Meniscal Injury Flashcards
Epidemiology
- MC indication for knee surgery
- higher risk in ACL deficient knees
Medial Tears- Intro
- More common than lateral tears
- Exception is in the setting of an acute ACL tear where lateral tears are more common
where do degenerative medial tears in older patients tend to occur?
posterior horn medial meniscus
Lateral Tears- More common when
acute ACL tears
Descriptive Classification
- location
- size
- pattern
Descriptive Classification- Location
- red zone
- red-white zone
- white zone
Red zone
outer third, vascularized
Red-white zone
middle third
white zone
inner third, avascular
Descriptive Classification- Pattern
- vertical/longitudinal
- Bucket handle
- oblique/flap/parrot beak
- radial
- horizontal
- complex
vertical/longitudinal tear
- common, esp with ACL tear
- repair when periph
bucket handle tear
-vertical tear which may displace into the notch
oblique/flap/parrot beak tear
-may cause mechanical locking symptoms
horizontal tear
- more common in older population
- may be a/w meniscal cysyts
Symptoms
- pain localizing to medial or lateral side
- mechanical symptoms (locking and clicking)
- delayed or intermittent swelling
Exam
- joint line tenderness
- effusion
- provocative tests (Apley, Thessaly and McMurray)
Apley Compression Test
- Prone
- bend affected knee to 90 p
- axial force and rotate tibia
- distraction force and rotate tibia
Thessaly Test
- 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
McMurray’s Test
- 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
Treatment- Nonop
rest, nsaids rehab
rest, nsaids rehab
indications
- first line tx degenerative tears
Treatment- operative
- Partial Meniscectomy
- Meniscal Repair
3, Meniscal transplantation - total meniscectomy
Partial Meniscectomy- Indications
-tears not amenable to repair (complex, degenerative and radial)
Partial Meniscectomy- Outcomes
- > 80% satisfactory fxn at minimum f/u
- 50% have Fairbanks radiographic changes (osteophytes, flattening, joint space narrowing)
What are Fairbanks radiographic changes?
osteophytes, flattening, joint space narrowing
Partial Meniscectomy- predictors of success
- <40
- normal alignment
- minimal or no arthritis
- single tear
Meniscal Repair- Indications
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
Meniscal Repair- Outcomes
- 70-95% successful
- highest success when done with concomitant ACL recon
- porr results with untreated ACL- deficiency
Meniscal Transplantation- Indication
young patient with near total meniscectomy, especially lateral
Meniscal Transplantation- Contraindications
- inflammatory arthritis
- instability
- marked obesity
- grade 4 chondrosis
- malalignment
- diffuse arthritis
Meniscal Transplantation- Outcomes
- 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
Total Menisectomy
- 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
