Tears in this area are typically more likely to heal on their own. PubMed If the tear is too big to repair, your surgeon may remove all or part of the meniscus. Last medically reviewed on February 8, 2022, The knee is one of the body's more complicated joints and is susceptible to various injuries. 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]. An intermediate (ACLR+LM tears left in situ) showed narrowing of 0.33mm of the lateral joint space at 3years postoperatively, and Shelbourne et al. This post will carry two messages, both equally important. Note that meniscectomy may cause osteoarthritis in the long term. 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. The menisci are crescent-shaped, fibrocartilaginous structures that play a crucial role in the load transition and distribution of the contact forces along the tibiofemoral articulation. At the time the article was created Yuranga Weerakkody had no recorded disclosures. A hip labral tear is an injury to the labrum, the soft tissue that covers the acetabulum (socket) of the hip. 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. WebThe outside one-third of the meniscus has a rich blood supply. A nonsurgical treatment approach typically involves rest and avoiding activities that trigger symptoms. Several strategies have been proposed to reduce allograft extrusion. complex tear: a combination of all or some horizontal, vertical, and radial-type tears. 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. RICE stands for rest, ice, compression and elevation. A torn or strained meniscus is generally treated with rest, ice, over-the-counter anti-inflammatory medicines and physical therapy. Most people will need to perform exercises following surgery. A more posterolateral placement of the tibial tunnel aperture may induce extrusion of the LM following ACLR. root tear: typically radial-type tear located at the meniscal root. Meniscus tears are the most frequently treated knee injuries. 2023 Healthline Media LLC. Skeletal Radiol 26(7):424427, Article Kneecap pain. 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]. 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]. Conservative treatment for some meniscus tears is well documented as effective. Knee Surg Sports Traumatol Arthrosc 27(8):26172623, Astur DC, Novaretti JV, Gomes ML, Rodrigues AG, Kaleka CC, Cavalcante ELB et al (2020) Medial opening wedge high tibial osteotomy decreases medial meniscal extrusion and improves clinical outcomes and return to activity. 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. 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. 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]. Lie on the back, with the unaffected knee bent. The menisci play an important role in stabilizing the knee, easing movement of the knee joint, and absorbing shock from walking and other weight bearing activities. A small 2018 randomized controlled study comparing conventional to Ayurvedic treatment in 151 people found that Ayurvedic treatments were beneficial in reducing osteoarthritis knee symptoms at 3, 6, and 12 months. {"url":"/signup-modal-props.json?lang=us"}, Weerakkody Y, Baba Y, Knipe H, Meniscal maceration. The goal of the anatomic reconstruction of the ACL rupture is to replicate the normal knee anatomy. Improper positioning of the posterior horn causes a similar deviation to the anterior horn. Am J Sports Med 38(8):15421548, Yanagisawa S, Kimura M, Hagiwara K, Ogoshi A (2020) Association between postoperative meniscal extrusion and clinical outcomes of the pullout fixation technique for medial meniscus posterior root tear. Arthritis (a breakdown of cartilage in the joints) can also lead to a meniscus tear. 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. 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. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. 3). 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? Goto et al. 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. A tear can result from a trauma, such as twisting the leg, or age-related degeneration of the knee joint. 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). If your symptoms persist after 3 months or your symptoms become significant, your doctor may recommend surgery to repair the tear. Treatment usually starts with the RICE method: Rest. A physical therapist can provide a daily routine of exercises and stretches to improve your muscle strength, flexibility, range of motion, and stability. One way to reduce postoperative ME is by early intervention, specifically within 3months after the MPRT [70,71,72]. Meniscus Wang et al. The inner two-thirds of the meniscus, however, lacks a blood supply. Some clinical studies on its effectiveness exist, but more research is needed. https://doi.org/10.1002/acr.24394, Wu PT, Shao CJ, Wu KC, Wu TT, Chern TC, Kuo LC et al (2012) Pain in patients with equal radiographic grades of osteoarthritis in both knees: the value of gray scale ultrasound. This can result from disruption of collagen fibers within the meniscus that provide hoop strength 8.. Results regarding the correlation of ME with pain in knee OA remain controversial. 3. J Knee Surg. Home treatment, If you've been sidelined by a common sports injury like an ACL tear, you're likely wondering how long it will take to heal. 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. The outer one-third of the meniscus has a blood supply, and so doctors refer to this area as the red zone. Clinical significance and management of meniscal extrusion in different knee pathologies: a comprehensive review of the literature and treatment algorithm. This puts tension on a torn meniscus. But you can reduce your risk of a torn meniscus if you: Most people who tear a meniscus can return to full activity. Root repair is indicated when varus malalignment is minimal (<5), the cartilage wear is not advanced (Outerbridge grade 12) and it can be performed arthroscopically either with a transtibial pullout technique or with suture anchors, each with its respective advantages and disadvantages [58]. In a biomechanical study, Paletta et at. Nguyen J, De Smet A, Graf B, Rosas H. MR Imaging-Based Diagnosis and Classification of Meniscal Tears. CAS Rheumatol Oxf Engl 53(9):16251629, Podlipsk J, Koski JM, Kaukinen P, Haapea M, Tervonen O, Arokoski JP et al (2017) Structure-symptom relationship with wide-area ultrasound scanning of knee osteoarthritis. Meniscus tears are very common. It also outlines symptoms, diagnosis, and treatment and provides information on when to contact a doctor. J Knee Surg. The menisci can be torn or strained by any rotation or twisting motion that puts stress on the knee. It usually results from twisting your knee suddenly. In addition, when there is ACL rupture and the preoperative extrusion of the LM is 1.1mm, the surgeon should consider the possibility of a complete posterior root tear (PRT) of the LM. That can increase your risk of other knee injuries like an ACL tear or other torn ligament. Knee Surg Sports Traumatol Arthrosc. There is no consensus whether medial or lateral MAT is superior in terms of medium-term (510years) and long-term (>10years) survival. Surgery versus conservative treatment for meniscus tears has been a medical topic of controversy for many years. Unable to process the form. J ISAKOS 6(1):3545, Beaufils P, Becker R, Kopf S, Englund M, Verdonk R, Ollivier M et al (2017) Surgical management of degenerative meniscus lesions: the 2016 ESSKA meniscus consensus. Also consult a doctor if you continue to have pain after a course of conservative treatment. On the contrary, traumatic tears usually involve the lateral meniscus after an acute traumatic episode with concomitant ligamentous injury, especially anterior cruciate ligament tear, in younger patients [5]. We avoid using tertiary references. Here's what to expect from. Am J Sports Med 45(4):900908, Yoon JR, Kim TS, Lee YM, Jang HW, Kim YC, Yang JH (2011) Transpatellar approach in lateral meniscal allograft transplantation using the keyhole method: can we prevent graft extrusion? 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 Int Orthop 43(11):25492556, Figueroa F, Figueroa D, Calvo R, Vaisman A, Espregueira-Mendes J (2019) Meniscus allograft transplantation: indications, techniques and outcomes. Strengthen the muscles that support and stabilize your knee. volume34, Articlenumber:35 (2022) Knee Surgery & Related Research If you have a if you have sudden pain from a knee injury. 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. All rights reserved. Small tears often heal on their own, while others may require arthroscopic surgery. Privacy PolicyThe information on this site is not intended or implied to be medical advice, diagnosis, or treatment. It can lead to pain, swelling, and a sensation of the knee giving way. Meniscal tear: Presentation, diagnosis and management. 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]. A torn meniscus is a very common knee injury. 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. According to the American Academy of Orthopaedic Surgeons, treatment of a meniscus tear depends on the location of the injury, alongside other factors, including a persons: Below, we outline some potential treatment options. Semin Arthritis Rheum 46(5):552561, LaPrade RF, LaPrade CM, James EW (2015) Recent advances in posterior meniscal root repair techniques. occasionally a surgery we refer to as an arthroscopy. Cleveland Clinic is a non-profit academic medical center. However, it remains unknown whether it is capable of delaying or modifying OA progression, and further research is warranted [32, 48, 49]. Work up slowly to more intense exercise activity. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If these measures do not alleviate a persons symptoms, doctors may recommend surgical options, such as a partial meniscectomy or a meniscus repair. 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. A longitudinal tear is an example of this kind of tear. 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. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The above part of the examination does not always lead to a diagnosis. Whilst APM is one of the most commonly performed orthopaedic procedures [], meniscal repair is the treatment of choice for the young athlete with an acute meniscal tear [].Meniscal repair is most commonly performed in younger populations aged under 35 years [10, 2127] and aims to preserve the entire meniscus, without excision.The WebDamage to the medial meniscus root, for example by a complete radial tear, destroys the ability of the knee to withstand hoop strain, resulting in contact pressure increases and kinematic alterations. It has been suggested that a 510% reduction of implant size from the estimated one reduces postoperative extrusion [2, 105, 123]. If the repaired meniscus failed to heal, lateral extrusion progressed significantly [92]. CAS (2018). Not all are severe, but some can last longer than others. In some cases, surgery may be recommended to repair a torn meniscus. Brignardello-Petersen R, et al. Clin Anat N Y N 28(6):792799, Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA et al (2019) OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Theres an inner (medial) meniscus and an outer (lateral) meniscus. 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. Meniscal tears: Current understanding, diagnosis, and management. Older people are likely to have meniscus damage related to degeneration from wear-and-tear. Dawson LJ, et al. The authors did not receive funding for this study. Your doctor may give you a joint injection of glucocorticoids to reduce swelling. Eur J Orthop Surg Traumatol 28(4):727734, Chernchujit B, Agrawal S (2019) Arthroscopic all-inside medial meniscus extrusion reduction. The ACL is the main restrictor in the anterior tibial translation, while the posterior part of the medial meniscus (MM) acts as a secondary stabilizer [83, 84]. 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]. The diagnostic process starts with a medical history and a thorough examination that may include clinical tests. Am J Sports Med 45(8):18641871, Novaretti JV, Astur DC, Cavalcante ELB, Kaleka CC, Amaro JT, Cohen M (2020) Preoperative meniscal extrusion predicts unsatisfactory clinical outcomes and progression of osteoarthritis after isolated partial medial meniscectomy: a 5-year follow-up study. 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 46(5):12431250, Noyes FR, Barber-Westin SD (2016) Long-term survivorship and function of meniscus transplantation. However, to date there is still no well-designed clinical trial available to ascertain the effectiveness of centralization in reducing ME. 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. If your injury doesnt improve with RICE, NSAIDs and physical Doral MN, et al. Over time, the joint can break down. Treatment for knee meniscus tears may involve: using the rest, ice, compression, and elevation (RICE) method. 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. This site should be used for informational purposes only. 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. Knee 24(6):14081413, Phua JKS, Razak HRBA, Mitra AK (2020) Arthroscopic procedures could delay the need for a subsequent knee arthroplasty in older patients with end-stage osteoarthritis. Knee 23(4):627630, Ishii Y, Ishikawa M, Kurumadani H, Hayashi S, Nakamae A, Nakasa T et al (2020) Increase in medial meniscal extrusion in the weight-bearing position observed on ultrasonography correlates with lateral thrust in early-stage knee osteoarthritis. Arthritis Care Res 68(10):15601566, Article Lie on Intermediate routine. Degenerative lesions of the knee joint are more commonly present during concurrent ACLR with meniscectomy than with intact or repaired menisci. By using this website, you agree to our Effectiveness of an Ayurveda treatment approach in knee osteoarthritis A randomized controlled trial. Meniscus tears are a very common knee injury, especially among athletes. Does a degenerative meniscus tear need surgery? Feeling like your knee might give out beneath you. Younger people, especially athletes, are likely to have a sudden meniscus injury. After healing occurs, a doctor will recommend a rehabilitation program of exercises to improve range of motion and strength. Can I make a meniscus tear worse if I run on it? 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]. 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. Orthop J Sports Med 4(8):2325967116663185, Van Der Straeten C, Byttebier P, Eeckhoudt A, Victor J (2016) Meniscal allograft transplantation does not prevent or delay progression of knee osteoarthritis. 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. Reference article, Radiopaedia.org (Accessed on 01 May 2023) https://doi.org/10.53347/rID-70702. 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]. Conservative treatment is recommended for tears associated with the wear and tear of age. an assessment by MRI and arthroscopy. Sometimes, degeneration from arthritis causes a tear, even without a knee injury.