horizontal tear of medial meniscus treatmenthorizontal tear of medial meniscus treatment

Although there have been arguments that the radiological changes do not always match clinical symptoms11, it is more likely that the severe radiological changes correlate with worse clinical outcomes12. Noble, J. Lesions of the menisci: Autopsy incidence in adults less than fifty-five years old. A horizontal meniscal tear, also known as a cleavage tear, is a type of meniscal tear in which the tear is oriented horizontally, parallel to the tibial plateau. Eng. J.K.L. For the posteriorly-placed tears, an open technique with the use of special retractors is used in order to protect the neurovascular structures. Bucket Handle Meniscus Tear: What It Is, Causes & Treatment Use of porous polyurethanes for meniscal reconstruction and prosthesis. With meniscus tears, the pain is felt along the knee joint plane, either medially or laterally. Exclusion criteria for the study were the patients (1) who had combined ligament injury or other types of meniscus tear such as longitudinal, radial, flap, root, and complex (853 knees), (2) who had less than a 2-year follow up (1204 knees), (3) who underwent non-arthroscopic surgery or who had operations of any kind to the knee lesion at another hospital during the 2-year follow-up (80 knees). Difficulty bending and straightening the leg. Sex, age, JLT, TF angle, and ICRS grade were the meaningful factors in the single variable analyses (Table 1). Acta Orthop. : A systematic review of preclinical studies. These tears usually do not cause locking but they can progress to flap tears which can cause popping or clicking. Bhatia S, LaPrade CM, Ellman MB, LaPrade RF. Repair of isolated horizontal meniscal tears with all-inside suture Anatomy Two bones meet to form your knee joint: the femur and the tibia. The malalignment, instability and limb length inequality of the patients must be corrected beforehand or concomitantly. In the latter cases, meniscal reconstruction is a last chance to fill the defect after meniscectomy in patients who are unresponsive to other treatments. The datasets analyzed in this study are not publically available but are available from the corresponding author on appropriate request. The meniscus can get torn, but not all tears are the same. Application of biologics in the treatment of the rotator cuff, meniscus, cartilage, and osteoarthritis, Meniscal repair of degenerative horizontal cleavage tears using fibrin clots: clinical and arthroscopic outcomes in 10 cases, Trephination of incomplete meniscal tears, Synovial abrasion for isolated, partial thickness, undersurface, medial meniscus tears. So does obesity. The location of a horizontal tear determines the healing potential and course of treatment: A narrative review with focus on relevance for osteoarthritis research. Cite this article. Thomas Annandale: the first meniscus repair, Open meniscus repair. Regardless of the factors, 70% of the meniscus horizontal tear patients were successfully treated non-surgically. The medial and lateral menisci primarily serve as shock . What are the treatment options for an ACL tear? In this study, the authors focused on these factors that could affect the outcome of arthroscopic and non-surgical treatments. The risk factors for meniscal tears were summarized in a recent systematic review.17 In this study, on the one hand, advanced age (> 60 years), male gender, work-related kneeling, squatting and climbing stairs (> 30 flights) were found as risk factors for degenerative tears with strong supporting evidence. Knee Surg. Incidence and detection of meniscal ramp lesions on magnetic resonance imaging in patients with anterior cruciate ligament reconstruction, Diagnosis and treatment of discoid meniscus, https://creativecommons.org/licenses/by-nc/4.0/. The pain may be felt on the inner or outer side of the knee depending on which tissues or structures are affected. Single variable analyses with Chi-square tests of mechanical symptom to non-surgical treatment (p value=0.770, Table 1), and arthroscopic surgery (p value=0.755, Table 3) showed there were no definite relationships between mechanical symptom and treatment results. the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Objective results, such as radiographic changes, were not evaluated. 1Hacettepe University, Faculty of Medicine, Department of Orthopaedics and Traumatology, Department of Sports Medicine, Ankara, Turkey, 2Konya N.E. If the patient is symptomatic, the preferred method is APM (saucerization) with preservation of the stable peripheral rim, which has seen successful clinical results.102. Factors considered for failure and success of treatments were age (divided into 3 groups; under 50, 5060, over 60years), sex, joint line tenderness (JLT), mechanical symptom, widest tear gap width on sagittal MRI (Fig. Sports Traumatol. Results of arthroscopic repair of partial- or full-thickness longitudinal medial meniscal tears by single or double vertical sutures using the inside-out technique. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Diagnosis can be suspected clinically with joint line tenderness and a positive Mcmurray's test, and can be confirmed with MRI studies. Provided by the Springer Nature SharedIt content-sharing initiative. Rsultats long terme de 258 interventions, Meniscal lesion. Meniscus Tears Why Surgery Isnt Always Necessary, Batters Shoulder : Posterior Labral Tears, Runners require strength too: What to do and when to do it, Lactate, the lactate shuttle, and lactate threshold workouts in polarized training, Zone 2 Heart Rate Training For Longevity and Performance, Pain In The Front Of The Knee: 6 Common Causes, Sometimes our joints just hurt, and its ok not to know why. This last slogan will probably constitute the basis for newer alternative biological treatment methods in the future. Lateral and medial menisci are attached to the tibial plateau anteriorly and posteriorly via meniscal root ligaments. A meta-analysis comparing meniscal repair with meniscectomy in the treatment of meniscal tears: the more meniscus, the better outcome? They are not solely a separate structure; they are a part of the meniscus-meniscal ligament complex together with the surrounding ligamentous structures (menisco-tibial, menisco-femoral, menisco-patellar, intermeniscal ligaments) and bony attachments as anterior and posterior roots. volume12, Articlenumber:17293 (2022) The body mass index could be considered an important factor, however, in the usual outpatient office/clinic setting in Korea, it was hard to obtain the height and weight data of the patients, and we could not include it as one of the factors. HHS Vulnerability Disclosure, Help ISSN 2045-2322 (online). Then, with the factors that had meaningful relationships (p<0.20)20,21, multiple logistic regression analyses were done to determine the factors that had a significant impact on the failure of non-surgical treatment or the success of arthroscopic surgery, respectively. Data was collected by a single author (*). Am. Wear and tear on your knees as you age increases the risk of a torn meniscus. Finally, meniscus surgery has come a long way from the old slogan if it is torn, take it out!, to the currently accepted Save the meniscus!, which now guides the evolving modern treatment methods for meniscal tears. PDF Standard of Care: Meniscal Tears Conservative management of the patient Bucket handle tear: A large type of horizontal tear. In previous reports, some studies suggested poorer outcomes after meniscectomy in older patients26, on the other hand, some reported that age did not influence the outcome of meniscectomy27. The improper apposition of the ends of the meniscal tear is an important disadvantage of this technique. the contents by NLM or the National Institutes of Health. They only included patients with daily knee pain on the medial side with mechanical symptoms18. Knee Surg. Indications, technique, and results, Arthroscopic meniscus repair with a posterior incision, Combined posterior incision and arthroscopic intra-articular repair of the meniscus. These are the menisci . Pain Relief Medications. Am. Am. collected the data, performed the measurement and analysis, participated in the study design, and drafted the manuscript. 13, 14 (1985). Lohmander, L. S. & Roos, H. Knee ligament injury, surgery and osteoarthrosis: Truth or consequences?. The hypothesis was that the mechanical symptom was a critical factor in the failure of non-surgical treatment and the success of arthroscopic surgery. During this surgery, your surgeon uses an arthroscope (tiny . Failure strengths of suture versus biodegradable arrow for meniscal repair: an in vitro study, Load to failure testing of new meniscal repair devices. CAS Beaufils P, Becker R, Kopf S, Matthieu O, Pujol N. The knee meniscus: management of traumatic tears and degenerative lesions, A comparative study of meniscectomy and nonoperative treatment for degenerative horizontal tears of the medial meniscus. However, numerous studies revealed the adverse consequences of meniscectomy. Meniscus Surgery: Who Needs It, What to Expect Before & After Grassi A, Zaffagnini S, Marcheggiani Muccioli GM, Benzi A, Marcacci M. Clinical outcomes and complications of a collagen meniscus implant: a systematic review, Meniscus transplantation in animal experiments and initial clinical results, A study of the biological behavior of the meniscus as a transplant in the medial compartment of a dogs knee. DePhillipo NN, Cinque ME, Chahla J, et al. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. A. Steadman JR, Matheny LM, Singleton SB, et al. 8600 Rockville Pike 1).5,6 The morphology of this load-bearing complex structure, which contains radial fibrils centrally, circumferential fibrils peripherally and perforating fibres, determines its vital functions: load bearing, joint stability, joint congruity, increasing joint contact area, decreasing joint contact stresses, protection of articular cartilage, shock absorption, lubrication, limitation of extreme movement and proprioception.7-9 The structural degeneration or deterioration of the menisci due to senescence, trauma or surgery eventually leads to osteoarthritis of the knee joint, independent of meniscus morphology.10-16. A Biomechanical Comparison of All-Inside Versus Transtibial Meniscus Mordecai SC, Al-Hadithy N, Ware HE, Gupte CM. J. Clin. 11, 295300 (1996). The medial and lateral menisci are two C-shaped pieces of cartilage that act as cushions between the shinbone and thighbone . J. Knee Surg. Surgeons should strive not to operate in most cases, but to protect, repair or reconstruct, in order to prevent early development of osteoarthritis by restoring the native structure, function, and biomechanics of the meniscus. FOIA Partial meniscectomy can be performed in an open or more frequently arthroscopic fashion. Meniscal tear - Symptoms, diagnosis and treatment - BMJ Best Practice Osiewicz, M., Lobbezoo, F., Ciapala, B., Pytko-Polonczyk, J. These are difficult tears because they can go deep into the joint capsule. Tissue ingrowth after implantation of a novel, biodegradable polyurethane scaffold for treatment of partial meniscal lesions, Regeneration of meniscal cartilage with use of a collagen scaffold. An official website of the United States government. Moreover, radiographic evaluation is performed for malalignment, concomitant bony pathology, presence of arthritic changes, etc. A five year follow-up. 9, 1518 (2001). For example, the pain of a medial or lateral collateral ligament injury is felt directly over the affected ligament. This site should be used for informational purposes only. The main aims of meniscal reconstruction procedures are to place safely a functional meniscus that is anatomically and structurally similar to the native meniscus, to restore the knee and lower extremity biomechanics, to improve joint function, to relieve pain and eventually to prevent or delay the degenerative process in the knee joint. Haklar U, Donmez F, Basaran SH, Canbora MK. Management of traumatic meniscus tears: the 2019 ESSKA meniscus It couldve gone either way, success or failure. MRI and arthroscopy are still the benchmark non-invasive and invasive methods for the evaluation of meniscal tears, respectively.21-23, Meniscal tears can be classified according to the tear patterns, aetiology and MRI. Multiple logistic regression analysis with those factors revealed that the widest tear gap width and ICRS grade were the only significant factors contributingto the success of arthroscopic surgery in meniscus horizontal tear (Table 4). Surg. Mutsaerts ELAR, van Eck CF, van de Graaf VA, Doornberg JN, van den Bekerom MPJ. Arthroscopic repair for horizontal cleavage tears of medial meniscus. This is due to its detrimental effects, most importantly development of early osteoarthritis and unsuccessful long-term clinical results.10,11 Interestingly, although the rate of total knee arthroplasty due to symptomatic osteoarthritis of the knee after open total meniscectomy in adolescence was found to have increased comparatively in a prospective longitudinal 40-year follow-up study, it should also be noted that not all the patients had undergone surgery.31 Currently in the modern treatment of meniscal tears, neither open nor arthroscopic total meniscectomy are advised to be performed primarily in most cases. A wider tear gap could also lead to more symptoms and, therefore, arthroscopic surgery could have yielded better results. 1). Among the factors evaluated, varus alignment and advanced cartilage lesions were the factors for the poor outcome of non-surgical treatment. Swelling. Torn or Frayed Meniscus Healing and Treatment - Verywell Health 50, 469475 (2004). Asymptomatic discoid meniscus is classically treated conservatively. Khan M, Evaniew N, Bedi A, Ayeni OR, Bhandari M. Arthroscopic surgery for degenerative tears of the meniscus: a systematic review and meta-analysis. B. Arthroscopic partial meniscectomy: A long-term follow-up. The site is secure. In some studies, age and grade of osteoarthritis were used to stratify the comparison groups or to include or exclude the study subjects. Kirkley, A. et al. Hypothesis: The clinical outcomes of arthroscopic meniscectomy will be better than those of nonoperative treatment for a degenerative horizontal tear of the medial meniscus. This study was approved by the institutional review board at Seoul National University College of Medicine/Seoul National University Hospital (H-1009-036-331). 58, 599604 (1976). There must be numerous factors that affect the outcomes of these patients other than treatment modality, but these studies did not look into those factors in detail. Outside-in techniques were described by Warren and Levy and Morgan and Casscells.59,60 In this less frequently used technique, passing sutures were passed through the previously passed two spinal needles from the meniscal rim to the meniscal body across the meniscal tear. Apre-osteoarthritic condition of the knee joint, The role of the meniscus in osteoarthritis genesis, Meniscus tear surgery and meniscus replacement, Meniscus morphology: does tear type matter? From these assessments, the authors tried to help out the decision-making of the treatment option for meniscus horizontal tear. Inside-out versus all-inside repair of isolated meniscal tears. Thaunat M, Fayard JM, Guimaraes TM, et al. and JavaScript. The treatment options following an ACL tear are individualized for each patient depending on age, activity level, and the presence or absence of injury to other structures within the knee. The .gov means its official. Prognostic factors for the treatment of meniscus horizontal tear - Nature Christoforakis, J., Pradhan, R., Sanchez-Ballester, J., Hunt, N. & Strachan, R. K. Is there an association between articular cartilage changes and degenerative meniscus tears?. The purpose of this review was to systematically assess the outcomes and complications for patients undergoing the surgical treatment of HCTs. Scand. A popping sensation during the injury. Treatment of meniscal tears: An evidence based approach Your menisci act like shock absorbers, absorbing the impact of your upper leg on your lower leg. 2 This is likely due to the long-held belief that horizontal cleavage tears have minimal capacity to heal. You might be more likely to develop osteoarthritis in the injured knee. The type of tear determines how much damage there is to your knee and what your recovery will be like. McDermott, I. D. & Amis, A. Since Fairbank first described radiological changes after meniscectomy8, plenty of reports followed with similar observations9,10. Clin. The expense of seeing specialists in university hospitals or private clinics is very low, so patients tend to visit several hospitals. Among four storage methods of meniscal allografts (fresh viable, fresh-frozen, cryopreserved and lyophilized), fresh viable and fresh-frozen allograft are recommended.90,91 The optimal-sized allograft, according to the MRI or radiological knee films of the patient, can be fixed with or without bone plugs or block. Meniscus Tear Management: Indications, Technique, and Outcomes Swelling. Arthroscopy 21, 13661369 (2005). 59, 480483 (1977). Snoeker BAM, Bakker EWP, Kegel CAT, Lucas C. Risk factors for meniscal tears: a systematic review including meta-analysis, Incidental meniscal findings on knee MRI in middle-aged and elderly persons. Kotsovolos ES, Hantes ME, Mastrokalos DS, Lorbach O, Paessler HH. Privacy PolicyThe information on this site is not intended or implied to be medical advice, diagnosis, or treatment. And the criteria that divided success and failure were clear that improved symptoms and not seeking further treatment at 2-year follow-up were defined as success. participated in the study design, supervised the whole study process, and helped to draft and review the manuscript. The repair of horizontal cleavage tears yields higher - PubMed Patients were treated non-surgically or arthroscopically. Therefore, in deciding the treatment modality for patients with meniscus horizontal tear, thorough evaluations of the various factors should be performed case by case and not focus on the mechanical symptom alone, since the mechanical symptom is not an adequate factor for arthroscopic surgery. A novel repair method for radial tears of the medial meniscus: biomechanical comparison of transtibial 2-tunnel and double horizontal mattress suture techniques under cyclic loading, Clinical healing rates of meniscus repairs of tears in the central-third (red-white) zone, Meniscal ramp lesions: anatomy, incidence, diagnosis, and treatment. 58, 583594 (1976). Third, a retrospective design was used. and lesions (location, type, aetiology, tissue quality, associated lesions, etc.). Patients who had meniscus horizontal tears were the subjects of this study. A comparative study of meniscectomy and nonoperative treatment for degenerative horizontal tears of the medial meniscus. Patients may have the following complaints: pain, subacute swelling, hearing or sensation of a pop during injury, and mechanical symptoms such as popping, limitation of range of movement, catching, locking, etc. Horizontal Meniscus Tears: Surgery or Conservative Care? Inclusion in an NLM database does not imply endorsement of, or agreement with, government site. Arthroscopic view of acute, traumatic, longitudinal-vertical tear of the lateral meniscus posterior horn (a). The two ends of the passing sutures were tied onto the capsule, under direct vision. These procedures can be performed arthroscopically, as described previously.78 Regarding clinical efficacy, good mid-term and long-term clinical outcomes of polyurethane-based scaffolds and CMI were recently reported.82-85 Currently, it is concluded that the mid-term survival rate of scaffolds is favourable compared with meniscal repair, but unfavourable compared with MAT.82 In conclusion, the chondroprotective effects of these implants are still controversial, and long-term higher level of evidence comparative studies are required to clarify the clinical efficacy of these implants. The most recent concise, reliable, and valid classification system for meniscal tears is the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) Classification, which takes into account the subsequent parameters: tear depth, tear pattern, tear length, tear location/rim width, radial location, location according to the popliteal hiatus, and quality of the meniscal tissue. University, Meram Faculty of Medicine, Department of Orthopaedics and Traumatology, Department of Sports Medicine, Konya, Turkey, 3Hacettepe University, Faculty of Medicine, Department of Orthopaedics and Traumatology, Ankara, Turkey, 4Ghent University, Faculty of Medicine, Department of Orthopaedics and Traumatology, De Pintelaan, Ghent, Belgium.