If the repaired meniscus failed to heal, lateral extrusion progressed significantly [92]. However, it remains unknown whether it is capable of delaying or modifying OA progression, and further research is warranted [32, 48, 49]. The inner two-thirds of the meniscus have only a limited blood supply, which is why doctors call this the white zone. 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. During this procedure, the surgeon inserts a tiny camera (called an arthroscope) through a small incision into your knee. If the tear is too big to repair, your surgeon may remove all or part of the meniscus. 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. Your doctor may give you a joint injection of glucocorticoids to reduce swelling. In this review, we delineate the clinical significance of ME in various knee pathologies, as well as when, why and how it should be managed. Conservative treatment constitutes the first line of therapy in mild or moderate knee OA [46, 47]. Often, athletes and people who play sports for fun suffer meniscus tears. 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]. (2017). Bhan, K. (2020). This value is identified as the optimal cutoff point for a complete PRT of the LM and has 100% sensitivity and 83% specificity [92]. 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. 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? Without surgery, recovery will take about 6 to 8 weeks, though this can vary. Terms and Conditions, People who play sports (like tennis, soccer, basketball or football) that involve sudden twisting movements are most likely to tear a meniscus. https://doi.org/10.1186/s43019-019-0019-x, Article Have swelling that doesnt go away with a few days of RICE and taking NSAIDs. Recovery after a meniscectomy takes 36 weeks, and recovery after a meniscus repair takes 36 months. WebYour doctor will remove a piece of the torn meniscus so your knee can function normally. CAS These fibers specifically act on the LM anterior root attachment itself, explaining the reduction in the ultimate failure of the anterior root strength of the LM with disruption of these fibers [87, 93]. A more posterolateral placement of the tibial tunnel aperture may induce extrusion of the LM following ACLR. 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]. 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? This study was exempted from the requirement for local institutional review board approval as it is a narrative review of the literature. 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. The outer one-third of the meniscus has a blood supply, and so doctors refer to this area as the red zone. Although it has never been reported, it is worth researching, as it could have a beneficial effect. Eur Radiol 30(7):39964004, Svensson F, Felson DT, Turkiewicz A, Guermazi A, Roemer FW, Neuman P et al (2019) Scrutinizing the cut-off for pathological meniscal body extrusion on knee MRI. [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. What are signs the injury is getting worse instead of healing? The menisci can be torn or strained by any rotation or twisting motion that puts stress on the knee. The medial meniscus covers 5060% of the medial tibial plateau, and the lateral meniscus covers 7080% of the lateral tibial plateau. 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? Cite this article. Meniscal allograft extrusion causes incongruity with the femoral condyle, and therefore the allograft cannot perform normal load transmission and shock absorption. Google Scholar, Ozeki N, Seil R, Krych AJ, Koga H (2021) Surgical treatment of complex meniscus tear and disease: state of the art. 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. Meniscal extrusion (ME) is a radiological finding, especially in magnetic resonance imaging (MRI) scans, for which there has been growing interest in recent years. Rheumatol Oxf Engl 53(9):16251629, Podlipsk J, Koski JM, Kaukinen P, Haapea M, Tervonen O, Arokoski JP et al (2017) Structure-symptom relationship with wide-area ultrasound scanning of knee osteoarthritis. Meniscus tears are the most frequently treated knee injuries. 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. This article discusses what a meniscus injury is, including the different types of meniscus tears. 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. Although in mild/moderate knee OA there is still no specific treatment targeting ME, the established conservative and operative treatment modalities seem equally successful in delaying the progression of OA and improving symptoms when ME is also present. Torn Meniscus: Causes, Symptoms, Treatments, 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. 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. A physical therapist can provide a daily routine of exercises and stretches to improve your muscle strength, flexibility, range of motion, and stability. PLoS ONE 9(3):e92901, Article CAS More serious meniscus tears may not heal on their own. J Orthop Surg Hong Kong 28(1):2309499020906745, McCormack DJ, Puttock D, Godsiff SP (2021) Medial compartment osteoarthritis of the knee: a review of surgical options. Reference article, Radiopaedia.org (Accessed on 01 May 2023) https://doi.org/10.53347/rID-70702. Symptoms include pain in the hip or stiffness. 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. Torn shoulder labrum: Causes, symptoms, and treatment Red-red tears are within the red zone, and red-white tears have central margins that extend into the white zone. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 28(4):11771194, Swamy N, Wadhwa V, Bajaj G, Chhabra A, Pandey T (2018) Medial meniscal extrusion: detection, evaluation and clinical implications. 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? Can I make a meniscus tear worse if I run on it? In a biomechanical study, Paletta et at. A person may feel a pop when they tear the meniscus. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Knee Surg Relat Res. Finally, meniscal allograft extrusion is also associated with subchondral bone marrow lesions and cysts [2, 115]. 2023 Healthline Media LLC. During the meniscus surgery, a small instrument called an arthroscope, which has a camera at its tip, is inserted into your knee. Antony B, Driban J, Price L et al. Most of the meniscus pathologies have recently been correlated with meniscal extrusion [3, 6]. PubMed Younger people, especially athletes, are likely to have a sudden meniscus injury. 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 Jones JC, et al. Am J Sports Med 38(8):15421548, Yanagisawa S, Kimura M, Hagiwara K, Ogoshi A (2020) Association between postoperative meniscal extrusion and clinical outcomes of the pullout fixation technique for medial meniscus posterior root tear. View Yuranga Weerakkody's current disclosures, see full revision history and disclosures, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, Ahlback classification system in assessing osteoarthritis of the knee joint, Kellgren and Lawrence system for classification of osteoarthritis, anterior cruciate ligament mucoid degeneration, MRI grading system for meniscal signal intensity. However, efforts to standardize or optimize the treatment for MMPRT are much needed. Moreover, it has been shown that allograft extrusion does not correlate with clinical outcomes and tends to be stable postoperatively during follow-up [62, 108, 113]. Meniscus tear surgery is very common, with about 850,000 surgeries performed each year in the United States. Your healthcare provider may recommend taking a nonsteroidal anti-inflammatory (NSAID) medicine (such as ibuprofen or aspirin) to relieve pain and reduce swelling. 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). Although meta-analyses validate the superiority of root repair over partial meniscectomy in terms of clinical outcomes, they also highlight the inability of root repair to successfully reduce ME [68, 69]. 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 49(3):684692, Ichiba A, Makuya K (2012) Radial displacement of the lateral meniscus before and after anterior cruciate ligament reconstruction. 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. Using the back of a chair for support, stand upright. Surgery for degenerative meniscus tears is rarely necessary. Osteoarthritis Cartilage 26(7):912919, Roubille C, Martel-Pelletier J, Abram F, Dorais M, Delorme P, Raynauld JP et al (2015) Impact of disease treatments on the progression of knee osteoarthritis structural changes related to meniscal extrusion: data from the OAI progression cohort. Meniscus injury: Types, symptoms, treatment, and more 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. An MRI will confirm a suspected diagnosis. Being unable to fully bend or straighten your leg. What is a meniscus injury, and how common is it? MAT is a potential surgical procedure for young, active patients with symptomatic meniscal insufficiency that does not respond to conservative treatment [102, 103]. ME depends largely on the severity and type of tear [87, 89, 91]. J Orthop Sci 25(4):640646. 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. MK, VSI and GP participated in the study design and helped to draft the manuscript. Medial meniscus posterior root tear: a comprehensive Webinferior leaet of the meniscus tear. If you have surgery to remove all or part of your meniscus, you may be at higher risk of developing arthritis down the road. Unable to process the form. Hold the position for 5 seconds and then relax. It has been suggested that a 510% reduction of implant size from the estimated one reduces postoperative extrusion [2, 105, 123]. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 31(9):18081816, Jeon SW, Jung M, Choi CH, Kim SG, Kim SH (2021) Factors related to meniscal extrusion and cartilage lesions in medial meniscus root tears. The Relationship Between Meniscal Pathology and Osteoarthritis Depends on the Type of Meniscal Damage Visible on Magnetic Resonance Images: Data from the Osteoarthritis Initiative. Radiographics. Following proper treatment and rehabilitation, people can typically resume their pre-injury activities. 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. WebArthroscopic surgery. Some clinical studies on its effectiveness exist, but more research is needed. If your injury doesnt improve with RICE, NSAIDs and physical therapy, your healthcare provider may recommend arthroscopic surgery. All rights reserved. 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 above part of the examination does not always lead to a diagnosis. 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. However, further investigation is needed to evaluate the effect of the ACLR on the restoration of the MM function [88]. When diagnosing a meniscus tear, a doctor will carry out a detailed medical history and a thorough examination of the knee joint. Arthrosc Tech 10(1):e43e48, Okazaki Y, Furumatsu T, Miyazawa S, Kodama Y, Kamatsuki Y, Hino T et al (2019) Meniscal repair concurrent with anterior cruciate ligament reconstruction restores posterior shift of the medial meniscus in the knee-flexed position. 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. Generally speaking, the treatment options for meniscus tears include: rest, physical therapy, activity modification, and occasionally a surgery we refer to as an 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. Physical therapy generally leads to a good outcome. Fig 3. If you have surgery to repair a torn meniscus, your knee should be fully recovered after a few months of physical therapy. Google Scholar, Raynauld JP, Martel-Pelletier J, Bias P, Laufer S, Haraoui B, Choquette D et al (2009) Protective effects of licofelone, a 5-lipoxygenase and cyclo-oxygenase inhibitor, versus naproxen on cartilage loss in knee osteoarthritis: a first multicentre clinical trial using quantitative MRI. It permits immediate weight bearing following surgery and provides a full range of motion soon afterward. A narrative review with focus on relevance for osteoarthritis research. To perform this exercise, a person should follow these steps: An advanced exercise routine may include an exercise that involves partially bending the knee. Improper positioning of the posterior horn causes a similar deviation to the anterior horn. Those that are caused by an injury are often the ones that can be, A meniscectomy is a procedure that repairs a torn meniscus. J Orthop Surg 24(13):97. 2014;34(4):981-99. Arthroscopy 32(10):20002008, Chernchujit B, Prasetia R (2018) Arthroscopic direct meniscal extrusion reduction: surgical tips to reduce persistent meniscal extrusion in meniscal root repair. Today, in general, doctors recommend conservative treatment, not surgery, when meniscus tears result from degeneration. Privacy PolicyThe information on this site is not intended or implied to be medical advice, diagnosis, or treatment. Associations. Treatments for macerated skin caused by wounds include specific types of bandages and dressings, including: Occlusive dressings. (2018). 3. 3). 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. According to the American Academy of Orthopaedic Surgeons, treatment of a meniscus tear depends on the location of the injury, alongside other factors, including a persons: Below, we outline some potential treatment options. Orthop J Sports Med. It can happen playing sports, exercising or just doing daily activities. 2. Complex meniscal tears usually require surgery. Adv Orthop. J Knee Surg 34(2):178186, Furumatsu T, Kodama Y, Kamatsuki Y, Hino T, Okazaki Y, Ozaki T (2017) Meniscal extrusion progresses shortly after the medial meniscus posterior root tear. Knee Surg Sports Traumatol Arthrosc 27(2):361368, Jacob G, An S, Kumar G, Varghese J (2020) Percutaneous arthroscopic assisted knee medial collateral ligament repair. This site should be used for informational purposes only. Dawson LJ, et al. A systematic review of radiological outcomes. WebItll help increase your range of motion and help your knee get stronger. It also outlines symptoms, diagnosis, and treatment and provides information on when to contact a doctor. Therefore, the relative values may be significant [17]. Surgical treatment of complex meniscus tear and an assessment by MRI and arthroscopy. This suggests that if patients with minimal degeneration and accurate indications undergo MAT with a well-placed graft, the graft extrusion will be minimal and the results will remain unchanged. Sonographic evaluation of lateral meniscal extrusion: implementation and validation|SpringerLink [Internet]. 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]. 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]. Meniscus As a result, post-traumatic transposition and degeneration of the MM may not be completely prevented by ACLR alone. There is no consensus whether medial or lateral MAT is superior in terms of medium-term (510years) and long-term (>10years) survival. You may also get imaging tests, such as X-rays or an MRI, to assess the damage. [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. Therefore, proper placement of the posterior horn is critical to the anatomical repair of the meniscus [125,126,127]. Healthline Media does not provide medical advice, diagnosis, or treatment. 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 A hip labral tear can be treated nonsurgically, or with surgery in severe cases. Slowly raise the extended leg 12 inches from the floor and then slowly lower it back. To the best of our knowledge, the exact clinical significance of ME after ACLR has not yet been clearly elucidated, although efforts are continuously being made to minimize this phenomenon. 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]. Meniscal extrusion or subluxation refers to the peripheral meniscal margin extending beyond the external aspect of the tibiofemoral compartment of the knee.. PubMed This puts tension on a torn meniscus. Am J Roentgenol 216(5):13181328, Teichtahl AJ, Cicuttini FM, Abram F, Wang Y, Pelletier JP, Dodin P et al (2017) Meniscal extrusion and bone marrow lesions are associated with incident and progressive knee osteoarthritis. Usually you will be able to leave the hospital the same day. Severe Meniscus Tear: Treatment Options 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. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. However, it is still controversial whether meniscal pathology leads to osteoarthritis (OA), or vice versa. A novel technique has been developed based on a measurement grid in order to determine the precise aperture of the tibial tunnel. Your provider may recommend knee arthroscopy to better view and accurately diagnose your injury. 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. A persons initial exercise routine may include an exercise called hamstring contractions. Adv Orthop. 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. 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. A critical review of the literature. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. An individual should seek guidance from a physical therapist about which exercises to perform to assist their healing. Knee Surg & Relat Res 34, 35 (2022). Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. David Prado/Stocksy United. However, to date there is still no well-designed clinical trial available to ascertain the effectiveness of centralization in reducing ME. Note that meniscectomy may cause osteoarthritis in the long term. 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. For an athlete, playing through knee pain can cause greater problems later. 2017;25(1):76-84. (ACLR+LM tears left in situ) showed narrowing of 1.0mm at 10-year follow-up [96, 97]. Meniscal tears are grossly divided into degenerative and traumatic [3]. Conservative treatment is recommended for tears associated with the wear and tear of age. On the other hand, the suture-only technique has its own advantages and is therefore chosen by many surgeons [104, 111]. Babu J, et al. Medial Compartment Osteoarthritis