Without surgery, recovery will take about 6 to 8 weeks, though this can vary. In a recent study by Tsujii et al., it was shown that after concurrent ACLR and meniscal repair, the lateral extrusion of the LM was correlated with its healing status. What are signs the injury is getting worse instead of healing? It can lead to pain, swelling, and a sensation of the knee giving way. Our friendly team is here to answer your questions about knee injuries or any other problems with your bones or joints. A tear can result from a trauma, such as twisting the leg, or age-related degeneration of the knee joint. The choice of treatment depends on several factors, including severity of Finally, meniscal allograft extrusion is also associated with subchondral bone marrow lesions and cysts [2, 115]. 3). Check for errors and try again. Generally speaking, the treatment options for meniscus tears include: rest, physical therapy, activity modification, and occasionally a surgery we refer to as an 3. 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. It is often used with chronic degenerative conditions although some authors also propose this term in the setting of a tear (macerated tear)2. Medial meniscal extrusion (MME) is measured 5.6mm. 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? Other symptoms include: If your torn meniscus doesnt heal properly, your knee wont be as stable as it was before the injury. Without nutrients from blood, tears in this "white" zone cannot heal. 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. This post goes into considerable detail about managing a knee with arthritis and a complex or degenerative meniscus tear. People with arthritis in their knees are also more prone to meniscus tears. 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? Hold the position for 5 seconds and then relax. Also taking into consideration that residual ME after MPRT repair correlates with worse outcomes regarding both clinical parameters and OA progression [72, 73], a better understanding of the causality of ME is needed in order to appropriately address it. A critical review of the literature. 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. Therefore, with this article we aim to provide an up-to-date review of the literature with an emphasis on the clinical significance and new concepts in the treatment and reduction of ME in the different knee pathologies in which it is encountered. 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. 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 Orthop Traumatol Surg Res 105(7):13951399, Everhart JS, Magnussen RA, Abouljoud MM, Regalado LE, Kaeding CC, Flanigan DC (2020) Meniscus tears accelerate joint space loss and lateral meniscal extrusion increases risk of knee arthroplasty in middle-aged adults. It also outlines symptoms, diagnosis, and treatment and provides information on when to contact a doctor. Radiographics. [13] proved biomechanically that ME is possible with intact meniscal roots and that centralization of the meniscus restores the tibiofemoral contact pressures back to normal. Surgery is a very effective way to repair a torn meniscus. One way to reduce postoperative ME is by early intervention, specifically within 3months after the MPRT [70,71,72]. 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? ME has no specific clinical finding or sign and it is encountered in many knee pathologies. Surgery for degenerative meniscus tears is rarely necessary. By using this website, you agree to our Am J Sports Med 44(9):23302338, Parkinson B, Smith N, Asplin L, Thompson P, Spalding T (2016) Factors predicting meniscal allograft transplantation failure. This will reduce the stress on your knee. Strengthen the muscles that support and stabilize your knee. WebItll help increase your range of motion and help your knee get stronger. (2018). Most often, the meniscus tears during a sudden motion in which your knee twists while your foot stays planted on the ground. medial meniscal extrusion is associated with OrthoInfo from the American Academy of Orthopaedic Surgeons. Winkler. Most research shows that people do just as well with physical therapy. Current research has directed its focus to meniscotibial ligaments (MTL), which stabilize on the tibial plateau and centralize the meniscus, as an additional potential causative factor for ME. 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. Sometimes, degeneration from arthritis causes a tear, even without a knee injury. 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. A Special Tear Pattern of Anterior Horn of the Lateral WebArthroscopic surgery. Arthroscopy. Our website services, content, and products are for informational purposes only. no financial relationships to ineligible companies to disclose. 2014;34(4):981-99. A hip labral tear can be treated nonsurgically, or with surgery in severe cases. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. 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. A hip labral tear can be caused by injury, structural problems, or degenerative issues. Some clinical studies on its effectiveness exist, but more research is needed. PubMed Central Spang RC III, et al. This can provide pain relief for 2 to 4 weeks. 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]. Am J Sports Med 42(10):23292337, Jauregui JJ, Wu ZD, Meredith S, Griffith C, Packer JD, Henn RF (2018) How should we secure our transplanted meniscus? 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. ME depends largely on the severity and type of tear [87, 89, 91]. The outer one-third of the meniscus has a blood supply, and so doctors refer to this area as the red zone. If you have surgery to repair a torn meniscus, your knee should be fully recovered after a few months of physical therapy. 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. However, it has also been hypothesized that MPRT is not the sole contributing factor predisposing to ME. Part of Google Scholar, Malas F, Kara M, Kaymak B, Aknc A, zakar L (2014) Ultrasonographic evaluation in symptomatic knee osteoarthritis: clinical and radiological correlation. Another successful strategy is osteophyte resection. Orthop J Sports Med. 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. Several preoperative and intraoperative factors (Table 3) are associated with the absolute value of allograft extrusion [16, 102, 106, 109, 120]. Interest in ME has grown exponentially in recent years, as it is associated with several pathologies, such as knee OA, meniscal posterior root tears (MPRT), post-anterior cruciate ligament reconstruction (ACLR) and post-meniscal allograft transplantation (MAT) [6, 23, 24]. [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. Healthline Media does not provide medical advice, diagnosis, or treatment. 2. PubMed [31] showed that lateral ME was associated with worsening of patellofemoral joint OA features at 2-year follow-up. 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. Knee Surgery & Related Research Knee Surg & Relat Res 34, 35 (2022). Arthroscopy 31(4):699706, Lee SM, Bin SI, Kim JM, Lee BS, Park JG (2020) Absolute meniscal extrusion after lateral meniscal allograft transplantation does not progress during long-term follow-up: average of 10.3 years follow-up longitudinal magnetic resonance imaging study. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7359983/, https://orthoinfo.aaos.org/en/recovery/knee-arthroscopy-exercise-guide/, https://orthoinfo.aaos.org/en/diseases--conditions/meniscus-tears/, https://www.ncbi.nlm.nih.gov/books/NBK431067/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5444079/, New clues to slow aging? volume34, Articlenumber:35 (2022) [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. if you have sudden pain from a knee injury. (2018). (2017). This can result from disruption of collagen fibers within the meniscus that provide hoop strength 8.. Also consult a doctor if you continue to have pain after a course of conservative treatment. ME, in the coronary plane, is defined as the maximum distance of the most distal end of the meniscus from the border of the tibial plateau, where the tibial eminences are the most prominent, without taking into account the osteophytes. (ACLR+LM tear repair) demonstrated that the narrowing was only 0.04mm at 3.4years postoperatively, whereas another study showed widening of 0.1mm at 3.5years postoperatively [85, 90]. Sonographic evaluation of lateral meniscal extrusion: implementation and validation|SpringerLink [Internet]. 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. The different types of meniscus tear include: Additionally, doctors categorize tears according to their location. This condition may lead to increased cartilage degeneration, progressive OA and allograft failure, as mentioned in several biomechanical studies [17, 111]. Have swelling that doesnt go away with a few days of RICE and taking NSAIDs. Does a degenerative meniscus tear need surgery? Based on these findings, they concluded that the all-inside repair of the radial tear of the LM could help maintain its dynamic behavior, thus reducing the biomechanical stress exerted on the adjacent cartilage [89]. Google Scholar, Okada K, Yamaguchi S, Sato Y, Enomoto T, Ogawa Y, Ohtori S et al (2019) Comparison of meniscal extrusion and osteophyte formation at the intercondylar notch as a predictive biomarker for incidence of knee osteoarthritis-Data from the Osteoarthritis Initiative-. As you get older, the cartilage in your knees wears down and gets weaker. Sudden twisting movements such as pivoting to catch a ball can tear the cartilage. Most of the meniscus pathologies have recently been correlated with meniscal extrusion [3, 6]. Treatment for knee meniscus tears may involve: using the rest, ice, compression, and elevation (RICE) method. 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 results as to which technique is superior to the others remain controversial. 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 A more posterolateral placement of the tibial tunnel aperture may induce extrusion of the LM following ACLR. Google Scholar, Kim SJ, Choi CH, Chun YM, Kim SH, Lee SK, Jang J et al (2017) Relationship between preoperative extrusion of the medial meniscus and surgical outcomes after partial meniscectomy. 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]. 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]. Antony B, Driban J, Price L et al. redness or streaking at the site of the injury, persistent symptoms despite appropriate self-care. Recovery time can be lengthy with either one. Mordecai SC, et al. Knee Surg Sports Traumatol Arthrosc 25(2):383389, Pache S, Aman ZS, Kennedy M, Nakama GY, Moatshe G, Ziegler C et al (2018) Meniscal root tears: current concepts review. Meniscus Tear 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. More serious meniscus tears may not heal on their own. Surgical treatment of complex meniscus tear and Beaufils P, et al. Knee arthroscopy, a minimally invasive procedure, is often used to treat meniscal tears. (ACLR+LM tears left in situ) showed narrowing of 1.0mm at 10-year follow-up [96, 97]. complex tear: a combination of all or some horizontal, vertical, and radial-type tears. 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. 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]. 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. Lie on the back, with the unaffected knee bent. WebMedial compartment osteoarthritis is a type of arthritis in your knee. 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. Cleveland Clinic is a non-profit academic medical center. PubMedGoogle Scholar. Although there is a need for longer follow-up periods, the currently available data suggest a benefit of concomitant ACLR with the repair of longitudinal, radial, posterior horn and posterior root tears of the menisci, because the combination can even better reduce their shape and extrusion [92, 98,99,100]. There are two main types of arthroscopic surgery for a meniscus tear: partial meniscectomy and meniscus repair. PubMed Central If your injury doesnt improve with RICE, NSAIDs and physical Many techniques have been described for meniscal transplantation, but the most commonly used are (a) the suture-only technique, (b) bone-plug technique, (c) keyhole technique and (d) bridge-in-slot technique [102, 104, 111]. Shiraev T, et al. Where possible, doctors will recommend nonsurgical forms of treatment. Osteoarthritis Cartilage. his post talks about the importance of balance training and strengthening-, Muscle mass.. or larger muscles are associated with longevity and better health. Alternatively, the surgeon may be able to modify the ACL reconstruction technique to decrease the risk of growth plate injury during surgery. Kessler CS, et al. Exercises Initial routine. Orthop J Sports Med. Clinical significance and management of meniscal extrusion in different knee pathologies: a comprehensive review of the literature and treatment algorithm. 2017;25(1):76-84. 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? The inner two-thirds of the meniscus, however, lacks a blood supply. A torn or strained meniscus is generally treated with rest, ice, over-the-counter anti-inflammatory medicines and physical therapy. WebThere are two general forms of treatment for meniscus tears: conservative, or nonsurgical, and surgical. radial tear: perpendicular to both the tibial plateau and the long axis of the meniscus. What is a meniscus injury, and how common is it? It is associated with either rapidly progressive knee osteoarthritis or early onset of knee osteoarthritis and increased morbidity. 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. Accessed 22 May 2021. 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. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. 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. https://doi.org/10.1186/s43019-022-00163-1, DOI: https://doi.org/10.1186/s43019-022-00163-1. Konstantinos G. Makiev. Red-red tears are within the red zone, and red-white tears have central margins that extend into the white zone. Meniscus Tears, Repair, and Transplantation > Fact To perform this exercise, a person should follow these steps: An advanced exercise routine may include an exercise that involves partially bending the knee. 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. Zheng J, Zhai W, Li Q, Jia Q, Lin D. A Special Tear Pattern of Anterior Horn of the Lateral Meniscus: Macerated Tear. An MRI will confirm a suspected diagnosis. We avoid using tertiary references. These are the knee compression sleeves we recommend for stability during exercise. Often, athletes and people who play sports for fun suffer meniscus tears. an assessment by MRI and arthroscopy. There is no established optimal surgical technique at present for restoring ME to normal values, and thus there will be a strong need for more effective and refined techniques. If the repaired meniscus failed to heal, lateral extrusion progressed significantly [92]. 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]. 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]. 1. AJR Am J Roentgenol 183(1):1723, Muzaffar N, Kirmani O, Ahsan M, Ahmad S (2015) Meniscal extrusion in the knee: should only 3 mm extrusion be considered significant? Am J Sports Med 40(7):15911596, Lee BS, Kim JM, Kim JM, Kim KA, Bin SI (2015) Patient-related risk factors for the extrusion of lateral meniscal allograft transplants. WebYour doctor will remove a piece of the torn meniscus so your knee can function normally. After healing occurs, a doctor will recommend a rehabilitation program of exercises to improve range of motion and strength. A nonsurgical treatment approach typically involves rest and avoiding activities that trigger symptoms. Goto et al. J Orthop Surg 13(1):181, Ha JK, Shim JC, Kim DW, Lee YS, Ra HJ, Kim JG (2010) Relationship between meniscal extrusion and various clinical findings after meniscus allograft transplantation. There were 6 patients with AHLM cysts in macerated tear group and one patient in vertical tear group. These are nonabsorbent 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. 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]. Arthroscopy 27(7):914922, Kim JH, Lee S, Ha DH, Lee SM, Jung K, Choi W (2018) The effects of graft shrinkage and extrusion on early clinical outcomes after meniscal allograft transplantation. Post-ACLR ME is also a concern and should be prevented by repairing concurrent meniscal tears and centralizing the meniscus along with the ACLR. Tears in this area are typically more likely to heal on their own. maceration 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]. This post will carry two messages, both equally important. Associations. Fig 3. Bend the unaffected leg, touching the toe to the floor as necessary for balance. The lateral meniscus (LM) is a secondary stabilizer in the knee joint during pivot-shift loading [85]. Torn Meniscus | Johns Hopkins Medicine 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 tear that gives you a lot of pain or impairs use of your knee may require surgery to remove or repair the torn part of the meniscus. Studies show that exercise routines can significantly improve knee pain and function.