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. Without nutrients from blood, tears in this "white" zone cannot heal. if you have sudden pain from a knee injury. 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. Knee Surg Sports Traumatol Arthrosc 23(1):290302, Gelber PE, Torres-Claramunt R, Poggioli F, Prez-Prieto D, Monllau JC (2020) Polyurethane Meniscal Scaffold: Does Preoperative Remnant Meniscal Extrusion Have an Influence on Postoperative Extrusion and Knee Function? Following proper treatment and rehabilitation, people can typically resume their pre-injury activities. 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. CAS Prepatellar bursitis is a common complaint of people who work on their knees or who engage in activities that risk blows to the knee. Surgical versus conservative interventions for treating meniscal tears of the knee in adults. This condition may lead to increased cartilage degeneration, progressive OA and allograft failure, as mentioned in several biomechanical studies [17, 111]. Torn shoulder labrum: Causes, symptoms, and treatment National Institute of Arthritis and Musculoskeletal and Skin Diseases. 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]. Eur J Radiol 1(102):115124, Karpinski K, Diermeier T, Willinger L, Imhoff AB, Achtnich A, Petersen W (2019) No dynamic extrusion of the medial meniscus in ultrasound examination in patients with confirmed root tear lesion. A narrative review with focus on relevance for osteoarthritis research. 2. 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]. Become a Gold Supporter and see no third-party ads. (2018). Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. People who have surgery on these complex degenerative posterior horn tears are at higher risk of developing arthritis than those treated with surgery. By using this website, you agree to our Ice. Conservative treatment constitutes the first line of therapy in mild or moderate knee OA [46, 47]. Check for errors and try again. Surgery for degenerative meniscus tears is rarely necessary. Spang RC III, et al. These are the knee compression sleeves we recommend for stability during exercise. Also consult a doctor if you continue to have pain after a course of conservative treatment. As you get older, the cartilage in your knees wears down and gets weaker. 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. Note that meniscectomy may cause osteoarthritis in the long term. Effectiveness of an Ayurveda treatment approach in knee osteoarthritis A randomized controlled trial. Correspondence to (2016). Tears in this area are typically more likely to heal on their own. If the tear is too big to repair, your surgeon may remove all or part of the meniscus. The outer one-third of the meniscus has a blood supply, and so doctors refer to this area as the red zone. However, evaluation by absolute value alone may be limited due to differences in implant size, bone and cartilage condition, and individual patient characteristics. https://doi.org/10.1177/2325967120913531, Bhatia S, LaPrade CM, Ellman MB, LaPrade RF (2014) Meniscal root tears: significance, diagnosis, and treatment. ME is strongly correlated with posterior root tears of the menisci [6]. Although there is a need for longer follow-up periods, the currently available data suggest a benefit of concomitant ACLR with the repair of longitudinal, radial, posterior horn and posterior root tears of the menisci, because the combination can even better reduce their shape and extrusion [92, 98,99,100]. During this procedure, your doctor will remove the a Meniscotibial ligament repair with three interconnected suture anchors, b centralization with a transtibial tunnel or c with isolated suture anchors (usually with two or three suture anchors). Orthopaedics, University General Hospital of Alexandroupolis, St. Niarhos 1, Dragana, 68100, Alexandroupolis, Greece, Konstantinos G. Makiev,Ioannis S. Vasios&Paraskevas Georgoulas, Orthopaedics, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece, Konstantinos Tilkeridis,Georgios Drosos&Athanasios Ververidis, You can also search for this author in A tear in this "red" zone may heal on its own, or can often be repaired with surgery. 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. Alternatively, the surgeon may be able to modify the ACL reconstruction technique to decrease the risk of growth plate injury during surgery. 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. Arthritis Care Res 68(10):15601566, Article Lie on Intermediate routine. complex tear: a combination of all or some horizontal, vertical, and radial-type tears. Pathology. 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]. Where possible, doctors will recommend nonsurgical forms of treatment. 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. 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. This suggests that if patients with minimal degeneration and accurate indications undergo MAT with a well-placed graft, the graft extrusion will be minimal and the results will remain unchanged. Arthroscopic total meniscectomy. A persons initial exercise routine may include an exercise called hamstring contractions. However, to date there is still no well-designed clinical trial available to ascertain the effectiveness of centralization in reducing ME. A physical therapist will individualize a persons exercise regimen to prevent further injury. Exercises Initial routine. 2a), and found that postoperative ME was significantly reduced. 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]. Astur et al. 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]. statement and 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]. Finally, meniscal allografts often result in extrusion, thus potentially reducing the clinical benefits of transplantation. 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. It will also help stabilize your balance and help prevent another knee injury. California Privacy Statement, 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. To perform this exercise, a person should do the following: An intermediate exercise routine may include straight leg raises. Another successful strategy is osteophyte resection. If your injury doesnt improve with RICE, NSAIDs and physical Krych et al. Meniscal maceration | Radiology Reference Article This can provide pain relief for 2 to 4 weeks. 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. Try to rest your knee for a few days and keep pressure off it. Not all are severe, but some can last longer than others. Advertising on our site helps support our mission. 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]. This article outlines two types and their associated symptoms and causes. Zheng J, Zhai W, Li Q, Jia Q, Lin D. A Special Tear Pattern of Anterior Horn of the Lateral Meniscus: Macerated Tear. Pharmaceuticals 14(3):205, Raynauld JP, Pelletier JP, Abram F, Dodin P, Delorme P, Martel-Pelletier J (2016) Long-term effects of glucosamine and chondroitin sulfate on the progression of structural changes in knee osteoarthritis: six-year followup data from the osteoarthritis initiative. 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. 3. Furthermore, at 2-year follow-up, patients experienced significantly less pain, with improved clinical outcomes. Am J Sports Med 46(5):12431250, Noyes FR, Barber-Westin SD (2016) Long-term survivorship and function of meniscus transplantation. 3). However, its posterior extrusion progressed significantly regardless of the healing status [90]. Work up slowly to more intense exercise activity. 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. 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. 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. Most often, the meniscus tears during a sudden motion in which your knee twists while your foot stays planted on the ground. Reference article, Radiopaedia.org (Accessed on 01 May 2023) https://doi.org/10.53347/rID-70702. Orthopaedic knee surgeons use 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]. Knee Surg Sports Traumatol Arthrosc. Furthermore, Lee et al. After recovery, your knee will be more stable, and youll be less likely to develop additional knee problems. Other symptoms include: If your torn meniscus doesnt heal properly, your knee wont be as stable as it was before the injury. Slowly lower the body, keeping the foot flat. A hip labral tear can be caused by injury, structural problems, or degenerative issues. 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 Theres an inner (medial) meniscus and an outer (lateral) meniscus. 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. Meniscus Tear Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. 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. 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. The authors declare that they have no competing interests. Meniscal extrusion (ME) is a radiological finding, especially in magnetic resonance imaging (MRI) scans, for which there has been growing interest in recent years. WebYour doctor will remove a piece of the torn meniscus so your knee can function normally. Policy. {"url":"/signup-modal-props.json?lang=us"}, Weerakkody Y, Baba Y, Knipe H, Meniscal maceration. Most of the meniscus pathologies have recently been correlated with meniscal extrusion [3, 6]. Magnetic resonance imaging (MRI) is the method of choice for the detection and evaluation of ME (Fig. (ACLR+LM tears left in situ) showed narrowing of 0.33mm of the lateral joint space at 3years postoperatively, and Shelbourne et al. But you can reduce your risk of a torn meniscus if you: Most people who tear a meniscus can return to full activity. Experts say choosing between knee repair and knee reconstruction surgery isn't a simple decision.
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