Meniscal Injury

Question 1

Epidemiology

Answer 1

• MC indication for knee surgery

- higher risk in ACL deficient knees

Question 2

Medial Tears- Intro

Answer 2

• More common than lateral tears

- Exception is in the setting of an acute ACL tear where lateral tears are more common

Question 3

where do degenerative medial tears in older patients tend to occur?

Answer 3

posterior horn medial meniscus

Question 4

Lateral Tears- More common when

Answer 4

acute ACL tears

Question 5

Descriptive Classification

Answer 5

• location
• size
• pattern

Question 6

Descriptive Classification- Location

Answer 6

1. red zone
2. red-white zone
3. white zone

Question 7

Red zone

Answer 7

outer third, vascularized

Question 8

Red-white zone

Answer 8

middle third

Question 9

white zone

Answer 9

inner third, avascular

Question 10

Descriptive Classification- Pattern

Answer 10

1. vertical/longitudinal
2. Bucket handle
3. oblique/flap/parrot beak
4. radial
5. horizontal
6. complex

Question 11

vertical/longitudinal tear

Answer 11

• common, esp with ACL tear

- repair when periph

Question 12

bucket handle tear

Answer 12

-vertical tear which may displace into the notch

Question 13

oblique/flap/parrot beak tear

Answer 13

-may cause mechanical locking symptoms

Question 14

horizontal tear

Answer 14

• more common in older population

- may be a/w meniscal cysyts

Question 15

Symptoms

Answer 15

• pain localizing to medial or lateral side
• mechanical symptoms (locking and clicking)
• delayed or intermittent swelling

Question 16

Exam

Answer 16

• joint line tenderness
• effusion
• provocative tests (Apley, Thessaly and McMurray)

Question 17

Apley Compression Test

Answer 17

• Prone
• bend affected knee to 90 p
• axial force and rotate tibia
• distraction force and rotate tibia

Question 18

Thessaly Test

Answer 18

• standing at 20 degrees of knee flexion on the affected limb, the patient twists with knee external and internal rotation
• positive test = discomfort or clicking

Question 19

McMurray’s Test

Answer 19

• flex the knee and place a hand on the medial side of the knee, externally rotate the leg and bring the knee into extension
• palpable pop/click + pain is a positive test and can correlate with medical meniscus tear

Question 20

Treatment- Nonop

Answer 20

rest, nsaids rehab

Question 21

rest, nsaids rehab

Answer 21

indications

- first line tx degenerative tears

Question 22

Treatment- operative

Answer 22

1. Partial Meniscectomy
2. Meniscal Repair
   3, Meniscal transplantation
3. total meniscectomy

Question 23

Partial Meniscectomy- Indications

Answer 23

-tears not amenable to repair (complex, degenerative and radial)

Question 24

Partial Meniscectomy- Outcomes

Answer 24

• > 80% satisfactory fxn at minimum f/u

- 50% have Fairbanks radiographic changes (osteophytes, flattening, joint space narrowing)

Question 25

What are Fairbanks radiographic changes?

Answer 25

osteophytes, flattening, joint space narrowing

Question 26

Partial Meniscectomy- predictors of success

Answer 26

- <40 - normal alignment - minimal or no arthritis - single tear

Question 27

Meniscal Repair- Indications

Answer 27

best candidate for repair... - peripheral in the red-red zone (vascularized region) - rim width is distance from the tear to peripheral meniscocapsular junction (blood supply) - rim width correlated with the ability of meniscal repair to heal (lower rim width has better blood supply) - vertical and longitudinal tear (rather than radial, horizontal or degenerative) - 1-4cm in length - acute repair combined with ACL recon * traditional literature report higher healing rates with concurrent ACL recon * current literature shows no difference in healing for 2nd generation all-inside repairs with/w/o concomitant ACL recon

Question 28

Meniscal Repair- Outcomes

Answer 28

- 70-95% successful - highest success when done with concomitant ACL recon - porr results with untreated ACL- deficiency

Question 29

Meniscal Transplantation- Indication

Answer 29

young patient with near total meniscectomy, especially lateral

Question 30

Meniscal Transplantation- Contraindications

Answer 30

- inflammatory arthritis - instability - marked obesity - grade 4 chondrosis - malalignment - diffuse arthritis

Question 31

Meniscal Transplantation- Outcomes

Answer 31

- requires 8-12 months for graft to fully heal - return to sports 6-9 months - 10 year f/u showed.. * persistent improvement in subjective pain and function scores * most had radiographic progression of degenerative changes - re-teats or extrusions are common

Question 32

Total Menisectomy

Answer 32

- historical ONLY - Outcomes * 20% significant arthritic changes 3 years after surgery * 100 have arthritis at 20 years * severity of degenerative changes is proportional to % of the meniscus that was removed