(ACLR+LM tear repair) demonstrated that the narrowing was only 0.04mm at 3.4years postoperatively, whereas another study showed widening of 0.1mm at 3.5years postoperatively [85, 90]. Shiraev T, et al. Without nutrients from blood, tears in this "white" zone cannot heal. MPRT are defined as an avulsion fracture or a radial lesion occurring within 1cm of the bony tibial attachment [56]. 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. 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. 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. 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. Work up slowly to more intense exercise activity. We do not endorse non-Cleveland Clinic products or services. Meniscus tears are the most frequently treated knee injuries. Arthroscopy. 2023 Healthline Media UK Ltd, Brighton, UK. radial tear: perpendicular to both the tibial plateau and the long axis of the meniscus. WebOne of the main tests for meniscus tears is the McMurray test. It was also shown that after ACLR, without concomitant tears of the menisci, the anteroposterior and radial extrusion of the MM tended to increase compared with preoperative levels, but all measurements remained below the threshold value of 3mm [24, 44, 95]. When we talk about the meniscus, only about 30 % of the meniscus has an intact blood supply and is called the red zone. The remaining part of the meniscus does not have a blood supply and thus, once injured or torn, it cannot heal or be treated. So whether ayurvedic, homeopathic or allopathic medication, none of them can really help. PLoS One. You may also get imaging tests, such as X-rays or an MRI, to assess the damage. Feel like your knee locks up or might give way underneath you. 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. defined significant ME as when more than 25% of the meniscal body width extends beyond the tibial limit [14,15,16,17]. (ACLR+LM tears left in situ) showed narrowing of 0.33mm of the lateral joint space at 3years postoperatively, and Shelbourne et al. 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]. A systematic review of radiological outcomes. Putting ice on your knee for 10 to 15 minutes A true knee lock occurs when something in your knee joint gets stuck and. As you get older, the cartilage in your knees wears down and gets weaker. CAS Am J Sports Med 46(5):12431250, Noyes FR, Barber-Westin SD (2016) Long-term survivorship and function of meniscus transplantation. An MRI will confirm a suspected diagnosis. An individual should seek guidance from a physical therapist about which exercises to perform to assist their healing. During this procedure, the surgeon inserts a tiny camera (called an arthroscope) through a small incision into your knee. 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. Part of 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. (2017). Doctors may use additional clinical tests that assess range of motion in the knee from various positions. (2018). For a simple tear here, doctors may advise a short course of rest and physical therapy to see whether spontaneous healing occurs. taking pain medications. Terms and Conditions, 3. This is probably why capsulodesis is so effective in minimizing extrusion. Bhan, K. (2020). Many recent studies have shown that theres no advantage to surgery with this type of tear, and that physical therapy works just as well. Makiev, K.G., Vasios, I.S., Georgoulas, P. et al. Meniscal injury decreases their functional properties, resulting in degeneration of the knee joint [2]. Most people fully recover from a torn meniscus and can get back to doing their favorite activities without knee pain. The survival of the graft depends substantially on the condition of the articular cartilage [117,118,119]. 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]. Furthermore, Lee et al. Treatment for knee meniscus tears may involve: using the rest, ice, compression, and elevation (RICE) method. Pathology. 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. 2b, c) [78,79,80,81,82]. 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. The menisci are crescent-shaped, fibrocartilaginous structures located between femoral and tibial condyles, which are important for load transmission and distribution, shock absorption, secondary stability and proprioception of the knee joint [1]. A Meta-analysis Am J Sports Med 46(9):22852290, Smith NA, Parkinson B, Hutchinson CE, Costa ML, Spalding T (2016) Is meniscal allograft transplantation chondroprotective? Incidence and risk factors associated with meniscal injuries among active-duty US military service members. Privacy PolicyThe information on this site is not intended or implied to be medical advice, diagnosis, or treatment. Our website services, content, and products are for informational purposes only. Knee Surg & Relat Res 34, 35 (2022). 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? 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. We, Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. CAS However, evaluation by absolute value alone may be limited due to differences in implant size, bone and cartilage condition, and individual patient characteristics. 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. Over time, the joint can break down. Become a Gold Supporter and see no third-party ads. Exercises Initial routine. 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. Your doctor may give you a joint injection of glucocorticoids to reduce swelling. 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. Theres an inner (medial) meniscus and an outer (lateral) meniscus. 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 We also explore recovery and when to contact a doctor. [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. 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. 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. Kijima et al. Without surgery, recovery will take about 6 to 8 weeks, though this can vary. Surgery versus conservative treatment for meniscus tears has been a medical topic of controversy for many years. There are two main types of arthroscopic surgery for a meniscus tear: partial meniscectomy and meniscus repair. Knee arthroscopy, a minimally invasive procedure, is often used to treat meniscal tears. Your doctor will likely recommend physical therapy. A nonsurgical treatment approach typically involves rest and avoiding activities that trigger symptoms. 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. Lie on Intermediate routine. It can lead to pain, swelling, and a sensation of the knee giving way. 2021. https://link.springer.com/article/10.1007%2Fs00402-020-03683-1. 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. Jones JC, et al. When diagnosing a meniscus tear, a doctor will carry out a detailed medical history and a thorough examination of the knee joint. The diagnostic process starts with a medical history and a thorough examination that may include clinical tests. J Knee Surg. However, it is still controversial whether meniscal pathology leads to osteoarthritis (OA), or vice versa. 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 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. Am J Roentgenol 216(5):13181328, Teichtahl AJ, Cicuttini FM, Abram F, Wang Y, Pelletier JP, Dodin P et al (2017) Meniscal extrusion and bone marrow lesions are associated with incident and progressive knee osteoarthritis. https://doi.org/10.1186/s43019-022-00163-1, DOI: https://doi.org/10.1186/s43019-022-00163-1. A tear on the inner two-thirds of the meniscus that wont heal on its own because the area lacks blood flow to stimulate the immune system response. Am J Sports Med 40(7):15911596, Lee BS, Kim JM, Kim JM, Kim KA, Bin SI (2015) Patient-related risk factors for the extrusion of lateral meniscal allograft transplants. PubMed Meniscal tear: Presentation, diagnosis and management. All rights reserved. MPRT should be repaired earlier than 3months after diagnosis. It has been shown from studies that the risk for TKA after ACLR is seven timesgreater than in normal individuals [88]. 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]. Most often, the meniscus tears during a sudden motion in which your knee twists while your foot stays planted on the ground. Arthroscopy 36(4):11351141, Article 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. Google Scholar, Malas F, Kara M, Kaymak B, Aknc A, zakar L (2014) Ultrasonographic evaluation in symptomatic knee osteoarthritis: clinical and radiological correlation. The aim is to strengthen the muscles surrounding the knee, such as the front thigh muscles, known as the quadriceps. Slowly raise the extended leg 12 inches from the floor and then slowly lower it back. Diagnosis and management of meniscal injury. 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]. Moreover, extrusion of the LM does not improve after ACLR unless the meniscal tear is repaired [87, 92]. 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. 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. Alternatively, the surgeon may be able to modify the ACL reconstruction technique to decrease the risk of growth plate injury during surgery. Most research shows that people do just as well with physical therapy. More serious meniscus tears may not heal on their own. his post talks about the importance of balance training and strengthening-, Muscle mass.. or larger muscles are associated with longevity and better health. How can you tell whether you have a meniscus tear? Finally, meniscal allografts often result in extrusion, thus potentially reducing the clinical benefits of transplantation. These fibers specifically act on the LM anterior root attachment itself, explaining the reduction in the ultimate failure of the anterior root strength of the LM with disruption of these fibers [87, 93]. ME has no specific clinical finding or sign and it is encountered in many knee pathologies. Causes of the injury include trauma and degenerative changes to the knee joint. 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]. 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. All authors read and approved the final manuscript. Effectiveness of an Ayurveda treatment approach in knee osteoarthritis A randomized controlled trial. Antony B, Driban J, Price L et al. PubMed A tear can result from a trauma, such as twisting the leg, or age-related degeneration of the knee joint. Lie on the back and bend both knees at a 10-degree angle. 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 Arch Bone Jt Surg 6(4):250259, PubMed Treatment of meniscal tears: An evidence based approach. [31] showed that lateral ME was associated with worsening of patellofemoral joint OA features at 2-year follow-up. 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. 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]. A tear that gives you a lot of pain or impairs use of your knee may require surgery to remove or repair the torn part of the meniscus. 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. Meniscal tears: Current understanding, diagnosis, and management. 29(4):295301, Moon HS, Choi CH, Jung M, Lee DY, Hong SP, Kim SH (2020) Early surgical repair of medial meniscus posterior root tear minimizes the progression of meniscal extrusion: 2-year follow-up of clinical and radiographic parameters after arthroscopic transtibial pull-out repair. J Orthop Sci 24(1):121127, Chiba D, Sasaki E, Ota S, Maeda S, Sugiyama D, Nakaji S et al (2020) US detection of medial meniscus extrusion can predict the risk of developing radiographic knee osteoarthritis: a 5-year cohort study. Physical therapy generally leads to a good outcome. The medial meniscus covers 5060% of the medial tibial plateau, and the lateral meniscus covers 7080% of the lateral tibial plateau. Arthritis Care Res. The knee meniscus: Management of traumatic tears and degenerative lesions. Orthop J Sports Med. 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. Today, in general, doctors recommend conservative treatment, not surgery, when meniscus tears result from degeneration. 2014;34(4):981-99. [74] retrospectively analyzed MRI series with isolated ME without concomitant serious knee pathologies, and found that isolated significant ME (>3mm) was associated with MTL abnormalities. Meniscal extrusion (ME) is a radiological finding, especially in magnetic resonance imaging (MRI) scans, for which there has been growing interest in recent years. 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]. 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. In the days following your injury, you should also follow the RICE protocol. 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. People who tear a meniscus often feel like something has popped in their knee at the time of the injury. They may also share some exercises you can do at home.

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