Knee Surg Sports Traumatol Arthrosc 29(4):11971205, Song JH, Bin SI, Kim JM, Lee BS (2020) Postoperative subchondral bone marrow lesion is associated with graft extrusion after lateral meniscal allograft transplantation. Knee Surg Sports Traumatol Arthrosc 19(2):222229, Oo WM, Linklater JM, Bennell KL, Pryke D, Yu S, Fu K et al (2021) Are OMERACT knee osteoarthritis ultrasound scores associated with pain severity, other symptoms, and radiographic and magnetic resonance imaging findings? An MRI scan is the method of choice for confirming a suspected diagnosis. Other symptoms include: If your torn meniscus doesnt heal properly, your knee wont be as stable as it was before the injury. All authors read and approved the final manuscript. If your symptoms persist after 3 months or your symptoms become significant, your doctor may recommend surgery to repair the tear. The precise location of your knee pain can help you narrow down the potential cause. WebHip Labral Tear. To address the problems of patients with meniscectomy, efforts are constantly being made to develop techniques that aim at meniscal regeneration or development of meniscal scaffolds. Slowly lower the body, keeping the foot flat. Most research shows that people do just as well with physical therapy. Partial meniscectomy involves trimming away the damaged meniscus. Another successful strategy is osteophyte resection. The knee is a complex synovial joint that can be affected by a range of pathologies: ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. J Orthop Sci 25(4):640646. Treatments for macerated skin caused by wounds include specific types of bandages and dressings, including: Occlusive dressings. Results regarding the correlation of ME with pain in knee OA remain controversial. 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. It permits immediate weight bearing following surgery and provides a full range of motion soon afterward. 2017;12(1):e0170710. Cookies policy. The term meniscal extrusion (ME) is used to describe the radial meniscal body displacement beyond the peripheral tibial plateau margin [7, 8]. 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. This article discusses what a meniscus injury is, including the different types of meniscus tears. WebMedial compartment osteoarthritis is a type of arthritis in your knee. ACL Injury: Does It Require Surgery? - OrthoInfo - AAOS (2012). Furthermore, supplementary centralization of the meniscus appears to be able to adequately reduce the ME, as it also addresses potential MTL lesions. This cartilage is the meniscus. ME can occur in knee OA [8, 10], and its presence is significantly correlated with increased articular cartilage loss in the tibiofemoral joint and osteophyte formation [29, 30]. Doral MN, et al. Studies show that exercise routines can significantly improve knee pain and function. They may also share some exercises you can do at home. This can result from disruption of collagen fibers within the meniscus that provide hoop strength 8.. Although it has never been reported, it is worth researching, as it could have a beneficial effect. Am J Sports Med 48(13):31633169, Bin SI, Nha KW, Cheong JY, Shin YS (2018) Midterm and long-term results of medial versus lateral meniscal allograft transplantation: a meta-analysis. 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. Torn shoulder labrum: Causes, symptoms, and treatment an assessment by MRI and arthroscopy. A critical review of the literature. Dawson LJ, et al. PubMed 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. 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]. WebYour doctor will remove a piece of the torn meniscus so your knee can function normally. 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. A torn meniscus is a very common knee injury. Meniscal injury decreases their functional properties, resulting in degeneration of the knee joint [2]. WebThe outside one-third of the meniscus has a rich blood supply. (2018). Some meniscus tears require surgery to heal the meniscus and restore the knees range of motion. Usually you will be able to leave the hospital the same day. An inappropriate tibial tunnel may also cause extrusion of the LM. meniscus extrusion It is a very common injury, especially among people who play sports. Where possible, doctors will recommend nonsurgical forms of treatment. Rehabilitation following meniscal repair: A systematic review. Moreover, centralization of the allograft can be performed to help stabilize it on the tibial plateau; however, there are not yet sufficient data in the literature to support its benefits. More serious meniscus tears may not heal on their own. A physical therapist can provide a daily routine of exercises and stretches to improve your muscle strength, flexibility, range of motion, and stability. The medial meniscus covers 5060% of the medial tibial plateau, and the lateral meniscus covers 7080% of the lateral tibial plateau. Have swelling that doesnt go away with a few days of RICE and taking NSAIDs. Most authors agree that the transplanted menisci are extruded more frequently than endogenous menisci [15, 102, 105]. However, knowledge regarding the management of ME remains limited. If these measures do not alleviate a persons symptoms, doctors may recommend surgical options, such as a partial meniscectomy or a meniscus repair. A torn or strained meniscus is generally treated with rest, ice, over-the-counter anti-inflammatory medicines and physical therapy. 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. The menisci are crescent-shaped, fibrocartilaginous structures located between femoral and tibial condyles, which are important for load transmission and distribution, shock absorption, secondary stability and proprioception of the knee joint [1]. ME is found in several knee pathologies and is well correlated with rapid knee OA progression as well as increased morbidity. Arthroscopic total meniscectomy. Orthop J Sports Med 8(7):2325967120936672, Koga H, Muneta T, Watanabe T, Mochizuki T, Horie M, Nakamura T et al (2016) Two-year outcomes after arthroscopic lateral meniscus centralization. PubMed Central Meniscus Tears Why Surgery Isnt Always Necessary, Batters Shoulder : Posterior Labral Tears, Runners require strength too: What to do and when to do it, Lactate, the lactate shuttle, and lactate threshold workouts in polarized training, Zone 2 Heart Rate Training For Longevity and Performance, Pain In The Front Of The Knee: 6 Common Causes, Sometimes our joints just hurt, and its ok not to know why. Severe Meniscus Tear: Treatment Options The above part of the examination does not always lead to a diagnosis. 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]. Osteoarthritis Cartilage. An individual should seek guidance from a physical therapist about which exercises to perform to assist their healing. Over time, the joint can break down. 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. 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]. The knee is the largest and most complex joint in the body, holding together the thigh bone, shin bone, fibula (on the outer side of the shin), and, Torn meniscus is perhaps the most common type of knee injury in which a ligament in the knee becomes lacerated, affecting stability and causing pain, Locked knee refers to an inability to either bend or straighten the knee. 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. Reference article, Radiopaedia.org (Accessed on 01 May 2023) https://doi.org/10.53347/rID-70702. 1), although it may underestimate ME, as the assessment is routinely not performed under weight-bearing conditions [18,19,20]. Am J Sports Med 45(1):4249, Krych AJ, Bernard CD, Leland DP, Camp CL, Johnson AC, Finnoff JT et al (2020) Isolated meniscus extrusion associated with meniscotibial ligament abnormality. {"url":"/signup-modal-props.json?lang=us"}, Weerakkody Y, Baba Y, Knipe H, Meniscal maceration. If the repaired meniscus failed to heal, lateral extrusion progressed significantly [92]. Our friendly team is here to answer your questions about knee injuries or any other problems with your bones or joints. 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. Meniscal extrusion or subluxation refers to the peripheral meniscal margin extending beyond the external aspect of the tibiofemoral compartment of the knee.. After ACLR, extrusion of the is more frequently seen than that of the LM. https://doi.org/10.1155/2017/6793026, Berthiaume MJ, Raynauld JP, Martel-Pelletier J, Labont F, Beaudoin G, Bloch DA et al (2005) Meniscal tear and extrusion are strongly associated with progression of symptomatic knee osteoarthritis as assessed by quantitative magnetic resonance imaging. Nogueira-Barbosa MH, Gregio-Junior E, Lorenzato MM, Guermazi A, Roemer FW, Chagas-Neto FA et al (2015) Ultrasound assessment of medial meniscal extrusion: a validation study using MRI as reference standard. Am J Sports Med 38(12):24482455, Ha JK, Jang HW, Jung JE, Cho SI, Kim JG (2014) Clinical and radiologic outcomes after meniscus allograft transplantation at 1-year and 4-year follow-up. 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. California Privacy Statement, Strengthen the muscles that support and stabilize your knee. We do not endorse non-Cleveland Clinic products or services. medial meniscal extrusion is associated with [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. To perform this exercise, a person should follow these steps: An advanced exercise routine may include an exercise that involves partially bending the knee. This puts tension on a torn meniscus. How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction. 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. PLoS ONE 11(5):e0156183, Noyes FR, Barber-Westin SD (2015) A systematic review of the incidence and clinical significance of postoperative meniscus transplant extrusion. (2017). 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]. For example: Surgery may be a meniscus repair or a trimming of the meniscus tissue, which is called a partial meniscectomy. Malays Orthop J 9(2):1720, Article 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]. Therefore, they suggested that this type of OA patient, with MME and varus malalignment with a low MPTA, could benefit primarily from an early intervention with high tibial osteotomy (HTO), thus delaying the progression of knee OA. This thinner cartilage can tear more easily. 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. 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. no financial relationships to ineligible companies to disclose. However, more research with high-quality studies is needed in order to refine the technique and validate its long-term results in reducing ME. In addition, it has been shown that after lateral MAT, the extrusion is correlated with the progression of joint space narrowing (JSN) during long-term follow-up, while after medial MAT, JSN is observed during medium-term follow-up [114]. Med Hypotheses 1(101):4851, Article Arthritis Rheum 64(6):18881898, Kim DH, Lee GC, Kim HH, Cha DH (2020) Correlation between meniscal extrusion and symptom duration, alignment, and arthritic changes in medial meniscus posterior root tear: research article. 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]. 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. Int Orthop 43(11):25492556, Figueroa F, Figueroa D, Calvo R, Vaisman A, Espregueira-Mendes J (2019) Meniscus allograft transplantation: indications, techniques and outcomes. Am J Sports Med 46(5):12431250, Noyes FR, Barber-Westin SD (2016) Long-term survivorship and function of meniscus transplantation. 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. A systematic review of radiological outcomes. The diagnostic process starts with a medical history and a thorough examination that may include clinical tests. 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. Am J Sports Med 47(12):28882894, Delinc P, Ghafil D (2012) Anterior cruciate ligament tears: conservative or surgical treatment? Can I make a meniscus tear worse if I run on it? 60 patients were performed arthroscopic meniscus repairs PubMed Knee Surg Sports Traumatol Arthrosc Off J ESSKA 25(2):335346, Kopf S, Beaufils P, Hirschmann MT, Rotigliano N, Ollivier M, Pereira H et al (2020) Management of traumatic meniscus tears: the 2019 ESSKA meniscus consensus. 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. Hart et al. Core tip:The healing potential of chronic degenerative menisci remains poor. 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. 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]. 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]. [53], in a retrospective review of 131 patients who had undergone arthroscopic surgery for knee OA and were followed up for 4years, found that in regard to pain relief, arthroscopic surgery was also beneficial in patients with major MME (>3mm). Meniscal tear | Radiology Reference Article 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. (D) After the 2 suture limbs have been tied arthroscopically forming a circumferential compression stitch. 2023 Healthline Media UK Ltd, Brighton, UK. CAS PLoS ONE 9(3):e92901, Article 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. An MRI will confirm a suspected diagnosis. For instance, an oversized allograft achieves adequate coverage of the tibial plateau while exhibiting a large amount of extrusion, whereas the opposite applies for undersized or shrunken allografts [112]. 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. Arthroscopy 31(12):2380-2391.e2, Ren S, Zhang X, You T, Jiang X, Jin D, Zhang W (2018) Clinical and radiologic outcomes after a modified bone plug technique with anatomical meniscal root reinsertion for meniscal allograft transplantation and a minimum 18-month follow-up. Some clinical studies on its effectiveness exist, but more research is needed. 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. Treatment for knee meniscus tears may involve: using the rest, ice, compression, and elevation (RICE) method. You can learn more about how we ensure our content is accurate and current by reading our. The knee meniscus: Management of traumatic tears and degenerative lesions. WebThere are two general forms of treatment for meniscus tears: conservative, or nonsurgical, and surgical. A Meta-analysis Am J Sports Med 46(9):22852290, Smith NA, Parkinson B, Hutchinson CE, Costa ML, Spalding T (2016) Is meniscal allograft transplantation chondroprotective? Several strategies have been proposed to reduce allograft extrusion. Spang RC III, et al. Slowly raise the extended leg 12 inches from the floor and then slowly lower it back. Meniscus tears are very common. Symptoms include pain in the hip or stiffness. Meniscus tears can occur at any age. J Am Acad Orthop Surg 23(2):7176, Kwak YH, Lee S, Lee MC, Han HS (2018) Large meniscus extrusion ratio is a poor prognostic factor of conservative treatment for medial meniscus posterior root tear. Meniscal allograft extrusion causes incongruity with the femoral condyle, and therefore the allograft cannot perform normal load transmission and shock absorption. 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. Meniscus Tear Treatment Makiev, K.G., Vasios, I.S., Georgoulas, P. et al. However, efforts to standardize or optimize the treatment for MMPRT are much needed. As you get older, the cartilage in your knees wears down and gets weaker. Am J Sports Med 42(12):30163030, Jarraya M, Roemer FW, Englund M, Crema MD, Gale HI, Hayashi D et al (2017) Meniscus morphology: does tear type matter? Surgical versus conservative interventions for treating meniscal tears of the knee in adults. 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]. Arthrosc Tech 8(9):e941e946, Leafblad ND, Smith PA, Stuart MJ, Krych AJ (2021) Arthroscopic centralization of the extruded medial meniscus. A doctor may recommend one of the following nonsurgical treatment options for people who do not experience persistent symptoms or symptoms of knee locking or swelling: If nonsurgical methods do not alleviate a persons symptoms, a doctor may suggest arthroscopic surgery. Also consult a doctor if you continue to have pain after a course of conservative treatment. 2023 Healthline Media LLC. 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. You can learn more about how we ensure our content is accurate and current by reading our. Knee Surg Sports Traumatol Arthrosc. National Center for Biotechnology Information To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Bend the unaffected leg, touching the toe to the floor as necessary for balance. Tsujii et al. Astur et al. The menisci can be torn or strained by any rotation or twisting motion that puts stress on the knee. Knee Surg Sports Traumatol Arthrosc 28(11):35993605, Krych AJ, LaPrade MD, Hevesi M, Rhodes NG, Johnson AC, Camp CL et al (2020) Investigating the chronology of meniscus root tears: do medial meniscus posterior root tears cause extrusion or the other way around? 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]. This is probably why capsulodesis is so effective in minimizing extrusion. At the time the article was last revised Yahya Baba had Incidence and risk factors associated with meniscal injuries among active-duty US military service members. Work up slowly to more intense exercise activity. For a simple tear here, doctors may advise a short course of rest and physical therapy to see whether spontaneous healing occurs. It is often used with chronic degenerative conditions although some authors also propose this term in the setting of a tear (macerated tear)2.
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