure, the surgeon inserts a tiny camera (called an arthroscope) through a small incision into your knee. Slowly raise the extended leg 12 inches from the floor and then slowly lower it back. California Privacy Statement, If your injury doesnt improve with RICE, NSAIDs and physical Factors that increase the risk of a meniscus tear include: Doctors classify meniscus tears according to their shape and location. You should call your healthcare provider if you: You may want to ask your healthcare provider: A torn meniscus is a very common knee injury. medial meniscal extrusion is associated with 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. A tear can result from a trauma, such as twisting the leg, or age-related degeneration of the knee joint. See additional information. Does a degenerative meniscus tear need surgery? After ACLR, extrusion of the is more frequently seen than that of the LM. treatment (2012). taking pain medications. 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. We avoid using tertiary references. 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]. Physical therapy generally leads to a good outcome. 2021. https://link.springer.com/article/10.1007%2Fs00402-020-03683-1. People who have surgery on these complex degenerative posterior horn tears are at higher risk of developing arthritis than those treated with surgery. (ACLR+LM tears left in situ) showed narrowing of 1.0mm at 10-year follow-up [96, 97]. Arch Bone Jt Surg 6(4):250259, PubMed The injury also commonly affects older people and those with arthritis in their knees. 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. People who play sports (like tennis, soccer, basketball or football) that involve sudden twisting movements are most likely to tear a meniscus. A torn or strained meniscus is generally treated with rest, ice, over-the-counter anti-inflammatory medicines and physical therapy. Medial and Lateral Meniscus Tears | Cedars-Sinai Arthritis Care Res 68(10):15601566, Article There is no consensus whether medial or lateral MAT is superior in terms of medium-term (510years) and long-term (>10years) survival. 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. (C) After the suture has been passed through the meniscus with free limbs su-perior and inferior to the meniscus tear. Healthline Media does not provide medical advice, diagnosis, or treatment. 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. Theres an inner (medial) meniscus and an outer (lateral) meniscus. (2018). 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. PubMed EFORT Open Rev 6(2):113117, Wang YX, Li ZL, Li J, Zhao ZD, Wang HR, Hou C et al (2019) Effect of medial meniscus extrusion on arthroscopic surgery outcome in the osteoarthritic knee associated with medial meniscus tear: a minimum 4-year follow-up. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. 2023 BioMed Central Ltd unless otherwise stated. What is a meniscus injury, and how common is it? Your doctor may give you a joint injection of glucocorticoids to reduce swelling. Moreover, instead of a single value, Miller et al. Lie on the back, with the unaffected knee bent. Results regarding the correlation of ME with pain in knee OA remain controversial. 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. The menisci can be torn or strained by any rotation or twisting motion that puts stress on the knee. Your doctor will bend your knee, then straighten and rotate it. Do I need surgery to repair or remove the torn meniscus? 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? 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. Reference article, Radiopaedia.org (Accessed on 01 May 2023) https://doi.org/10.53347/rID-70702. Meniscus tears can occur at any age. [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. 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 Modern treatment of meniscal tears. A threshold of 3mm, which was initially introduced, is most commonly used to define a significant ME [8]. Torn shoulder labrum: Causes, symptoms, and treatment Here's what you need to know as well as a chart. After recovery, your knee will be more stable, and youll be less likely to develop additional knee problems. Osteoarthritis Cartilage 26(7):912919, Roubille C, Martel-Pelletier J, Abram F, Dorais M, Delorme P, Raynauld JP et al (2015) Impact of disease treatments on the progression of knee osteoarthritis structural changes related to meniscal extrusion: data from the OAI progression cohort. Advertising on our site helps support our mission. Treatment with glucosamine, chondroitin sulfate and licofelone has 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. PubMed 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. Is the ketogenic diet right for autoimmune conditions? (2018). 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. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Meniscus Tear Privacy PolicyThe information on this site is not intended or implied to be medical advice, diagnosis, or treatment. The survival of the graft depends substantially on the condition of the articular cartilage [117,118,119]. Conservative treatment is recommended for tears associated with the wear and tear of age. Kneecap pain. J Knee Surg. 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]. 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. Malays Orthop J 9(2):1720, Article 2017;12(1):e0170710. Arthroscopy 32(7):13371345, Kim NK, Bin SI, Kim JM, Lee CR, Kim JH (2017) Meniscal extrusion does not progress during the midterm follow-up period after lateral meniscal transplantation. Koga et al. 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. Moreover, extrusion of the LM does not improve after ACLR unless the meniscal tear is repaired [87, 92]. 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. This article discusses what a meniscus injury is, including the different types of meniscus tears. J Orthop Surg 24(13):97. With a surgical treatment approach, exercises are necessary for recovery. 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. Therefore, improvements in surgical techniques are necessary [102, 109]. Interest in ME has grown exponentially in recent years, as it is associated with several pathologies, such as knee OA, meniscal posterior root tears (MPRT), post-anterior cruciate ligament reconstruction (ACLR) and post-meniscal allograft transplantation (MAT) [6, 23, 24]. Lie on the back and bend both knees at a 10-degree angle. 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. Many techniques have been described for meniscal transplantation, but the most commonly used are (a) the suture-only technique, (b) bone-plug technique, (c) keyhole technique and (d) bridge-in-slot technique [102, 104, 111]. Future research should focus on the role of additional centralization of the meniscus during arthroscopic debridement for the treatment of moderate knee OA. Depending on your symptoms, your doctor may recommend a special knee brace or other mechanisms to limit your joint movement and stabilize the knee.

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