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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. Makiev, K.G., Vasios, I.S., Georgoulas, P. et al. 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. Knee Surg Sports Traumatol Arthrosc 27(8):26172623, Astur DC, Novaretti JV, Gomes ML, Rodrigues AG, Kaleka CC, Cavalcante ELB et al (2020) Medial opening wedge high tibial osteotomy decreases medial meniscal extrusion and improves clinical outcomes and return to activity. To the best of our knowledge, this is the first study to elaborate on these topics. Note that meniscectomy may cause osteoarthritis in the long term. For these reasons, certain contraindications have been introduced (Table 2) [102, 103, 105,106,107,108,109]. 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 Symptoms include pain in the hip or stiffness. Bend the unaffected leg, touching the toe to the floor as necessary for balance. Physical therapy can help you recover from a meniscus tear by decreasing pain, strengthening and improving the flexibility in your knee, and increasing its range of 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]. Sometimes, degeneration from arthritis causes a tear, even without a knee injury. 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? Terms and Conditions, Treatment with glucosamine, chondroitin sulfate and licofelone has 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. WebDamage to the medial meniscus root, for example by a complete radial tear, destroys the ability of the knee to withstand hoop strain, resulting in contact pressure increases and kinematic alterations. We also explore recovery and when to contact a doctor. Adv Orthop. National Institute of Arthritis and Musculoskeletal and Skin Diseases. However, the incidence of severe knee OA is much higher in patients who have been subjected to ACLR than individuals with intact ACL [86, 87]. 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 Consequently, partial meniscectomy is only utilized for symptomatic MPRT (catching/locking) when a root repair, due to excessive degenerative changes and poor quality of meniscal tissue, is contraindicated [61, 64]. 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. PubMed Central However, further investigation is needed to evaluate the effect of the ACLR on the restoration of the MM function [88]. Radiographics. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. WebIs knee surgery necessary to repair a torn meniscus? A torn meniscus is a very common knee injury. Using the back of a chair for support, stand upright. 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. 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. Furthermore, at 2-year follow-up, patients experienced significantly less pain, with improved clinical outcomes. The authors did not receive funding for this study. 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? Studies show that exercise routines can significantly improve knee pain and function. Furthermore, Lee et al. Slowly lower the body, keeping the foot flat. Get useful, helpful and relevant health + wellness information, 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://www.merckmanuals.com/home/injuries-and-poisoning/sprains-and-other-soft-tissue-injuries/knee-sprains-and-related-injuries), (https://www.niams.nih.gov/health-topics/knee-problems#tab-overview), (https://orthoinfo.aaos.org/en/treatment/knee-arthroscopy/), (https://orthoinfo.aaos.org/en/diseases--conditions/meniscus-tears/), (https://www.physio-pedia.com/Meniscal_Repair). Last reviewed by a Cleveland Clinic medical professional on 04/17/2021. Can I make a meniscus tear worse if I run on it? J Orthop Res 35(8):16251633, Shefelbine SJ, Ma CB, Lee KY, Schrumpf MA, Patel P, Safran MR et al (2006) MRI analysis of in vivo meniscal and tibiofemoral kinematics in ACL-deficient and normal knees. 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. Many recent studies have shown that theres no advantage to surgery with this type of tear, and that physical therapy works just as well. PLoS ONE 9(3):e92901, Article Knee Surg Sports Traumatol Arthrosc 28(11):34163425, Stein T, Mehling AP, Welsch F, von Eisenhart-Rothe R, Jger A (2010) Long-term outcome after arthroscopic meniscal repair versus arthroscopic partial meniscectomy for traumatic meniscal tears. This post goes into considerable detail about managing a knee with arthritis and a complex or degenerative meniscus tear. If these measures do not alleviate a persons symptoms, doctors may recommend surgical options, such as a partial meniscectomy or a meniscus repair. Meniscus PubMed Hart et al. In addition, given that the presence of severe ME promotes rapid progression of knee OA [44, 45], the importance of inhibiting this process and delaying the inevitable total knee replacement (TKR) is critical. The inner two-thirds of the meniscus have only a limited blood supply, which is why doctors call this the white zone. Osteoarthritis Cartilage 13(7):568574, Chan KKW, Sit RWS, Wu RWK, Ngai AHY (2014) Clinical, radiological and ultrasonographic findings related to knee pain in osteoarthritis. 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. Future research should focus on the role of additional centralization of the meniscus during arthroscopic debridement for the treatment of moderate knee OA. Post-ACLR ME is also a concern and should be prevented by repairing concurrent meniscal tears and centralizing the meniscus along with the ACLR. 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. Cant fully bend or straighten your leg without knee pain. David Prado/Stocksy United. However, it has also been hypothesized that MPRT is not the sole contributing factor predisposing to ME. Straighten the opposite knee using the muscles on the front of the thigh. Hold the position for 5 seconds and then relax. To perform this exercise, a person should do the following: An intermediate exercise routine may include straight leg raises. Last medically reviewed on December 21, 2020. PubMed Central Depending on your symptoms, your doctor may recommend a special knee brace or other mechanisms to limit your joint movement and stabilize the knee. The injury also commonly affects older people and those with arthritis in their knees. A true knee lock occurs when something in your knee joint gets stuck and. 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. You can learn more about how we ensure our content is accurate and current by reading our. Although there is still controversy in the literature in respect of the optimal cutoff value, a threshold of 3mm is considered significant. After recovery, your knee will be more stable, and youll be less likely to develop additional knee problems. However, its posterior extrusion progressed significantly regardless of the healing status [90]. These findings suggest that the tension of the graft and the excessive external rotation of the tibia are also factors that can affect the condition of the MM. A novel technique has been developed based on a measurement grid in order to determine the precise aperture of the tibial tunnel. 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. Does a degenerative meniscus tear need surgery? It should be highlighted that the clinical significance of meniscal allograft extrusion has not yet been clearly elucidated, since it is difficult to draw firm conclusions. https://doi.org/10.1186/s43019-019-0019-x, Article A systematic review of radiological outcomes. [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. MAT is a potential surgical procedure for young, active patients with symptomatic meniscal insufficiency that does not respond to conservative treatment [102, 103]. Manage cookies/Do not sell my data we use in the preference centre. After healing occurs, a doctor will recommend a rehabilitation program of exercises to improve range of motion and strength. Knee 26(6):12921298, Zhang ZZ, Zhou YF, Luo H, Zhang HZ, Chen Z, Jiang C et al (2020) A novel surgical technique for arthroscopic repair of type II posterior lateral meniscal root tear. Theres an inner (medial) meniscus and an outer (lateral) meniscus. Cleveland Clinic is a non-profit academic medical center. 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-. Meniscal extrusion or subluxation refers to the peripheral meniscal margin extending beyond the external aspect of the tibiofemoral compartment of the knee.. Chin Med J (Engl) 132(21):25502558, Goto N, Okazaki K, Akiyama T, Akasaki Y, Mizu-uchi H, Hamai S et al (2019) Alignment factors affecting the medial meniscus extrusion increases the risk of osteoarthritis development. Knee Surg Sports Traumatol Arthrosc 23(1):290302, Gelber PE, Torres-Claramunt R, Poggioli F, Prez-Prieto D, Monllau JC (2020) Polyurethane Meniscal Scaffold: Does Preoperative Remnant Meniscal Extrusion Have an Influence on Postoperative Extrusion and Knee Function? Surgery versus conservative treatment for meniscus tears has been a medical topic of controversy for many years. Not all are severe, but some can last longer than others. 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. 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. These are the knee compression sleeves we recommend for stability during exercise. Complex meniscal tears usually require surgery. Historically, MPRT were treated with partial meniscectomy. In general, Ayurvedic treatment considers the whole state of the person, not just the specific location of the pain. On imaging, it is often seen as a meniscal loss with the destruction of expected architecture. An intermediate CAS What is a meniscus injury, and how common is it? A person should make an appointment with a doctor if they experience any of the following: A meniscus injury refers to a tear in one of the menisci within the knee. A threshold of 3mm, which was initially introduced, is most commonly used to define a significant ME [8]. A persons initial exercise routine may include an exercise called hamstring contractions. 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. The rubbery wedges of cartilage act like shock absorbers for your knee, providing cushioning for your bones and knee joint. It is often used with chronic degenerative conditions although some authors also propose this term in the setting of a tear (macerated tear) 2.On imaging, it There is no consensus whether medial or lateral MAT is superior in terms of medium-term (510years) and long-term (>10years) survival. The menisci are pads of cartilage in the knee joint. 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]. Knee Surg Sports Traumatol Arthrosc 27(10):33113317, Costa CR, Morrison WB, Carrino JA (2004) Medial meniscus extrusion on knee MRI: is extent associated with severity of degeneration or type of tear? Arthroscopy 30(11):14241429, Merkely G, Ogura T, Ackermann J, Mestriner AB, Minas T, Gomoll AH (2019) Open meniscal allograft transplantation with transosseous suture fixation of the meniscal body significantly decreases meniscal extrusion rate compared with arthroscopic technique. 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. Reference article, Radiopaedia.org (Accessed on 01 May 2023) https://doi.org/10.53347/rID-70702. Am J Sports Med 44(9):23302338, Parkinson B, Smith N, Asplin L, Thompson P, Spalding T (2016) Factors predicting meniscal allograft transplantation failure. Some meniscus tears require surgery to heal the meniscus and restore the knees range of motion. Incidence and risk factors associated with meniscal injuries among active-duty US military service members. During the meniscus surgery, a small instrument called an arthroscope, which has a camera at its tip, is inserted into your knee. During this procedure, the surgeon inserts a tiny camera (called an arthroscope) through a small incision into your knee. 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. Depending on the size and location of your meniscus tear, it may heal without surgery. VA conceived the idea for the study and supervised the whole study process. The menisci play an important role in stabilizing the knee, easing movement of the knee joint, and absorbing shock from walking and other weight bearing activities. 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. This article discusses what a meniscus injury is, including the different types of meniscus tears. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. Surgery for degenerative meniscus tears is rarely necessary. They will test your range of motion. 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. The precise location of your knee pain can help you narrow down the potential cause. 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]. How can I strengthen my knee meniscus? Causes of the injury include trauma and degenerative changes to the knee joint. 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. 2023 Healthline Media UK Ltd, Brighton, UK. The diagnostic process starts with a medical history and a thorough examination that may include clinical tests. Some clinical studies on its effectiveness exist, but more research is needed. When diagnosing a meniscus tear, a doctor will carry out a detailed medical history and a thorough examination of the knee joint. Careful preoperative planning for correct sizing and accurate placement of the allograft is critical for preventing ME. 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. Beaufils P, et al. 2023 Healthline Media LLC. WebYour doctor will remove a piece of the torn meniscus so your knee can function normally. It usually results from twisting your knee suddenly. 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. WebArthroscopic meniscus repairs typically takes about 40 minutes. If you have surgery to repair a torn meniscus, your knee should be fully recovered after a few months of physical therapy. Here's what you need to know as well as a chart. Therefore, proper placement of the posterior horn is critical to the anatomical repair of the meniscus [125,126,127]. And finally, the proper anatomical placement of the allograft is essential. Younger people, especially athletes, are likely to have a sudden meniscus injury. Most of the meniscus pathologies have recently been correlated with meniscal extrusion [3, 6]. Eur J Orthop Surg Traumatol 28(4):727734, Chernchujit B, Agrawal S (2019) Arthroscopic all-inside medial meniscus extrusion reduction. Meniscal tears: Current understanding, diagnosis, and management. Doral MN, et al. What is the usual treatment for a meniscal tear? Symptomatic meniscal tears are usually treated surgically. If the tear is in an area of the meniscus that has good blood supply, then it will generally be repaired with sutures. 2023 BioMed Central Ltd unless otherwise stated. medial meniscal extrusion is associated with It can lead to pain, swelling, and a sensation of the knee giving way. 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. 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]. However, efforts to standardize or optimize the treatment for MMPRT are much needed. 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]. Recovery after a meniscectomy takes 36 weeks, and recovery after a meniscus repair takes 36 months. [55] verified this hypothesis by performing 66 HTO, where they measured ME with MRI preoperatively and postoperatively, and found that at 6weeks postoperatively, the ME had decreased from a mean of 3.90.6mm to a mean of 0.90.5mm. J Orthop Surg 24(13):97. Following proper treatment and rehabilitation, people can typically resume their pre-injury activities. 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. Healthline Media does not provide medical advice, diagnosis, or treatment. Despite the advances in surgical techniques and the improved methods for the estimation of the implant size, MAT is successful in only up to 75% of patients [2, 16, 109]. Although it has never been reported, it is worth researching, as it could have a beneficial effect. Factors that increase the risk of a meniscus tear include: Doctors classify meniscus tears according to their shape and location. 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. Dawson LJ, et al. A torn or strained meniscus is generally treated with rest, ice, over-the-counter anti-inflammatory medicines and physical therapy. Meniscus tear surgery is very common, with about 850,000 surgeries performed each year in the United States. Strengthen the muscles that support and stabilize your knee. It is a very common injury, especially among people who play sports. Google Scholar, Malas F, Kara M, Kaymak B, Aknc A, zakar L (2014) Ultrasonographic evaluation in symptomatic knee osteoarthritis: clinical and radiological correlation. 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 physical therapist can provide a daily routine of exercises and stretches to improve your muscle strength, flexibility, range of motion, and stability. [31] showed that lateral ME was associated with worsening of patellofemoral joint OA features at 2-year follow-up. 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. 29(4):295301, Moon HS, Choi CH, Jung M, Lee DY, Hong SP, Kim SH (2020) Early surgical repair of medial meniscus posterior root tear minimizes the progression of meniscal extrusion: 2-year follow-up of clinical and radiographic parameters after arthroscopic transtibial pull-out repair. Meniscus tears are very common. [39,40,41]. Google Scholar, Hart HF, Crossley KM, Felson D, Jarraya M, Guermazi A, Roemer F et al (2018) Relation of meniscus pathology to prevalence and worsening of patellofemoral joint osteoarthritis: the multicenter osteoarthritis study.