ICD 9 Codes: 717.4 derangement of the lateral meniscus 717.3 derangement of the medial meniscus 836.0 lateral meniscus tear 836.1 medial meniscus tear Case Type / Diagnosis: Functional Anatomy: The menisci are semi lunar shaped cartilages on the medial and lateral sides of the knee joint. In addition to categorizing meniscal tears based on morphology, care should be taken to describe the exact location of meniscal tears. A tear can also develop slowly as the meniscus loses resiliency. In many cases, rehabilitation can be carried out at home, although your doctor may recommend working with a physical therapist. 2nd ed. Although all bucket handle tears are repair candidates,16 the bucket handle tear is an example of when the more severe appearing tear is actually better for the patient. 17 Old Kings Road N., Suite K Palm Coast, FL 32137, East Coast Surgery Center If you have a meniscus tear, this movement may cause pain, clicking, or a clunking sensation within the joint. Your meniscus acts like a cushion between your thigh bone (femur) and shin bone (tibia). How can I tell if I have an oblique fracture? (Right) Flap tear. The menisci of the knee have several important roles: The medial meniscus is 'C' shaped whereas the lateral is a shorter incomplete circle with closer spaced 'horns'. With regard to tear morphology, the classic ideal candidate for meniscal repair is the peripheral longitudinal tear. Types of meniscus tears:(Left) Bucket handle tear. This information is not intended as a substitute for professional medical care. The oblique meniscomeniscal ligament is but one of several known structures that can mimic meniscal pathology. In many areas, nonessential orthopaedic procedures that were postponed due to COVID-19 have resumed. Displaced meniscal tears are by definition unstable, and should be repaired relatively quickly, as displaced meniscal fragments may fibrose and distort, making delayed repair difficult or impossible. Torn meniscus symptoms Symptoms are usually sudden onset, however, can develop gradually over time. Know what to expect if you do not take the medicine or have the test or procedure. Referral to an orthopaedic surgeon is important if the diagnosis is uncertain or there is minimal improvement at clinical review. 1. apalia R, Del Buono A, Osti L, Denaro V, Maffulli N. Meniscectomy as a risk factor for knee osteoarthritis: a systematic review. They may not even be apparent with an arthroscopic examination. Think before you speak. Meniscal repair using an exogenous fibrin clot. Meniscus tears, indicated by MRI, are classified in three grades. Two months later, the post-operative image (17b) reveals a repaired, normal appearing lateral meniscal body (arrow), with resolution of the previously seen displaced fragment. oblique ligament, and the . Grades 1 and 2 are not considered serious. Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other abusable medications. The operative equipment needs and post-operative rehabilitation process markedly differ between meniscal repair and partial meniscectomy. All Rights Reserved. There may be some pain. These are often 'bucket-handle tears', in which there is a vertical or oblique tear in the posterior horn running toward the anterior horn,5 forming a loose section which remains attached anteriorly and posteriorly.1 In older patients, tears are generally due to degeneration associated with ageing and tend to be horizontal tears. In the early days of MR, it was often felt that the role of MR was simply to identify whether a tear was present or not, and treatment of meniscal tears was largely composed of operative resection. A meniscus tear is an injury to one of the bands of rubbery cartilage that act as shock absorbers for the knee. Rotator Cuff and Shoulder Conditioning Program. This most often happens when the tear develops over a period of time. If the knee is still painful, or if it locks, your doctor may recommend surgery. RICE stands for Rest, Ice, Compression, and Elevation. Arthroscopic partial meniscectomy The goal of this surgery is to remove a small piece of the torn meniscus in order to get the knee functioning normally. You will start with exercises to improve your range of motion. I read on a medical site that it is difficult to get to the posterior horn of the meniscus and sometimes there is a need to make an incision or the knee becomes dislocated. A meniscus tear can occur when the knee is suddenly twisted while the foot is planted on the ground. History, clinical findings, magnetic resonance imaging, and arthroscopic correlation in meniscal lesions. For patients whose procedures have not yet been rescheduled:What to Do If Your Orthopaedic Surgery Is Postponed. Explains two kinds of surgery. This region of the outer meniscus, sometimes referred to as the red zone, is thought to occupy approximately 15% of the peripheral meniscus.4 Tears that occur within the red zone of the meniscus are more likely to heal than those in the avascular, white zone of the meniscus. Parrot Beak Tear: MRI Horizontal cleavage, oblique, and complex meniscal tear patterns have traditionally been poor candidates for meniscal repair. Fat-suppressed coronal images demonstrate before and after images following repair of a bucket handle tear. London;1897. Not the symmetrical shape of the lateral meniscus (red outline) and the asymmetry of the medial meniscus (blue outline), where the posterior horn (asterisk) is significantly larger than the anterior horn. Meniscus surgery is a common operation to remove or repair a torn meniscus, a piece of cartilage in the knee. All rights reserved. Clin Sports Med 2010;29:81106. (Left) Radial tear. Location -A tear may be located in the anterior horn, body, or posterior horn.A posterior horn tear is the most common. Evaluation of meniscal injury accounts for most requests for MR imaging of the knee at most institutions. Psterior horn of medial meniscus Poterior oblique ligament . Another exam finding is palpating the anteromedial joint line, while placing a varus stress on a fully extended knee and feeling for meniscal extrusion. Radial tears, because they are oriented perpendicular to the c-shaped fibers of the meniscus, have a devastating effect upon meniscal function. Apley test (grinding) test: The patient lies prone, with their knee flexed to 90 degrees and their hip extended. The meniscus can tear from acute trauma or as the result of degenerative changes that happen over time. Meniscus tears are either degenerative or acute. Collateral and cruciate ligaments are intact. Unhappy Triad: Stress is put on medial side of the knee which potentially tears three related structures Repair is sometimes attempted even with these tear types, particularly when the patient is young and substantial loss of meniscal tissue would lead to an unacceptable risk of future arthritis.11 Repair of these challenging tear types should only be attempted when the meniscal tissue is of good quality and a stable result is achievable. A meniscectomy requires less time for healing approximately 3 to 6 weeks. Because a torn meniscus is made of cartilage, it won't show up on X-rays. Meniscal pain occurs during torsional, weight bearing knee movements (classically pivoting on the knee while walking) as a sharp stab lasting several seconds, often followed by a dull ache for several hours. It is possible that your symptoms of pain, etc will improve with time without surgery.But that doesn't mean the tear healed. HealthTap uses cookies to enhance your site experience and for analytics and advertising purposes. The menisci are two rubbery disks that help cushion the knee joint. Singapore: World scientific, 2010. AJR Am J Roentgenol 1998;170:5761. Meniscal tears may be categorized into five common configurations, including horizontal, longitudinal, radial, oblique (parrot-beak), and complex.5 Horizontal tears, the most common meniscal tear pattern, lie parallel to the tibial plateau and separate the meniscus into upper and lower parts (4a,4b). The outer one-third of the meniscus has a rich blood supply. However, meniscus tears do not always appear on MRIs. About OrthoInfoEditorial Board Our ContributorsOur Subspecialty Partners Contact Us, Privacy PolicyTerms & Conditions Linking Policy AAOS Newsroom Find an FAAOS Surgeon. X-rays provide images of dense structures, such as bone. I could not really walk on it. Verdonk PC, Demurie A, Almqvist KF, Veys EM, Verbruggen G, Verdonk R. Transplantation of viable meniscal allograft. Meniscal intra-substance signal abnormalities are defined as an increased signal that does not fulfill the criteria for a meniscal tear according the "two-slice-touch" rule (i.e., it does not reach the meniscal surface on two consecutive views) and is a common finding on routine MRI of the knee (Fig. These injuries have been reported to change joint loading due to failure of the meniscus to convert axial loads into hoop stresses. In older patients, referral is appropriate if conservative management fails to improve symptoms. Clin Orthop Related Res 2010;468:11902. You can tear a meniscus during any activity which involves forcefully twisting or rotating the knee. This often causes the knee to become stuck due to a portion of the meniscus blocking the knees normal motion. swelling . The posterior horn is located on the back half of the meniscus. Principles and decision making in meniscal surgery. These tendons have poor blood supply and will not heal themselves. J Fam Pract 2001;50:93844. The menisci the medial meniscus and lateral meniscus - are crescent-shaped bands of thick, rubbery cartilage attached to the shinbone (tibia). If your meniscus tear is not severe, your doctor will likely recommend the following treatment: If you have a meniscus tear, physical therapy can help to strengthen the muscles around the knee as well the muscles in your legs which in turn will stabilize and support the knee. Have swelling, stiffness or tightness in your knee. These tears often occur in association with ACL tears, but even if found in isolation, are highly likely to be clinically relevant, as the displaced meniscal fragment frequently results in knee locking. Submission to the Department of Health and Ageing. If the test is positive (suggesting a meniscal tear), the patient will feel pain and the clinician will feel and/or hear meniscal movement when the meniscus is compressed between the tibia and femur 32, Figure 2. It is estimated that only 10% of the injuries involving the tear of posterior horn medial meniscus are repairable. If you have a meniscus tear, this movement may cause pain, clicking, or a clunking sensation within the joint. It is important to describe your symptoms accurately. Meniscal tears within the body of the meniscus or at the meniscocapsular junction represent a well-understood and manageable condition encountered in clinical practice. Depending on the severity of the injury, surgical repair may or may not be needed. The lateral meniscus is on the outside of the knee. This extrusion should disappear without stress. Surgical treatment is usually reserved for younger patients with a vertical longitudinal tear within the vascularised outer third of the meniscus. Arthroscopy 2010;26:13689. Makris EA, Hadidi P, Athanasiou KA. They will also consider the type, size, and location of the injury. Knee Surg Sports Traumatol Arthrosc 2007;15:393401. While visualization of the meniscal root may be difficult due to MRI slice size, type of MRI and strength of MRI, an extrusion larger than 3 mm highly correlates with a root tear. There are numerous treatments for meniscus tears, but treatment generally begins conservatively depending on the location, type, and size of the tear. M23.322 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. These tears can be challenging to recognize on MRI,9 but are important to diagnose since they are often highly symptomatic due to a reactive synovitis. Displacement of the inner rim of the tear (arrowheads) results in the classic "bucket-handle" configuration. In the present case, a full-thickness radial tear of the medial meniscus is visualized (Fig 1).An arthroscopic torpedo shaver (Arthrex, Naples, FL, U.S.A.) is used to debride the meniscus tear edges back to a healthy, stable rim (Fig 2).For improved access to the medial meniscus, an 18-gauge spinal . Full thickness tears are the complete disruption of the fibers of the supraspinatus muscle, and generally require a more aggressive treatment plan and surgery. This tear pattern was historically unrecognized, although more recently it has been suggested this hidden pathology may account for nearly 80% of the total knee replacements in patients younger than 60 years. The meniscus root attachment aids meniscal function by securing the meniscus in place and allowing for optimal shock-absorbi Meniscal repairs are more likely to be successful when performed near the time of injury. Most people can still walk on their injured knee, and many athletes are able to keep playing with a tear. Studies have also reported that patients who underwent a repair of the posterior root in the medial meniscus slowed the progression of arthritic changes compared with those who had a meniscectomy; although, this did not completely prevent the arthritic changes. 3 Thornton DD, Rubin DA. Horizontal tear posterior horn medial meniscus, Tear of posterior horn of medial meniscus treatment, Horizontal tear posterior horn and body medial meniscus, Body and posterior horn of the medial meniscus, Homeopathy treatment posterior horn medial meniscus. Choose a doctor and schedule an appointment. X-rays and MRIsallow the doctor to evaluate the bone and soft tissue at the knee. Procedure. Tears present as severe pain, swelling, and possibly catching, clicking, difficulty on deep knee bending and locking of the knee in partial flexion. Symptomatic treatment with rest, ice, NSAIDs and/or an unloader brace may help alleviate symptoms in some cases. Semin Roentgenol. Radiology 2000; 217:193-200. Although surgical repair has led to improved patient-reported function, there are conflicting reports on the progression of cartilage degeneration. 14 Marzo JM, Kumar BA. This opening pushes the inside edge of your meniscus toward the middle of your knee. The tear should be eight millimeters or more in length, as shorter peripheral longitudinal tears are less likely to be symptomatic and may heal spontaneously. AJR 2003; 180:93-97. Complex or degenerative tears are where two or more tear patterns exist. The medial meniscus is on the innermost side of your knee (the C-shaped curve faces in toward your body, the opposite knee). The absent bow tie sign in bucket-handle tears of the menisci in the knee. One of the most common knee injuries is a torn meniscus. 1 article features images from this case One of the main tests for meniscus tears is the McMurray test. Meniscal repair is a more difficult surgical technique and requires a motivated, diligent patient in order to be successful. controlling the movements of the knee joint. Two wedge-shaped pieces of fibrocartilage act as shock absorbers between your femur and tibia. It has the shape of two C's. The medial meniscus is the C shape on the knee's inner side, and the lateral meniscus is the C shape on the outer side of the knee. Also know what the side effects are. Similarly, tears that are not associated with locking of the knee will typically become less painful over time. Complex degenerative tear. Of note, drilling tibial tunnels may improve healing of the meniscus-bone interface due to the presence of progenitor cells and growth factors derived from the bone marrow. At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. With proper diagnosis, treatment, and rehabilitation, patients often return to their pre-injury abilities. The Thessaly test is the most sensitive and specific clinical test to diagnose meniscal injury. It is therefore quite important in treatment planning for the pre-operative MR to provide information that can be used to determine whether meniscal repair rather than partial meniscectomy is to be performed. This means that athletes, especially those who participate in contact sports like football, are at a higher risk of sustaining this injury. Biomechanical studies have demonstrated that repair of medial meniscus posterior root tears leads to improved contact mechanics. As recognition of the critical function of the menisci in normal biomechanical function of the knee has grown, attempts at preserving meniscal tissue via repair as opposed to partial meniscectomy have also gained favor. Orthop Clin North Am. This type of tear is particularly devastating to meniscal function. Your doctor may inject a corticosteroid medication into your knee joint to help eliminate pain and swelling. pivoting). However, coronal sections may reveal the presence of meniscal extrusion or vertical defects, and sagittal sections may reveal the ghost sign (absence of an identifiable meniscus or increased signal replacing the normal hypointense signal of meniscal tissue). Br Med Bull 2007;84:523. McMurray (Figure 1) and Apley tests (Figure 2) are often positive, although these are specific but not sensitive specificity being 5798% and 8099%, and sensitivity being 1066% and 1658% respectively.2,9 The most useful clinical test for meniscal injury is the Thessaly test, which is demonstrated in Figure 3. A medial meniscus tear on the inside of the knee is more common.