Meniscal tears

Meniscal tears
Meniscal tears are common knee injuries. Athletes, particularly those who play contact sports, are at great risk for meniscal tears. However, anyone at any age can tear a meniscus. When people talk about torn cartilage in the knee, they are usually referring to a torn meniscus.


Meniscus anatomy
The knee joint is formed by the femur, the tibia, and the patella.Two wedge-shaped pieces of cartilage act as "shock absorbers" between the femur and the tibia. These are called meniscus. They are tough and rubbery to help cushion the joint and keep it stable.

 



The barrier effect of menisci, in rolling of the condyles on tibia.

The meniscus tear.
Tears are noted by how they look, as well as where the tear occurs in the meniscus. Common tears include longitudinal, parrot-beak, flap, bucket handle, and mixed/complex. Sports-related meniscal tears often occur along with other knee injuries, such as anterior cruciate ligament tears.Sports-related meniscal tears often occur along with other knee injuries, such as anterior cruciate ligament tears.


Pivot action


Meniscus tear

Common types of tears
Tear mechanism

Meniscal tears often happen during sports. Players may squat and twist the knee, causing a tear. Direct contact, like a tackle, is sometimes involved.Older people are more likely to have degenerativetears. Aged, worn tissue is more prone to tears. Just an awkward twist when getting up from a chair may be enough to cause a tear, if the menisci are weakened.




Symptoms
The patient might feel a "pop" when a meniscus tear is done. Most people can still walk on their injured knee. Many athletes may keep playing with a tear. Over 2 to 3 days, the knee will gradually become more stiff and swollen.
The most common symptoms of meniscal tear are: pain, swelling, locking especially in bucket tears, the sensation of "giving way" and sometimes inability to move the knee through its full range of motion.



Mc Murray test

Physical Examination and Patient History
Usually there is tenderness along the joint line where the meniscus sits. This often signals a tear.
One of the main tests for meniscal tears is the McMurray test. The test is performed bending the knee, and then extending and rotating it. This lead to tension on a torn meniscus. If a meniscal tear is present, this movement will cause a clicking sound. The knee will click each time the examiner does the test.

X-rays.
X-rays do not show meniscal tears, they may show other causes of knee pain.

Magnetic resonance imaging (MRI).
This imaging method can create better images of the soft tissues.


Meniscus tear - MRI imaging

Treatment
Treatment of a meniscus tear will depend on the tear type, its size and location.
The outside one-third of the meniscus has a rich blood supply. A tear in this "red" zone may heal on its own, or can often be repaired with surgery. A longitudinal tear is an example of this kind of tear.


If meniscus tear is located at the lateral third of its width, is a good prognostic factor for healing.

In contrast, the inner two-thirds of the meniscus donot have a rich blood supply. Without nutrients from blood, tears in this "white" zone cannot heal. These complex tears are often in thin, worn cartilage. Because the pieces cannot grow back together, tears in this zone are usually surgically trimmed away.

According to the type of tear, the age, the activity level and any related injuries the surgeon decides to the treatment plan.



Nonsurgical Treatment
If a tear is small and on the outer edge of the meniscus, it may not require surgical repair. As long as the symptoms do not persist and the knee is stable, nonsurgical treatment is the choice.

RICE.
The RICE protocol is effective for most sports-related injuries. RICE stands for Rest, Ice, Compression, and Elevation.Rest. Avoid the activity that caused the injury. You may need crutches for a while.Ice. Cold packs for 20 minutes at a time, several times a day.Compression. To prevent additional swelling and blood loss, wear an elastic compression bandage.Elevation. To reduce swelling, recline when you rest, and put your leg up higher than your heart.

Non-steroidal anti-inflammatory medicines. These drugs may reduce pain and swelling.


Surgical Treatment
If symptoms persist with nonsurgical treatment, the doctor may suggest arthroscopic surgery.

Procedure.
Knee arthroscopy is one of the most commonly performed surgical procedures. In it, a miniature camera is inserted through a small incision. This provides a clear view of the inside of the knee. The orthopaedic surgeon inserts miniature surgical instruments through other small incisions to trim or repair the t


Excising the torn part of the meniscus


Suture repair of meniscus tear

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