Meniscal Tears

Question 1

in young patients what are meniscal injuries usually caused by

Answer 1

sports related injury

Question 2

what percentage of acute ACL ruptures also have a meniscal tear

Answer 2

25%

Question 3

what can clinical exam reveal

Answer 3

effusion, joint line tenderness, pain on tibial rotation localising to the affected compartment (Steinmann’s test)

Question 4

are lateral or medial meniscal tears more common

Answer 4

medial

Question 5

how much more common are medial meniscal tears than lateral meniscal tears

Answer 5

10 times

Question 6

why are medial meniscal tears more common than lateral meniscal tears

Answer 6

medial meniscus is more fixed and less mobile and the force from pivoting movements is centred on the medial compartment

Question 7

what types of meniscal tears is there

Answer 7

longitudinal, radial, oblique and horizontal

Question 8

what type of tear can lead to a “bucket handle tear”

Answer 8

large longitudinal tears

Question 9

what are “bucket handle tears”

Answer 9

a large meniscal fragment is able to flip out of its normal position and displace anteriorly or into the intercondylar notch where the knee locks and is unable to fully extend (15 degree)

Question 10

why do degenerative meniscal tears occur

Answer 10

meniscus weakens with age

Question 11

what can cause the meniscus to tear secondary to degeneration

Answer 11

spontaneously or low impact injury

Question 12

what condition are degenerate tears probably the first stage of

Answer 12

knee OA

Question 13

is steinmann’s test usually positive or negative in degenerative meniscal tears

Answer 13

negative

Question 14

how should degenerative tears not be treated and why

Answer 14

should not be treated with arthroscopy as symptoms do not improve on resection

Question 15

what part of the meniscus has a arterial blood supply

Answer 15

outer 1/3

Question 16

what causes poor healing ability of meniscus

Answer 16

• limited blood supply
• increasing age (over 25-30 healing rates are poor)
• increased time since injury

Question 17

what does meniscal repair involve

Answer 17

suturing the meniscus to its bed

Question 18

who should meniscal repair be considered in

Answer 18

young patients with a reasonably fresh longitudinal meniscal tear on the outer 1/3

Question 19

what percentage of meniscal repairs fail despite selective patient selection

Answer 19

25%

Question 20

what can be done if meniscal repair fails

Answer 20

arthroscopic meniscectomy

Question 21

what percentage of meniscal tears are not suitable for repair

Answer 21

90%

Question 22

what can ease symptoms of degenerative meniscal tears in the early period

Answer 22

steroid injections

Question 23

what can be done if acute meniscal tear pain or mechanical symptoms do not settle within 3 months

Answer 23

arthroscopic meniscectomy

Question 24

what percentage of symptoms are improved by arthroscopic meniscectomy

Answer 24

70-80%

Question 25

what features mean a patient is unlikely to benefit from arthroscopic meniscectomy

Answer 25

degenerative changes on xray (loss of joint space, sclerosis, osteophytes) or on MRI (hyaline cartilage loss, bone marrow oedema)

Question 26

why do these features mean a patient is unlikely to benefit from arthroscopic meniscectomy

Answer 26

removal of meniscal tissue may increase the stress on already worn/damaged surfaces