Arthrosc Tech 6(2):e269e274, Ahn JH, Kang HW, Yang TY, Lee JY (2016) Multivariate analysis of risk factors of graft extrusion after lateral meniscus allograft transplantation. CAS A person with a meniscus injury should consult a healthcare professional, such as a physical therapist, before starting an exercise program. Being unable to fully bend or straighten your leg. Several studies also argue that the presence of ME is predictive of knee OA progression [32,33,34]. And finally, the proper anatomical placement of the allograft is essential. 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. Although meniscal allografts that are secured with the suture-only technique tend to show a greater degree of extrusion than the bony-fixation techniques, bony-fixation techniques still show high extrusion rates (2550%). 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. Meniscus repair involves stitching torn pieces of a meniscus back together. Exercise programs start with an initial routine and then progress to intermediate and advanced routines. WebIs knee surgery necessary to repair a torn meniscus? 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. On imaging, it is often seen as a meniscal loss with the destruction of expected architecture. Bend the unaffected leg, touching the toe to the floor as necessary for balance. 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]. Shiraev T, et al. medial meniscal extrusion is associated with 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. Incidence and risk factors associated with meniscal injuries among active-duty US military service members. 60 patients were performed arthroscopic meniscus repairs Surgical treatment of complex meniscus tear and Causes of the injury include trauma and degenerative changes to the knee joint. CAS Osteoarthritis Cartilage. J Knee Surg. 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. 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. TK and DG designed the manuscript and helped to draft the manuscript and review it. Lie on Intermediate routine. Diagnosis and management of meniscal injury. 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. Therefore, care should be taken to manage it appropriately and successfully reduce it. For a simple tear here, doctors may advise a short course of rest and physical therapy to see whether spontaneous healing occurs. 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. (2016). They may also share some exercises you can do at home. Knee Surg Relat Res. A nonsurgical treatment approach typically involves rest and avoiding activities that trigger symptoms. 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. This value is identified as the optimal cutoff point for a complete PRT of the LM and has 100% sensitivity and 83% specificity [92]. Cant fully bend or straighten your leg without knee pain. Here's what you need to know as well as a chart. Work up slowly to more intense exercise activity. 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]. Using the back of a chair for support, stand upright. Furthermore, at 2-year follow-up, patients experienced significantly less pain, with improved clinical outcomes. We also explore recovery and when to contact a doctor. Nguyen J, De Smet A, Graf B, Rosas H. MR Imaging-Based Diagnosis and Classification of Meniscal Tears. Sometimes, degeneration from arthritis causes a tear, even without a knee injury. 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. 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. volume34, Articlenumber:35 (2022) We link primary sources including studies, scientific references, and statistics within each article and also list them in the resources section at the bottom of our articles. 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. As you get older, the cartilage in your knees wears down and gets weaker. Factors that increase the risk of a meniscus tear include: Doctors classify meniscus tears according to their shape and location. The results as to which technique is superior to the others remain controversial. Core tip:The healing potential of chronic degenerative menisci remains poor. 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. A person may feel a pop when they tear the meniscus. PubMed Central J Knee Surg 34(2):178186, Furumatsu T, Kodama Y, Kamatsuki Y, Hino T, Okazaki Y, Ozaki T (2017) Meniscal extrusion progresses shortly after the medial meniscus posterior root tear. Some clinical studies on its effectiveness exist, but more research is needed. You can learn more about how we ensure our content is accurate and current by reading our. 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. The inner two-thirds of the meniscus have only a limited blood supply, which is why doctors call this the white zone. Treatment for knee meniscus tears may involve: using the rest, ice, compression, and elevation (RICE) method. statement and Comparative studies between normal knees and knees with ACL rupture demonstrated that the posterior extrusion of the MM during knee flexion is almost the same [83, 94]. Red-red tears are within the red zone, and red-white tears have central margins that extend into the white zone. Last reviewed by a Cleveland Clinic medical professional on 04/17/2021. The different types of meniscus tear include: Additionally, doctors categorize tears according to their location. 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]. Two pieces of cartilage sit inside your knee, between your thighbone (femur) and shinbone (tibia). Without nutrients from blood, tears in this "white" zone cannot heal. 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. Google Scholar, uczkiewicz P, Daszkiewicz K, Chrcielewski J, Witkowski W, Kuik L (2017) High meniscal slope angle as a risk factor for meniscal allograft extrusion. MPRT are defined as an avulsion fracture or a radial lesion occurring within 1cm of the bony tibial attachment [56]. degenerative meniscus Your healthcare provider will physically examine your knee, looking for signs of swelling. Torn Meniscus: Causes, Symptoms, Treatments, Clin Rheumatol 36(11):25572564, Kim JY, Bin SI, Kim JM, Lee BS, Oh SM, Park MH (2019) Tear gap and severity of osteoarthritis are associated with meniscal extrusion in degenerative medial meniscus posterior root tears. Conservative treatment constitutes the first line of therapy in mild or moderate knee OA [46, 47]. Am J Sports Med 39(7):14391443, Katagiri H, Miyatake K, Nakagawa Y, Otabe K, Ohara T, Shioda M et al (2019) The effect of a longitudinal tear of the medial meniscus on medial meniscal extrusion in anterior cruciate ligament injury patients. Meniscal tear: Presentation, diagnosis and management. 2023 BioMed Central Ltd unless otherwise stated. A Special Tear Pattern of Anterior Horn of the Lateral 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. 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. The time of recovery varies depending on: The meniscus is a C-shaped band of cartilage that goes around the knee joint and cushions the junction of your thighbone (femur) and shinbone (tibia). Debieux et al. extrusion Can I make a meniscus tear worse if I run on it? 2023 Healthline Media UK Ltd, Brighton, UK. The rubbery wedges of cartilage act like shock absorbers for your knee, providing cushioning for your bones and knee joint. A narrative review with focus on relevance for osteoarthritis research. Degenerative lesions of the knee joint are more commonly present during concurrent ACLR with meniscectomy than with intact or repaired menisci. Do I need surgery to repair or remove the torn meniscus? (ACLR+LM tears left in situ) showed narrowing of 0.33mm of the lateral joint space at 3years postoperatively, and Shelbourne et al. Scientists use genetic rewiring to increase lifespan of cells, Beyond amyloid and tau: New targets in developing dementia treatments, Napping longer than 30 minutes linked to higher risk of obesity and high blood pressure, Activity 'snacks' could lower blood sugar, complication risk in type 1 diabetes, In Conversation: Investigating the power of music for dementia, Daniel Bubnis, M.S., NASM-CPT, NASE Level II-CSS, stability through preventing the knee from bending and straightening at extreme angles, having an occupation that requires frequent squatting or bending, inability to fully bend and straighten the knee. People who have surgery on these complex degenerative posterior horn tears are at higher risk of developing arthritis than those treated with surgery. J Orthop Sci 25(4):640646. Furthermore, supplementary centralization of the meniscus appears to be able to adequately reduce the ME, as it also addresses potential MTL lesions. Asia-Pac J Sports Med Arthrosc Rehabil Technol 1(21):2731, Chung KS, Ha JK, Ra HJ, Kim JG (2016) A meta-analysis of clinical and radiographic outcomes of posterior horn medial meniscus root repairs. However, over a long-term period, the degenerative changes in the articular cartilage worsened, especially in the lateral tibial plateau, regardless of the healing status of the meniscus [85, 87, 90]. 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. 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. https://doi.org/10.1186/s43019-019-0019-x, Article Google Scholar, Raynauld JP, Martel-Pelletier J, Bias P, Laufer S, Haraoui B, Choquette D et al (2009) Protective effects of licofelone, a 5-lipoxygenase and cyclo-oxygenase inhibitor, versus naproxen on cartilage loss in knee osteoarthritis: a first multicentre clinical trial using quantitative MRI. You can learn more about how we ensure our content is accurate and current by reading our. maceration showed that the difference in the extrusion of the LM between a healthy knee and a knee with combined injury was not statistically significant. Arthroscopy. 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. However, it is still controversial whether meniscal pathology leads to osteoarthritis (OA), or vice versa. Last medically reviewed on February 8, 2022, The knee is one of the body's more complicated joints and is susceptible to various injuries. 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. This is probably why capsulodesis is so effective in minimizing extrusion. 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. An inappropriate tibial tunnel may also cause extrusion of the LM. 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. Theres an inner (medial) meniscus and an outer (lateral) meniscus. A physical therapist will individualize a persons exercise regimen to prevent further injury. More importantly, it leads to rapid progression of the degenerative process of the knee as well as substantial morbidity and pain [25,26,27,28]. A tear in this "red" zone may heal on its own, or can often be repaired with 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. 2023 Healthline Media LLC. Studies show that exercise routines can significantly improve knee pain and function. 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? [39,40,41]. A true knee lock occurs when something in your knee joint gets stuck and. 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. 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 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. 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 (ACLR+LM tears left in situ) showed narrowing of 1.0mm at 10-year follow-up [96, 97]. In a biomechanical study, Paletta et at. This thinner cartilage can tear more easily. Correct estimation of the allograft size is also important. 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. (2018). In a recent meta-analysis, the percentages of medium-term and long-term survival after medial MAT were 85.8% and 52.6%, respectively, whereas after lateral MAT they were 89.2% and 56.6%, respectively [116].