A partial or total tear of a meniscus may occur when a person quickly twists or rotates the upper leg while the foot stays planted. It is much less common to damage your articular cartilage than it is to damage your meniscal cartilage a meniscal tear. Rehabilitation exercises a meniscus tear is a common knee joint injury. Some clues that can help identify the source of pain are the mechanism of injury, radiographic findings consistent with osteoarthritis, and patient demographics. Managing atraumatic meniscal tears in middleaged patients. When people talk about torn cartilage in the knee, they are usually referring to a torn meniscus. Meniscal tear patterns image courtesy of michaela procaccini. The mri is not perfect in diagnosing a meniscal tear. Treatment of a torn meniscus may include observation and physical therapy with muscle strengthening to stabilize the knee joint. It is also common for the meniscus to be damaged in association with injuries to the anterior cruciate ligament. Mr imagingbased diagnosis and classification of meniscal tears. Background the relationship between meniscal tears and other joint pathologies with patient reported symptoms is not clear. There are different types of meniscal tears, describing the morphology of the injury.
Patient guide to meniscus injuries what is the meniscus. Work with your doctor to plan a rehabilitation rehab program that helps you regain as much. A meniscal tear occurs in 2 primary planes, vertical and horizontal. Clinical outcomes of insideout meniscal repair according to. Pain and swelling are the most common signs of an injury to your meniscus. Meniscal injuries can be the result of a forceful, twisting event in a young athletes knee or it can insid iously present in the older patient. If the meniscal tear is causing pain and problems, arthroscopy to treat the meniscal tear may be indicated. The majority of traumatic meniscal tears in young athletes should be treated with attempted surgical repair. Examiner flexes the hip and, with one hand on the joint line, rotates the foot internally and externally. Consequently, menisci can tear due to traumatic injury or degenerative wear e. As we age, this cartilage begins to lose elasticity and can easily be torn without any type of trauma.
Your physiotherapist has diagnosed you with a degenerative meniscal tear. Pdf medial and lateral knee joint menisci serve to transfer load and absorb shock, aid joint stability and provide lubrication. Rehabilitation guidelines for meniscal repair uw health. Objective meniscal tears occur frequently in the population and the most common surgical treatment, arthroscopic partial meniscectomy, is performed in approximately two million cases worldwide each year. They can occur in isolation or with associated injuries to knee ligaments, and often. How serious the injury is depends on how much is torn and the exact site of the tear. In fact,16%ofasymptomaticpatientshave meniscal tears demonstrated on magneticresonanceimagingmriwiththe incidence increasing to 36% for patients older than 45 years. To identify individuals who likely have meniscal pathology based on specific characteristics and examination findings.
Usually, surgical treatment of the bakers cyst in this setting is not necessary. Evaluating acutely injured patients for internal derangement. Nonsurgical treatment of meniscal tears initial treatment of a tear usually focuses on controlling inflammation and pain. Diagnosis and management of meniscal injury rhode island. Sudden meniscus tears often happen during a twisting injury or direct blow to the. Does this patient have a torn meniscus or ligament of the knee.
Posterior horn to lateral aspect of medial femoral condyle. Article pdf available in australian family physician 414. Injuries to the menisci are one of the most common knee injuries. Com meniscal cartilage tear top view femur thighbone tibia shinbone medical meniscus front view of knee lateral meniscus torn what are the symptoms. For some adults, a knee meniscal tear may be associated and cause a bakers cyst. This is typically performed with arthroscopic andor miniopen surgical techniques. Feb 01, 2012 a combination of historical features and examination findings will help alert physicians to the possibility of meniscal tear more than the results of any one test. Anatomic variants and pitfalls that can mimic a tear include discoid meniscus, meniscal flounce, a meniscal ossicle, and chondrocalcinosis. The meniscus is cartilage, which acts as a shockabsorbing structure in the knee. Meniscus injuries introduction every joint in the body is lined by extremely smooth tissue called articular cartilage. The knee is commonly injured in sports, especially rugby, football and skiing.
Treatment of meniscal tear annals of internal medicine. Therefore, its result must be correlated with a patients history and exam. Meniscal tears can occur when the knee is forcefully twisted, sustains a direct blow, deep squatting or during activities that require changing directions. Both clinically positive meniscal tear and mri positive tear were present in 37. This smooth cartilage allows the surfaces of your knee joint move without friction. We investigated associations between structural knee pathologies identified at surgery with preoperative knee pain and function in patients undergoing arthroscopic meniscal surgery. Knee cartilage injuries including meniscal tears patient. If you have any questions, please speak to your physiotherapist.
Jul 25, 2019 therefore, tear extension into the avascular zone is not a contraindication for repair, particularly in the young and active patient, because of the clinical benefits of meniscal preservation. You may tear a meniscus by a forceful knee movement. The findings suggest that the location and meniscal tear, rather than the age of the patient, determine the potential for successful repair. Methods this study included 443 patients from the knee arthroscopy cohort southern denmark. The menisci act as shock absorbers in the knee, and provide stability to the joint. Meniscal tears can occur in isolation or in combination with a ligamentous injury. In the previously published meteor study nejm jw gen med may 1 20 and n engl j med 20. An mri may be used to assist in making the diagnosis. Delayed, gadoliniumenhanced mri of cartilage dgemric is useful for assessing cartilage health. Therefore, its result must be correlated with a patient s history and exam.
Intenttotreat analyses showed that physical function and pain improved equally in. Occasionally a patient may be able to regain function through rehabilitation without surgery. Knee injuries are fairly common problems, not just in athletes. Clinical meniscal tear was positive in 41 82% patient while mri meniscal tear positive was present in 44 88%. Wild goose chase no predictable patient subgroups benefit from meniscal surgery. Dec 12, 2017 in some cases a tear develops due to repeated small injuries to the cartilage or to wear and tear degeneration of the meniscal cartilage in older people. When conservative measures are ineffective treatment may include surgery to repair or remove the damaged cartilage. Meniscal tears and other knee cartilage injuries patient.
Selfreduction of displaced buckethandle medial meniscal. Meniscus healing depends on many factors including tear type, tissue quality and mobility, proximity to the surrounding blood supply, patient factors. Symptoms of a torn meniscus include knee pain, swelling, popping, and giving way. If an athlete suffers a meniscal tear, the three options for treatment include. The meniscus is a cshaped piece of cartilage in the knee that cushions and acts as a shock absorber between your thigh. Meniscal tears are common, and surgery to treat meniscal tears is one of the most frequently performed orthopaedic procedures. The mean annual incidence of meniscal tears is about 6070 per 100,000. This test has low sensitivity and high specificity for diagnosing a meniscal tear. The meniscus in the knee is usually damaged by a twist occurring on a slightly flexed knee. The need to consider factors such as age, functional limitations, and type of meniscal tear in treatment of these injuries in elderly patients is demonstrated by this case. It is important to know the difference between these two types of injuries, because the way we treat them.
Meniscal tears in younger people are usually due to acute trauma, most commonly affecting men aged 2 years and girls and young women aged 1120 years. In this report, we examine the case of an uncommon presentation of a buckethandle medial meniscus tear in a 71yearold patient. The meniscus is a wedge shaped cartilage ring found on both the inside and outside of the knee between the femur thigh bone and tibia shin bone. Rehabilitation guidelines for meniscal repair of root and. Symptoms of a degenerative meniscus tear include swelling, pain along the joint line, catching and locking. Sports injury medicine department 9250 sw hall blvd. Symptoms include pain with bending and twisting on your knee, and sometimes pain at night.
Most often degenerative tears are surgically removed. Patient has an mri that shows a medial meniscus tear. How well the knee will heal and whether surgery will be needed depends in large part on the type of tear see figure in appendix and how bad the tear is. Four authors of this guideline revision completed the appraisal of guidelines for research and evaluation agree ii tool to assess the quality and reporting of the cpg published in. Because of this, it is less prone to tears than the medial meniscus just because it is. History of catching or locking reported by the patient. Meniscal tear incidence may be as high as six per population 6 with a 2.
Feb 01, 2017 incidental meniscal findings on mri scan of the knee are common in the general population and increase with increasing age. Meniscal tears may also occur without a sudden severe injury. Racgp meniscal tear presentation, diagnosis and management. Apr 24, 2020 the clinical diagnosis of meniscal tear is not easy. Often people with meniscal tears complain of stiffness within the joint. Oct 18, 2016 first, although apm is a risk factor for osteoarthritis progression, meniscal damage is a risk factor, as well 1. If you do injure your articular cartilage, it is very likely that you have also injured another part of your knee at the same time, such as one of the ligaments or your meniscus. In severe injuries, other parts of the knee may also be damaged in addition to a meniscal tear. There are two menisci in each knee, a medial one on the inside, and a lateral one on the outside.
Reliability of two clinical meniscal tests and magnetic resonance imaging. This booklet gives information on the different types of meniscus problems, the evidencebased management options, and how physiotherapy can help. In the second herrlin study, a prospective randomized study involving 96 middleaged patients with an mriverified medial meniscal tear and radiographic oa, the authors concluded that arthroscopic surgery followed by exercise therapy was not superior to the same exercise therapy alone. Patientreported outcome measures for patients with meniscal. When a meniscal tear is identified, accurate description and classification of the tear pattern can guide the referring clinician in patient education and surgical planning. Meniscus tears are among the most common knee injuries.
There are different types of tears depending on the location and how they look. The symptoms that you get from any other injury may be more noticeable than the symptoms that. The medial meniscus is semicircular in shape and the lateral meniscus is almost a. In older athletes, many meniscal tears are the result. The articular cartilage of the knee coats the end of the femur thigh bone, the top surface of the tibia shin bone and the back surface of the patella kneecap. Meniscal tear symptoms, diagnosis and treatment bmj best. Athletes, particularly those who play contact sports, are at risk for meniscus tears. Rice rest, ice, compression and elevation is the standard treatment.
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