2021. https://link.springer.com/article/10.1007%2Fs00402-020-03683-1. Healthline Media does not provide medical advice, diagnosis, or treatment. However, evaluation by absolute value alone may be limited due to differences in implant size, bone and cartilage condition, and individual patient characteristics. However, the incidence of severe knee OA is much higher in patients who have been subjected to ACLR than individuals with intact ACL [86, 87]. Arthroscopy 30(11):14241429, Merkely G, Ogura T, Ackermann J, Mestriner AB, Minas T, Gomoll AH (2019) Open meniscal allograft transplantation with transosseous suture fixation of the meniscal body significantly decreases meniscal extrusion rate compared with arthroscopic technique. In a recent meta-analysis, the percentages of medium-term and long-term survival after medial MAT were 85.8% and 52.6%, respectively, whereas after lateral MAT they were 89.2% and 56.6%, respectively [116]. Reference article, Radiopaedia.org (Accessed on 01 May 2023) https://doi.org/10.53347/rID-70702. People who tear a meniscus often feel like something has popped in their knee at the time of the injury. According to the American Academy of Orthopaedic Surgeons, treatment of a meniscus tear depends on the location of the injury, alongside other factors, including a persons: Below, we outline some potential treatment options. All rights reserved. The mechanical damage of the meniscus caused by extrusion seems to change the loading-bearing capacity of the tibiofemoral compartments, leading to the destruction of the articular cartilage as well the subchondral bone, ultimately contributing to the development or progression of OA [87, 89, 92]. 1. Most people will need to perform exercises following surgery. Several strategies have been proposed to reduce allograft extrusion. Another promising surgical approach for reducing the ME is the arthroscopic centralization of the extruded meniscus at the point where the capsule adjacent to the meniscus is repaired at the border of the tibial plateau [98, 101]. Arthritis Rheum 64(6):18881898, Kim DH, Lee GC, Kim HH, Cha DH (2020) Correlation between meniscal extrusion and symptom duration, alignment, and arthritic changes in medial meniscus posterior root tear: research article. A critical review of the literature. Traditional Ayurvedic treatments are widely used in South Asia to reduce swelling, pain, and motion restrictions in meniscus tears and knee osteoarthritis. First, surgery is rarely necessary for degenerative meniscus tears. 3). Medial Compartment Osteoarthritis Nogueira-Barbosa MH, Gregio-Junior E, Lorenzato MM, Guermazi A, Roemer FW, Chagas-Neto FA et al (2015) Ultrasound assessment of medial meniscal extrusion: a validation study using MRI as reference standard. The authors declare that they have no competing interests. Google Scholar, uczkiewicz P, Daszkiewicz K, Chrcielewski J, Witkowski W, Kuik L (2017) High meniscal slope angle as a risk factor for meniscal allograft extrusion. statement and Arthroscopy. A nonsurgical treatment approach typically involves rest and avoiding activities that trigger symptoms. Ice. Correspondence to How can you tell whether you have a meniscus tear? Arthrosc Tech 6(4):e1335e1339, Masferrer-Pino A, Monllau JC, Abat F, Gelber PE (2019) Capsular fixation limits graft extrusion in lateral meniscal allograft transplantation. Am J Sports Med 40(7):15911596, Lee BS, Kim JM, Kim JM, Kim KA, Bin SI (2015) Patient-related risk factors for the extrusion of lateral meniscal allograft transplants. Work up slowly to more intense exercise activity. The menisci are pads of cartilage in the knee joint. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. Am J Sports Med 49(3):684692, Ichiba A, Makuya K (2012) Radial displacement of the lateral meniscus before and after anterior cruciate ligament reconstruction. Heres what it involves: Treatment usually starts with the RICE method: If recommended by your doctor, use nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, or naproxen to reduce pain and swelling for 8 to 12 weeks. Also taking into consideration that residual ME after MPRT repair correlates with worse outcomes regarding both clinical parameters and OA progression [72, 73], a better understanding of the causality of ME is needed in order to appropriately address it. Conservative treatment for some meniscus tears is well documented as effective. Nonoperative treatment is associated with poor clinical outcomes, especially in the presence of a large ME [59], and exacerbation of OA with a higher incidence of subsequent arthroplasty over 5years of follow-up [60]. Surgical versus conservative interventions for treating meniscal tears of the knee in adults. It has been suggested that a 510% reduction of implant size from the estimated one reduces postoperative extrusion [2, 105, 123]. Knee Surg Sports Traumatol Arthrosc. ME has no specific clinical finding or sign and it is encountered in many knee pathologies. Most transplantations have been performed with the bone-plug technique because previous studies have shown its superiority in load-bearing function, resistance to hoop stresses, similar contact mechanics to endogenous menisci and lower extrusion rates compared with the other techniques [109, 111]. (2016). Kneecap pain. They may also share some exercises you can do at home. It can happen playing sports, exercising or just doing daily activities. It is a very common injury, especially among people who play sports. Google Scholar, Abat F, Gelber PE, Erquicia JI, Pelfort X, Gonzalez-Lucena G, Monllau JC (2012) Suture-only fixation technique leads to a higher degree of extrusion than bony fixation in meniscal allograft transplantation. Severe Meniscus Tear: Treatment Options To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Meniscus Tears, Repair, and Transplantation > Fact Winkler. Call the offices of Dr. Brett Gilbert at (919) 788-8797 or request an appointment online, and let Dr. Gilbert help you get back to These findings suggest that the tension of the graft and the excessive external rotation of the tibia are also factors that can affect the condition of the MM. There is no established optimal surgical technique at present for restoring ME to normal values, and thus there will be a strong need for more effective and refined techniques. The menisci are crescent-shaped, fibrocartilaginous structures located between femoral and tibial condyles, which are important for load transmission and distribution, shock absorption, secondary stability and proprioception of the knee joint [1]. Knee Surg Sports Traumatol Arthrosc 19(2):214217, Kim YS, Kang KT, Son J, Kwon OR, Choi YJ, Jo SB et al (2015) Graft extrusion related to the position of allograft in lateral meniscal allograft transplantation: biomechanical comparison between parapatellar and transpatellar approaches using finite element analysis. Beaufils P, et al. Improper positioning of the posterior horn causes a similar deviation to the anterior horn. Clinical significance and management of meniscal extrusion in different knee pathologies: a comprehensive review of the literature and treatment algorithm, https://doi.org/10.1186/s43019-022-00163-1, Anterior cruciate ligament reconstruction (ACLR), https://doi.org/10.1007/s00167-020-06363-0, https://link.springer.com/article/10.1007%2Fs00402-020-03683-1, https://doi.org/10.1186/s43019-019-0019-x, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. Although meta-analyses validate the superiority of root repair over partial meniscectomy in terms of clinical outcomes, they also highlight the inability of root repair to successfully reduce ME [68, 69]. See additional information. If you have surgery to remove all or part of your meniscus, you may be at higher risk of developing arthritis down the road. Arthroscopy 35(6):16581666, Jiang D, Ao YF, Gong X, Wang YJ, Zheng ZZ, Yu JK (2014) Comparative study on immediate versus delayed meniscus allograft transplantation: 4- to 6-year follow-up. The medial meniscus covers 5060% of the medial tibial plateau, and the lateral meniscus covers 7080% of the lateral tibial plateau. It usually results from twisting your knee suddenly. If the tear is too big to repair, your surgeon may remove all or part of the meniscus. This value is identified as the optimal cutoff point for a complete PRT of the LM and has 100% sensitivity and 83% specificity [92]. J Am Acad Orthop Surg 23(2):7176, Kwak YH, Lee S, Lee MC, Han HS (2018) Large meniscus extrusion ratio is a poor prognostic factor of conservative treatment for medial meniscus posterior root tear. [13] proved biomechanically that ME is possible with intact meniscal roots and that centralization of the meniscus restores the tibiofemoral contact pressures back to normal. Although the ultimate cause is unknown, it is quite common to see a subluxated joint capsule in the symptomatic meniscectomized compartment. However, it remains unknown whether it is capable of delaying or modifying OA progression, and further research is warranted [32, 48, 49]. The menisci play an important role in stabilizing the knee, easing movement of the knee joint, and absorbing shock from walking and other weight bearing activities. MPRT are defined as an avulsion fracture or a radial lesion occurring within 1cm of the bony tibial attachment [56]. VA conceived the idea for the study and supervised the whole study process. National Institute of Arthritis and Musculoskeletal and Skin Diseases. J Orthop Sci 24(1):121127, Chiba D, Sasaki E, Ota S, Maeda S, Sugiyama D, Nakaji S et al (2020) US detection of medial meniscus extrusion can predict the risk of developing radiographic knee osteoarthritis: a 5-year cohort study. ACL Injury: Does It Require Surgery? - OrthoInfo - AAOS Ann Rheum Dis 68(6):938947, Ishii Y, Deie M, Fujita N, Kurumadani H, Ishikawa M, Nakamae A et al (2017) Effects of lateral wedge insole application on medial compartment knee osteoarthritis severity evaluated by ultrasound. It permits immediate weight bearing following surgery and provides a full range of motion soon afterward. An individual should seek guidance from a physical therapist about which exercises to perform to assist their healing. a Meniscotibial ligament repair with three interconnected suture anchors, b centralization with a transtibial tunnel or c with isolated suture anchors (usually with two or three suture anchors). degenerative meniscus A person with a meniscus injury should consult a healthcare professional, such as a physical therapist, before starting an exercise program. Knee arthroscopy versus conservative management in patients with degenerative knee disease: A systematic review. ME is strongly correlated with posterior root tears of the menisci [6]. Doctors may use additional clinical tests that assess range of motion in the knee from various positions. During the meniscus surgery, a small instrument called an arthroscope, which has a camera at its tip, is inserted into your knee. It can be hard to prevent an accidental injury. Meniscal injury decreases their functional properties, resulting in degeneration of the knee joint [2]. However, to date there is still no well-designed clinical trial available to ascertain the effectiveness of centralization in reducing ME. Skeletal Radiol 26(7):424427, Article Complex meniscal tears usually require surgery. Finally, meniscal allograft extrusion is also associated with subchondral bone marrow lesions and cysts [2, 115]. Arthroscopy 31(12):2380-2391.e2, Ren S, Zhang X, You T, Jiang X, Jin D, Zhang W (2018) Clinical and radiologic outcomes after a modified bone plug technique with anatomical meniscal root reinsertion for meniscal allograft transplantation and a minimum 18-month follow-up. https://doi.org/10.1155/2015/210972, Kijima H, Miyakoshi N, Kasukawa Y, Ishikawa Y, Kinoshita H, Ohuchi K et al (2017) Cut-off value of medial meniscal extrusion for knee pain. Also consult a doctor if you continue to have pain after a course of conservative treatment. Studies show that exercise routines can significantly improve knee pain and function. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. https://doi.org/10.1007/s00167-020-06363-0, Miller TT, Staron RB, Feldman F, epel E (1997) Meniscal position on routine MR imaging of the knee. Prepatellar bursitis is a common complaint of people who work on their knees or who engage in activities that risk blows to the knee. Osteoarthritis Cartilage 27(11):15781589, Primorac D, Molnar V, Matii V, Hudetz D, Jele , Rod E et al (2021) Comprehensive review of knee osteoarthritis pharmacological treatment and the latest professional societies guidelines. Am J Roentgenol 204(3):584588, Foreman SC, Liu Y, Nevitt MC, Neumann J, Joseph GB, Lane NE et al (2020) Meniscal root tears and extrusion are significantly associated with the development of accelerated knee osteoarthritis: data from the osteoarthritis initiative. Arthrosc Tech 6(2):e269e274, Ahn JH, Kang HW, Yang TY, Lee JY (2016) Multivariate analysis of risk factors of graft extrusion after lateral meniscus allograft transplantation. On the other hand, the suture-only technique has its own advantages and is therefore chosen by many surgeons [104, 111]. Knee Surg & Relat Res 34, 35 (2022). Am J Sports Med 48(11):26922702, Chung KS, Ha JK, Ra HJ, Nam GW, Kim JG (2017) Pullout Fixation of posterior medial meniscus root tears: correlation between meniscus extrusion and midterm clinical results. A Meta-analysis Am J Sports Med 46(9):22852290, Smith NA, Parkinson B, Hutchinson CE, Costa ML, Spalding T (2016) Is meniscal allograft transplantation chondroprotective? showed that the difference in the extrusion of the LM between a healthy knee and a knee with combined injury was not statistically significant. Degenerative lesions of the knee joint are more commonly present during concurrent ACLR with meniscectomy than with intact or repaired menisci. Current research has directed its focus to meniscotibial ligaments (MTL), which stabilize on the tibial plateau and centralize the meniscus, as an additional potential causative factor for ME. Generally speaking, the treatment options for meniscus tears include: rest, physical therapy, activity modification, and occasionally a surgery we refer to as an A novel technique has been developed based on a measurement grid in order to determine the precise aperture of the tibial tunnel. We do not endorse non-Cleveland Clinic products or services. [74] retrospectively analyzed MRI series with isolated ME without concomitant serious knee pathologies, and found that isolated significant ME (>3mm) was associated with MTL abnormalities. Arthrosc Tech 10(1):e43e48, Okazaki Y, Furumatsu T, Miyazawa S, Kodama Y, Kamatsuki Y, Hino T et al (2019) Meniscal repair concurrent with anterior cruciate ligament reconstruction restores posterior shift of the medial meniscus in the knee-flexed position. Adv Orthop. (2018). Osteoarthritis Cartilage 26(7):912919, Roubille C, Martel-Pelletier J, Abram F, Dorais M, Delorme P, Raynauld JP et al (2015) Impact of disease treatments on the progression of knee osteoarthritis structural changes related to meniscal extrusion: data from the OAI progression cohort. ME is found in several knee pathologies and is well correlated with rapid knee OA progression as well as increased morbidity. A tear in this "red" zone may heal on its own, or can often be repaired with surgery. 2014;34(4):981-99. Moreover, extrusion of the LM does not improve after ACLR unless the meniscal tear is repaired [87, 92]. With a surgical treatment approach, exercises are necessary for recovery. CAS Mordecai SC, et al. For example: Surgery may be a meniscus repair or a trimming of the meniscus tissue, which is called a partial meniscectomy. Here are tips on how to prepare your room and your body for a good nights sleep, and what to do if your knee pain becomes more severe. Knee Surg Sports Traumatol Arthrosc 19(2):222229, Oo WM, Linklater JM, Bennell KL, Pryke D, Yu S, Fu K et al (2021) Are OMERACT knee osteoarthritis ultrasound scores associated with pain severity, other symptoms, and radiographic and magnetic resonance imaging findings? Today, in general, doctors recommend conservative treatment, not surgery, when meniscus tears result from degeneration. CAS This article outlines two types and their associated symptoms and causes. Eur Radiol 29(5):26162623, Debieux P, Jimenez AE, Novaretti JV, Kaleka CC, Kriscenski DE, Astur DC et al (2020) Medial meniscal extrusion greater than 4 mm reduces medial tibiofemoral compartment contact area: a biomechanical analysis of tibiofemoral contact area and pressures with varying amounts of meniscal extrusion. 60 patients were performed arthroscopic meniscus repairs The diagnostic process starts with a medical history and a thorough examination that may include clinical tests. These are nonabsorbent The authors did not receive funding for this study. To perform this exercise, a person should do the following: An intermediate exercise routine may include straight leg raises. Over time, the joint can break down. During this procedure, your doctor will remove the Knee Surg Sports Traumatol Arthrosc 27(8):26172623, Astur DC, Novaretti JV, Gomes ML, Rodrigues AG, Kaleka CC, Cavalcante ELB et al (2020) Medial opening wedge high tibial osteotomy decreases medial meniscal extrusion and improves clinical outcomes and return to activity. At the time the article was last revised Yahya Baba had Its best to see a doctor for diagnosis of knee pain and a treatment plan. taking pain medications. Therefore, proper placement of the posterior horn is critical to the anatomical repair of the meniscus [125,126,127]. Last medically reviewed on February 8, 2022, The knee is one of the body's more complicated joints and is susceptible to various injuries. You should call your healthcare provider if you: You may want to ask your healthcare provider: A torn meniscus is a very common knee injury. Knee Surg Sports Traumatol Arthrosc 28(11):34163425, Stein T, Mehling AP, Welsch F, von Eisenhart-Rothe R, Jger A (2010) Long-term outcome after arthroscopic meniscal repair versus arthroscopic partial meniscectomy for traumatic meniscal tears. Knee Surgery & Related Research Most people fully recover from a torn meniscus and can get back to doing their favorite activities without knee pain. These fibers specifically act on the LM anterior root attachment itself, explaining the reduction in the ultimate failure of the anterior root strength of the LM with disruption of these fibers [87, 93]. And finally, the proper anatomical placement of the allograft is essential. They then measured the medial meniscal extrusion (MME) with U/S under weight-bearing and reported a cutoff value of MME for knee pain of 4.3mm, with sensitivity of 84% and specificity of 85% [43]. Clin Rheumatol 36(11):25572564, Kim JY, Bin SI, Kim JM, Lee BS, Oh SM, Park MH (2019) Tear gap and severity of osteoarthritis are associated with meniscal extrusion in degenerative medial meniscus posterior root tears. Following surgery, a doctor may advise engaging in 2030 minutes of exercise twothree times per day. Based on these findings, they concluded that the all-inside repair of the radial tear of the LM could help maintain its dynamic behavior, thus reducing the biomechanical stress exerted on the adjacent cartilage [89]. X-rays are useful in finding other causes of knee pain, but they will not show a meniscus tear. maceration J Knee Surg 34(2):178186, Furumatsu T, Kodama Y, Kamatsuki Y, Hino T, Okazaki Y, Ozaki T (2017) Meniscal extrusion progresses shortly after the medial meniscus posterior root tear. meniscus Although it has never been reported, it is worth researching, as it could have a beneficial effect. Lie on the back and bend both knees at a 10-degree angle. Depending on your symptoms, your doctor may recommend a special knee brace or other mechanisms to limit your joint movement and stabilize the knee. J Rheumatol 48(2):270278, Chiba D, Maeda S, Sasaki E, Ota S, Nakaji S, Tsuda E et al (2017) Meniscal extrusion seen on ultrasonography affects the development of radiographic knee osteoarthritis: a 3-year prospective cohort study. 1), although it may underestimate ME, as the assessment is routinely not performed under weight-bearing conditions [18,19,20]. Those that are caused by an injury are often the ones that can be, A meniscectomy is a procedure that repairs a torn meniscus. PubMed Central CAS Meniscus tears are a very common knee injury, especially among athletes. Effectiveness of an Ayurveda treatment approach in knee osteoarthritis A randomized controlled trial. See this post to learn more about how a meniscus functions, As mentioned in my recent post, the majority of posterior horn tears are determined to be degenerative. Semin Arthritis Rheum 46(5):552561, LaPrade RF, LaPrade CM, James EW (2015) Recent advances in posterior meniscal root repair techniques. OrthoInfo from the American Academy of Orthopaedic Surgeons. Meniscal tears: Current understanding, diagnosis, and management. https://doi.org/10.1055/s-0040-1710377, Monllau JC, Ibaez M, Masferrer-Pino A, Gelber PE, Erquicia JI, Pelfort X (2017) Lateral capsular fixation: an implant-free technique to prevent meniscal allograft extrusion. AJR Am J Roentgenol 183(1):1723, Muzaffar N, Kirmani O, Ahsan M, Ahmad S (2015) Meniscal extrusion in the knee: should only 3 mm extrusion be considered significant? If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Privacy PolicyThe information on this site is not intended or implied to be medical advice, diagnosis, or treatment. Malays Orthop J 9(2):1720, Article When we talk about the meniscus, only about 30 % of the meniscus has an intact blood supply and is called the red zone. The remaining part of the meniscus does not have a blood supply and thus, once injured or torn, it cannot heal or be treated. So whether ayurvedic, homeopathic or allopathic medication, none of them can really help. Kessler CS, et al. MNT is the registered trade mark of Healthline Media. Tsujii et al. Am J Sports Med 38(8):15421548, Yanagisawa S, Kimura M, Hagiwara K, Ogoshi A (2020) Association between postoperative meniscal extrusion and clinical outcomes of the pullout fixation technique for medial meniscus posterior root tear. Scientists use genetic rewiring to increase lifespan of cells, Beyond amyloid and tau: New targets in developing dementia treatments, Napping longer than 30 minutes linked to higher risk of obesity and high blood pressure, Activity 'snacks' could lower blood sugar, complication risk in type 1 diabetes, In Conversation: Investigating the power of music for dementia, Daniel Bubnis, M.S., NASM-CPT, NASE Level II-CSS, stability through preventing the knee from bending and straightening at extreme angles, having an occupation that requires frequent squatting or bending, inability to fully bend and straighten the knee. However, its posterior extrusion progressed significantly regardless of the healing status [90]. A hip labral tear can be treated nonsurgically, or with surgery in severe cases. Torn or Frayed Meniscus: When Surgery May Be PLoS ONE 11(5):e0156183, Noyes FR, Barber-Westin SD (2015) A systematic review of the incidence and clinical significance of postoperative meniscus transplant extrusion. The goal of the anatomic reconstruction of the ACL rupture is to replicate the normal knee anatomy. Note that meniscectomy may cause osteoarthritis in the long term. There is no consensus whether medial or lateral MAT is superior in terms of medium-term (510years) and long-term (>10years) survival. ME can occur in knee OA [8, 10], and its presence is significantly correlated with increased articular cartilage loss in the tibiofemoral joint and osteophyte formation [29, 30]. Root repair is indicated when varus malalignment is minimal (<5), the cartilage wear is not advanced (Outerbridge grade 12) and it can be performed arthroscopically either with a transtibial pullout technique or with suture anchors, each with its respective advantages and disadvantages [58]. Eur J Radiol 1(102):115124, Karpinski K, Diermeier T, Willinger L, Imhoff AB, Achtnich A, Petersen W (2019) No dynamic extrusion of the medial meniscus in ultrasound examination in patients with confirmed root tear lesion. It was also shown that after ACLR, without concomitant tears of the menisci, the anteroposterior and radial extrusion of the MM tended to increase compared with preoperative levels, but all measurements remained below the threshold value of 3mm [24, 44, 95]. (2018). Terms and Conditions, Perhaps even more important is that once your knee feels better, and it Proposed treatment algorithm for meniscal extrusion (ME) in different knee pathologies (OA osteoarthritis, ME meniscal extrusion, HTO high tibial osteotomy, MPRTs meniscal posterior root tears, ACL anterior cruciate ligament reconstruction, LM lateral meniscus, PRT posterior root tear, MAT meniscal allograft transplantation), Krych AJ, Bernard CD, Kennedy NI, Tagliero AJ, Camp CL, Levy BA et al (2020) Medial versus lateral meniscus root tears: is there a difference in injury presentation, treatment decisions, and surgical repair outcomes? Although meniscal allografts that are secured with the suture-only technique tend to show a greater degree of extrusion than the bony-fixation techniques, bony-fixation techniques still show high extrusion rates (2550%).
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