A medial meniscus tear is more common than a lateral meniscus tear because it firmly attaches to the deep medial collateral ligament and the joint capsule. Fan RSP, Ryu RKN, Meniscal Lesions: Diagnosis and Treatment. i have a horizontal oblique tear of lateral of the posterior horn of medial meniscus with complex tear in body of anterior horn of medial menicus Dr. Kenneth Merriman answered 47 years experience Orthopedic Surgery Would you like email updates of new search results? Horizontal tears most commonly involve the body and posterior horn of the lateral greater than medial. Differentiating which meniscus is involved lies in the location of the symptoms. The all-inside technique was traditionally used to perform repairs of the far posterior horns, where a posterior accessory portal is used, along with passing a suture with a suture hook device. The knee should also be ACL-stable or stabilized. Tears amenable to repair include unstable tears > 1 cm in length and occurring in the outer 20% to 30% toward the periphery, or in the so-called red-red zone. Arthroscopic partial meniscectomy combined with medical exercise therapy versus isolated medical exercise therapy for degenerative meniscal tear: A meta-analysis of randomized controlled trials. [25] The majority of these tears, however, are asymptomatic and occur in association with degenerative joint disease. 5,7,8 A number of meniscectomy techniques for the treatment of horizontal cleavage tears ⦠Henning[36,37] first described the inside-out technique of arthroscopic meniscal repair. [40,41] The suture would then be tied intra-articularly. Level of evidence: These tears may be difficult to visualize on arthroscopy. Orthop J Sports Med. In: Balderston RA, Miller MD, eds. This site needs JavaScript to work properly. pain, function, daily living) and radiographic outcomes. Horizontal cleavage tear (HCT) is a type of meniscal tear in which the tear is oriented horizontally and extends from the inner free edge of the meniscus into the intra-meniscal substance [ 23 ]. Postoperative rehabilitation of the knee is controversial. The Methodological Index for Non-randomized Studies was used to assess study quality. Over exerting the knees during exercise can also cause tears in the meniscus. Although C, a vertical tear, is commonly used to describe such an appearance, the better answer is D, a longitudinal tear. 2015 Jan;31(1):92-8 S83.249A is a billable codeused to specify a medical diagnosis of other tear of Purpose Despite the well-documented advantages of meniscal repair over meniscectomy, horizontal cleavage tears (HCTs) are often not repaired. Methods: Complex degenerative tears occur in older patients. In older adults, attritional changes in the meniscus lead to fragmentation of the meniscus and a variety of tears (usually occur at the posterior horn of the medial meniscus) 8. Surgical Techniques and Outcomes of Repairing Meniscal Radial Tears: A Systematic Review. However, clinical reports on horizontal cleavage tear repair have challenged this belief by You have one meniscus on each side of your knee â the medial meniscus on the inside and the lateral meniscus on the outside. 3  Seen in the upper right corner of the image, a horizontal tear runs along the circumferential fibers of the meniscus. Arthroscopy; Avascular zone; Horizontal cleavage tear; Knee; Meniscus. Results: Alternatively, it may be detached at either end or transected in the middle with unstable anterior and posterior flaps. Click the topic below to receive emails when new articles are available. Kamimura M, Umehara J, Takahashi A, Mori Y, Chiba D, Kuwahara Y, Itoi E. Knee Surg Sports Traumatol Arthrosc. They extend from the inner free margin peripherally to the intrameniscal substance where myxoid degeneration may be present. Such tears account for 12-35% of all tear patterns and can be treated by partial meniscectomy or arthroscopic repair. Even better would be to describe a peripheral A potential disadvantage of the outside-in technique is difficulty in reducing the tear and opposing the edges while passing the sutures. A vertical or longitudinal tear occurs in line with the circumferential fibers of the meniscus (Figure 8). secondary meniscal procedures) as well as the potential for delay in the development of osteoarthritis. Burnout Might Really Be Depression; How Do Doctors Cope? The electronic databases PubMed, MEDLINE, and EMBASE were searched from data inception to December 30, 2018 for articles addressing the surgical treatment of HCTs. Such tears account for 12-35% of all tear patterns and can be treated by partial meniscectomy or arthroscopic repair. About meniscus tears. A horizontal tear (also known as fish-mouth tears) at the posterior horn of the medial meniscus means that the meniscus has torn along the horizontal plane - a type of tear that can be difficult to see when looking at some MRI's. There it may become trapped, causing pain by traction at the meniscocapsular junction. Horizontal meniscal tears (from side to side dividing the posterior horn in two parts) are the topic of this study from the Center for Joint Disease in Korea. A horizontal cleavage tear of the meniscus is considered to be an indication for partial or subtotal meniscectomy because when the tear is located within a large avascular area, it is usually difficult to induce healing of the pathological changes associated with degeneration. A small incision is then made at the joint line, where the protruding suture ends are retrieved and tied directly on the capsule. The sutures are swaged onto flexible needles. At arthroscopy, the bucket-handle tear may be seen as being attached anteriorly and posteriorly. Both medial and lateral meniscus tears present with the same symptoms. The tear usually starts as free (inner) edge fraying, and propagates toward the periphery of the meniscus. Forty-one papers describing ⦠Radial tears occur in a similar location. He advocated switching portals in order to adequately assess the meniscal contour and favored frequent use of a probe to provide tactile feedback. Vertical longitudinal (bucket-handle) tear. A bucket-handle tear may displace into the intercondylar notch, where it may cause true locking of the knee joint. Total meniscectomy was advocated as recently as 1971 for meniscal pathology. The image below shows the region of your knee where you may feel pain from a posterior horn tear. You will receive email when new content is published. To comment please, Comments on Medscape are moderated and should be professional in tone and on topic. More recently, technologic advances have brought about a number of implantable anchors, arrows, screws, and staples that facilitate meniscal repair without the need for accessory incisions or portals. An unstable tear is one where the entire tear or a portion thereof can be displaced into the joint space. Eur Radiol. Moulton SG, Bhatia S, Civitarese DM, Frank RM, Dean CS, LaPrade RF. Careers. These devices can be found of permanent, as well as absorbable materials. Meniscal tears are either partial or full thickness and stable or unstable. Treatment of meniscal tears includes simple observation, meniscectomy, and meniscal repair. Philadelphia, Pa: WB Saunders; 1995:30, Figure 1. Both meniscectomy and repair patients had improvements which surpassed minimal clinically important differences with regard to clinical (e.g. Please see our. 2020 Nov;30(11):5971-5980. doi: 10.1007/s00330-020-06960-0. Return to sports can be anticipated within 4 to 6 months. This type is the most commonly seen meniscus tear. A small posterior joint line incision is used to retrieve the sutures and tie directly on the capsule. Cite this: Meniscal Lesions: Diagnosis and Treatment - Medscape - Mar 21, 2000. Although the pullout strength of some of these devices has been shown to approximate those of mattress sutures in cadaveric studies,[42,43] there have been no long-term clinical studies that compare them to more traditional repair techniques (Figure 13). (Reprinted with permission.). Mulberry knots can then be tied on the intra-articular free ends of the suture. -, Knee Surg Sports Traumatol Arthrosc. Partial Meniscectomy for Degenerative Medial Meniscal Root Tears Shows Favorable Outcomes in Well-Aligned, Nonarthritic Knees. 23 In chronic ACL injuries, meniscus tears are found in as many as 98% of patients 3,23; the reported 3:1 ratio of medial to lateral tears is most likely due to the increased stress on the posterior horn of the medial â¦
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