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. Without nutrients from blood, tears in this "white" zone cannot heal. Osteoarthritis Cartilage 25(7):10761083, Naredo E, Cabero F, Palop MJ, Collado P, Cruz A, Crespo M (2005) Ultrasonographic findings in knee osteoarthritis: a comparative study with clinical and radiographic assessment. PubMed Central treatment Improper positioning of the posterior horn causes a similar deviation to the anterior horn. Getting hit or tackled can make you twist your knee, tearing the cartilage. maceration 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]. 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. Therefore, proper placement of the posterior horn is critical to the anatomical repair of the meniscus [125,126,127]. If these measures do not alleviate a persons symptoms, doctors may recommend surgical options, such as a partial meniscectomy or a meniscus repair. Konstantinos G. Makiev. Accessed 22 May 2021. 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. Last medically reviewed on December 21, 2020. Knee arthroscopy versus conservative management in patients with degenerative knee disease: A systematic review. 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. The aim is to strengthen the muscles surrounding the knee, such as the front thigh muscles, known as the quadriceps. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 28(4):11771194, Swamy N, Wadhwa V, Bajaj G, Chhabra A, Pandey T (2018) Medial meniscal extrusion: detection, evaluation and clinical implications. This is probably why capsulodesis is so effective in minimizing extrusion. Orthop J Sports Med 8(4):2325967120914568, Tsujii A, Yonetani Y, Kinugasa K, Matsuo T, Yoneda K, Ohori T et al (2021) Outcomes more than 2 years after meniscal repair for longitudinal tears of the lateral meniscus combined with anterior cruciate ligament reconstruction. Meniscal allograft extrusion causes incongruity with the femoral condyle, and therefore the allograft cannot perform normal load transmission and shock absorption. 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. Beaufils P, et al. Dawson LJ, et al. Medial Compartment Osteoarthritis 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. In the days following your injury, you should also follow the RICE protocol. There is no consensus whether medial or lateral MAT is superior in terms of medium-term (510years) and long-term (>10years) survival. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. 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 An inappropriate tibial tunnel may also cause extrusion of the LM. Therefore, improvements in surgical techniques are necessary [102, 109]. However, efforts to standardize or optimize the treatment for MMPRT are much needed. The lateral meniscus (LM) is a secondary stabilizer in the knee joint during pivot-shift loading [85]. 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]. For a simple tear here, doctors may advise a short course of rest and physical therapy to see whether spontaneous healing occurs. Mordecai SC, et al. https://doi.org/10.1155/2015/210972, Kijima H, Miyakoshi N, Kasukawa Y, Ishikawa Y, Kinoshita H, Ohuchi K et al (2017) Cut-off value of medial meniscal extrusion for knee pain. 2023 BioMed Central Ltd unless otherwise stated. Surgery versus conservative treatment for meniscus tears has been a medical topic of controversy for many years. Arthroscopy 36(4):11351141, Article This pattern completely disrupts the continuity of the circumferential fibers, leading to the loss of the hoop tension and substantial ME, thus promoting rapid progression of knee OA [1, 57]. 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. Most authors agree that the transplanted menisci are extruded more frequently than endogenous menisci [15, 102, 105]. Treatments for macerated skin caused by wounds include specific types of bandages and dressings, including: Occlusive dressings. Using the back of a chair for support, stand upright. redness or streaking at the site of the injury, persistent symptoms despite appropriate self-care. On the other hand, the suture-only technique has its own advantages and is therefore chosen by many surgeons [104, 111]. Surgery for degenerative meniscus tears is rarely necessary. PubMed Have swelling that doesnt go away with a few days of RICE and taking NSAIDs. Am J Sports Med 42(2):327335, Shelbourne KD, Roberson TA, Gray T (2011) Long-term evaluation of posterior lateral meniscus root tears left in situ at the time of anterior cruciate ligament reconstruction. Feeling like your knee might give out beneath you. 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. 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]. It has been shown from studies that the risk for TKA after ACLR is seven timesgreater than in normal individuals [88]. The goal of the anatomic reconstruction of the ACL rupture is to replicate the normal knee anatomy. Meniscus There are two main types of arthroscopic surgery for a meniscus tear: partial meniscectomy and meniscus repair. Furthermore, Lee et al. An MRI will confirm a suspected diagnosis. Eur J Orthop Surg Traumatol 28(4):727734, Chernchujit B, Agrawal S (2019) Arthroscopic all-inside medial meniscus extrusion reduction. 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. Int Orthop 39(12):24812487, Winkler PW, Wierer G, Csapo R, Hepperger C, Heinzle B, Imhoff AB et al (2020) Quantitative evaluation of dynamic lateral meniscal extrusion after radial tear repair. 2014;34(4):981-99. MPRT are defined as an avulsion fracture or a radial lesion occurring within 1cm of the bony tibial attachment [56]. The outer one-third of the meniscus has a blood supply, and so doctors refer to this area as the red zone. Fig 3. Another successful strategy is osteophyte resection. Wear athletic shoes that are appropriate for the sport youre doing. Eur Radiol 29(5):26162623, Debieux P, Jimenez AE, Novaretti JV, Kaleka CC, Kriscenski DE, Astur DC et al (2020) Medial meniscal extrusion greater than 4 mm reduces medial tibiofemoral compartment contact area: a biomechanical analysis of tibiofemoral contact area and pressures with varying amounts of meniscal extrusion. Today, in general, doctors recommend conservative treatment, not surgery, when meniscus tears result from degeneration. Makiev, K.G., Vasios, I.S., Georgoulas, P. et al. 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]. PubMed This post goes into considerable detail about managing a knee with arthritis and a complex or degenerative meniscus tear. Pathology. Goto et al. 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. As you get older, the cartilage in your knees wears down and gets weaker. 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]. 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. 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. Learn about the most common knee injuries from falling, as well as which ones you can treat at home and which ones require medical attention. 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]. A Special Tear Pattern of Anterior Horn of the Lateral A hip labral tear is an injury to the labrum, the soft tissue that covers the acetabulum (socket) of the hip. WebThe outside one-third of the meniscus has a rich blood supply. ME depends largely on the severity and type of tear [87, 89, 91]. Medial meniscal extrusion (MME) is measured 5.6mm. Playing contact sports also increases your risk of a meniscus tear. 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. We, Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. Zheng J, Zhai W, Li Q, Jia Q, Lin D. A Special Tear Pattern of Anterior Horn of the Lateral Meniscus: Macerated Tear. The above part of the examination does not always lead to a diagnosis. Clinical significance and management of meniscal extrusion in different knee pathologies: a comprehensive review of the literature and treatment algorithm, https://doi.org/10.1186/s43019-022-00163-1, Anterior cruciate ligament reconstruction (ACLR), https://doi.org/10.1007/s00167-020-06363-0, https://link.springer.com/article/10.1007%2Fs00402-020-03683-1, https://doi.org/10.1186/s43019-019-0019-x, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. Meniscus repair involves stitching torn pieces of a meniscus back together. 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]. MK, VSI and GP participated in the study design and helped to draft the manuscript. Arthrosc Tech 8(9):e941e946, Leafblad ND, Smith PA, Stuart MJ, Krych AJ (2021) Arthroscopic centralization of the extruded medial meniscus. (2017). David Prado/Stocksy United. root tear: typically radial-type tear located at the meniscal root. 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. Ann Rheum Dis 68(6):938947, Ishii Y, Deie M, Fujita N, Kurumadani H, Ishikawa M, Nakamae A et al (2017) Effects of lateral wedge insole application on medial compartment knee osteoarthritis severity evaluated by ultrasound. Careful preoperative planning for correct sizing and accurate placement of the allograft is critical for preventing ME. Those that are caused by an injury are often the ones that can be, A meniscectomy is a procedure that repairs a torn meniscus. People who have surgery on these complex degenerative posterior horn tears are at higher risk of developing arthritis than those treated with surgery. Note that meniscectomy may cause osteoarthritis in the long term. Here's what to expect from. https://doi.org/10.1007/s00167-020-06363-0, Miller TT, Staron RB, Feldman F, epel E (1997) Meniscal position on routine MR imaging of the knee. However, to date there is still no well-designed clinical trial available to ascertain the effectiveness of centralization in reducing ME. 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). Semin Arthritis Rheum 45(3):257267, Liu Y, Joseph GB, Foreman SC, Li X, Lane NE, Nevitt MC et al (2020) Determining a threshold of medial meniscal extrusion for prediction of knee pain and cartilage damage progression over 4 years: data from the osteoarthritis initiative. With a surgical treatment approach, exercises are necessary for recovery. [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. Acta Med Okayama 70(6):441448, Narazaki S, Furumatsu T, Tanaka T, Fujii M, Miyazawa S, Inoue H et al (2015) Postoperative change in the length and extrusion of the medial meniscus after anterior cruciate ligament reconstruction. [77] performed arthroscopic centralization of nine extruded lateral menisci with the use of suture anchors, and ME was significantly reduced in 2years of follow-up. Several studies also argue that the presence of ME is predictive of knee OA progression [32,33,34]. A true knee lock occurs when something in your knee joint gets stuck and. Hold the position for 5 seconds and then relax. Last medically reviewed on February 8, 2022, The knee is one of the body's more complicated joints and is susceptible to various injuries. 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? (C) After the suture has been passed through the meniscus with free limbs su-perior and inferior to the meniscus tear. Nonsurgical treatment may include interventions such as rest, exercises, and medication. While many studies have shown a positive association [35,36,37,38], other studies investigating the association between ultrasound features, including ME, and pain in a series of osteoarthritic knees found no correlation between pathological ME (>3mm) and pain in knee OA. Knee Surg Sports Traumatol Arthrosc 19(2):214217, Kim YS, Kang KT, Son J, Kwon OR, Choi YJ, Jo SB et al (2015) Graft extrusion related to the position of allograft in lateral meniscal allograft transplantation: biomechanical comparison between parapatellar and transpatellar approaches using finite element analysis. Putting ice on your knee for 10 to 15 minutes However, more research with high-quality studies is needed in order to refine the technique and validate its long-term results in reducing ME. OrthoInfo from the American Academy of Orthopaedic Surgeons. Thats because you now have less shock absorption in your joint. The results as to which technique is superior to the others remain controversial. 60 patients were performed arthroscopic meniscus repairs Usually you will be able to leave the hospital the same day.

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