Knee: Meniscus



Introduction:


Meniscii are highly specialised cartilaginous tissue acting as shock absorbers in the knee. Typically C-shaped, they can occasionally be discoid and help to improve the conformity of the tibial surface to convex femoral condyle.


Meniscal injury typically occurs due to a twisting injury, most often due to twisting of upper body on a planted foot while playing sports. Presence of a previous untreated cruciate ligament injury increases the risk of a subsequent meniscal tear manyfold.


Types of meniscal tear:


There are several types of meniscal tear. Horizontal, vertical, radial or complex.

Whether a meniscal tear heals up or not depends on the actual location of the tear. If the tear is in the periphery of the meniscus, it is more likely to heal due to the presence of lush bloody supply. (Classified as RED-RED tear vs WHITE-WHITE tear where there is no blood supply).


Diagnosis:


The diagnosis of meniscal tears can be clinical with main symptoms of pain on the side of the joint where there is a meniscal tear, clunking in the knee and intermittent locking of the knee. The main sign is joint line tenderness, and positive McMurrays test. Most often the diagnosis is based on an MRI scan which is highly sensitive and specific in picking up meniscal tears.




Treatment:


Meniscal tears rarely ever heal without treatment. Occasionally conservative treatment may help heal a peripheral tear with immobilisation, controlled ROM exercises, and avoiding sports/activities.

Most often they need surgery to repair and fix the tear to allow them to heal up. The aim of surgical treatment should always be to preserve the meniscus as much as possible.

Current techniques allow the meniscus to be fixed entirely from inside during a Keyhole surgery (Arthroscopic meniscal repair).

Rarely in complex irreparable tears, the meniscus will need to be excised/trimmed out.


Total meniscectomy is to be avoided as this results in accelerated degeneration of the articular cartilage and early arthritis.


For more information about specific meniscal tear or specific MRI findings of meniscal injuries, click on www.askthebonedoc.com/book-online.



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