Meniscal Injuries

Question 1

Meniscal attachments

Answer 1

> Transverse Ligament - connects anterior horns
Coronary Ligaments + horn attachment to tibial plateau
Meniscofemoral ligaments (wrisberg +humphrey) from lateral posterior horn to posterior aspect of medial femoral condyle
medial meniscus blends with MCL + capsule + horns are further apart
* Medial meniscus is less mobile + more commonly injured

Question 2

Vascularisation

Answer 2

> Red - Red = Outer is well vascularised - potential to heal (spindle shaped cells that display cell processes)
Red - White = Middle
White - White = Inner is avascular - poor healing potential (cells= chondrocyte like in appearance)
* Menisci are well vascularised at birth but vessels recede with maturation

Question 3

Meniscal tears

Answer 3

> Most common intra-articular injury
Medial = 5x more common
81% located posteriorly
60% Associated with acl

Question 4

Mechanism

Answer 4

> flexion
rotational forces
under compression
*e.g squatting/twisting/cutting manoeuvres

*may occur degeneratively in elderly

Question 5

Symptoms

Answer 5

> joint line tenderness
signs of effusion
MRI/Imaging - not usually needed (miss 5% of cases anyway)

Question 6

Classification

Answer 6

> Vertical longitudinal
- may not disrupt biomechanics
- possibly asymptomatic
Vertical Radial (Bucket handle)
- likely to disrupt biomechanics - locking
- white-white region is affected
- outer fibres are disrupted - impairs loading ability
Horizontal
- usually stable - can give rise to flap (splits to upper/lower)
Oblique
- gives rise to flap = mechanically unstable
- catching/locking
Complex/Degenerative
- 2 or more types of tear
- common in elderly - associated with OA

Question 7

Treatment

Answer 7

> Surgical removal or repair

likely to lead to OA so best to leave intact if possible