During this procedure, your doctor will remove the 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. There is no consensus whether medial or lateral MAT is superior in terms of medium-term (510years) and long-term (>10years) survival. [77] performed arthroscopic centralization of nine extruded lateral menisci with the use of suture anchors, and ME was significantly reduced in 2years of follow-up. And finally, the proper anatomical placement of the allograft is essential. We avoid using tertiary references. Conservative treatment for some meniscus tears is well documented as effective. However, over a long-term period, the degenerative changes in the articular cartilage worsened, especially in the lateral tibial plateau, regardless of the healing status of the meniscus [85, 87, 90]. We'll go over how it's done, the recovery timeline, and risks to watch for after the, There are two types of knee locking: a true knee lock and a pseudo knee lock. Fig 3. Alternatively, the surgeon may be able to modify the ACL reconstruction technique to decrease the risk of growth plate injury during surgery. Knee 24(6):14081413, Phua JKS, Razak HRBA, Mitra AK (2020) Arthroscopic procedures could delay the need for a subsequent knee arthroplasty in older patients with end-stage osteoarthritis. 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? This condition may lead to increased cartilage degeneration, progressive OA and allograft failure, as mentioned in several biomechanical studies [17, 111]. More serious meniscus tears may not heal on their own. Experts say choosing between knee repair and knee reconstruction surgery isn't a simple decision. 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. 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. People who play sports (like tennis, soccer, basketball or football) that involve sudden twisting movements are most likely to tear a meniscus. J ISAKOS 6(1):3545, Beaufils P, Becker R, Kopf S, Englund M, Verdonk R, Ollivier M et al (2017) Surgical management of degenerative meniscus lesions: the 2016 ESSKA meniscus consensus. MPRT are defined as an avulsion fracture or a radial lesion occurring within 1cm of the bony tibial attachment [56]. [31] showed that lateral ME was associated with worsening of patellofemoral joint OA features at 2-year follow-up. 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. J Orthop Res Off Publ Orthop Res Soc 24(6):12081217, Wenger A, Englund M, Wirth W, Hudelmaier M, Kwoh K, Eckstein F et al (2012) Relationship of 3D meniscal morphology and position with knee pain in subjects with knee osteoarthritis: a pilot study. Getting hit or tackled can make you twist your knee, tearing the cartilage. Int J Rheum Dis 17(5):536540, PubMed Its best to see a doctor as soon as possible: Untreated meniscus tears can get worse, or pieces of the meniscus can shed into the joint. ME has no specific clinical finding or sign and it is encountered in many knee pathologies. This can result from disruption of collagen fibers within the meniscus that provide hoop strength 8.. PubMed Central 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]. Moreover, centralization of the allograft can be performed to help stabilize it on the tibial plateau; however, there are not yet sufficient data in the literature to support its benefits. The different types of meniscus tear include: Additionally, doctors categorize tears according to their location. Treatment with glucosamine, chondroitin sulfate and licofelone has Adv Orthop. Knee Surg Sports Traumatol Arthrosc 26(3):781786, Krych AJ, Reardon PJ, Johnson NR, Mohan R, Peter L, Levy BA et al (2017) Non-operative management of medial meniscus posterior horn root tears is associated with worsening arthritis and poor clinical outcome at 5-year follow-up. With a surgical treatment approach, exercises are necessary for recovery. Healthline Media does not provide medical advice, diagnosis, or treatment. Several studies also argue that the presence of ME is predictive of knee OA progression [32,33,34]. 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. Arthrosc Tech 9(8):e1211e1218, DePhillipo NN, Kennedy MI, Chahla J, LaPrade RF (2019) Type II medial meniscus root repair with peripheral release for addressing meniscal extrusion. The authors declare that they have no competing interests. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 24(9):29232935, Lee SM, Bin SI, Kim JM, Lee BS, Lee CR, Son DW et al (2019) Long-term outcomes of meniscal allograft transplantation with and without extrusion: mean 12.3-year follow-up study. At the time the article was created Yuranga Weerakkody had no recorded disclosures. 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. Several other techniques of meniscal centralization with suture anchors as well as with transtibial tunnel, with or without prior meniscal release from its capsular attachments, have also been described in technical notes (Fig. Surgery is a very effective way to repair a torn meniscus. Pathology. They may also share some exercises you can do at home. nonsteroidal anti-inflammatory drugs (NSAIDs), rimed.org/rimedicaljournal/2016/10/2016-10-27-sports-babu.pdf, ncbi.nlm.nih.gov/pmc/articles/PMC5489759/, ncbi.nlm.nih.gov/pmc/articles/PMC6483631/, ncbi.nlm.nih.gov/pmc/articles/PMC5994634/, orthoinfo.aaos.org/en/diseases--conditions/meniscus-tears/, ncbi.nlm.nih.gov/pmc/articles/PMC3418117/, physioworks.com.au/pain-injury/knee-pain/meniscus-tear/, sciencedirect.com/science/article/pii/S1063458418300827, ncbi.nlm.nih.gov/pmc/articles/PMC4095015/, racgp.org.au/afp/2012/april/meniscal-tear/, ncbi.nlm.nih.gov/pmc/articles/PMC5905745/, How to Ease Knee Pain and Sleep Tight Through the Night, The 6 Best Knee Compression Sleeves of 2023, What Your Knee Pain May Indicate Based on Its Location, Prepatellar Bursitis on the Kneecap: Treatment and Recovery from this Injury, ACL Knee Repair Sometimes Leads to Better Outcomes Than Reconstruction. However, it has also been hypothesized that MPRT is not the sole contributing factor predisposing to ME. Beaufils P, et al. TK and DG designed the manuscript and helped to draft the manuscript and review it. However, it remains unknown whether it is capable of delaying or modifying OA progression, and further research is warranted [32, 48, 49]. 2b, c) [78,79,80,81,82]. Surgery for degenerative meniscus tears is rarely necessary. Spang RC III, et al. Am J Sports Med 45(1):4249, Krych AJ, Bernard CD, Leland DP, Camp CL, Johnson AC, Finnoff JT et al (2020) Isolated meniscus extrusion associated with meniscotibial ligament abnormality. Knee Surg Relat Res. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Studies show that exercise routines can significantly improve knee pain and function. Am J Sports Med 45(8):18641871, Novaretti JV, Astur DC, Cavalcante ELB, Kaleka CC, Amaro JT, Cohen M (2020) Preoperative meniscal extrusion predicts unsatisfactory clinical outcomes and progression of osteoarthritis after isolated partial medial meniscectomy: a 5-year follow-up study. Also consult a doctor if you continue to have pain after a course of conservative treatment. Am J Sports Med 44(9):23302338, Parkinson B, Smith N, Asplin L, Thompson P, Spalding T (2016) Factors predicting meniscal allograft transplantation failure. The rubbery wedges of cartilage act like shock absorbers for your knee, providing cushioning for your bones and knee joint. If your injury doesnt improve with RICE, NSAIDs and physical [55] verified this hypothesis by performing 66 HTO, where they measured ME with MRI preoperatively and postoperatively, and found that at 6weeks postoperatively, the ME had decreased from a mean of 3.90.6mm to a mean of 0.90.5mm. Although it has never been reported, it is worth researching, as it could have a beneficial effect. Shiraev T, et al. Antony B, Driban J, Price L et al. 3. 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]. Furthermore, Lee et al. Eur Radiol 30(7):39964004, Svensson F, Felson DT, Turkiewicz A, Guermazi A, Roemer FW, Neuman P et al (2019) Scrutinizing the cut-off for pathological meniscal body extrusion on knee MRI. This is probably why capsulodesis is so effective in minimizing extrusion. First, surgery is rarely necessary for degenerative meniscus tears. (ACLR+LM tear repair) demonstrated that the narrowing was only 0.04mm at 3.4years postoperatively, whereas another study showed widening of 0.1mm at 3.5years postoperatively [85, 90]. 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]. Terms and Conditions, It is associated with either rapidly progressive knee osteoarthritis or early onset of knee osteoarthritis and increased morbidity. Google Scholar, Okada K, Yamaguchi S, Sato Y, Enomoto T, Ogawa Y, Ohtori S et al (2019) Comparison of meniscal extrusion and osteophyte formation at the intercondylar notch as a predictive biomarker for incidence of knee osteoarthritis-Data from the Osteoarthritis Initiative-. For these reasons, certain contraindications have been introduced (Table 2) [102, 103, 105,106,107,108,109]. Sudden twisting movements such as pivoting to catch a ball can tear the cartilage. The menisci are crescent-shaped, fibrocartilaginous structures that play a crucial role in the load transition and distribution of the contact forces along the tibiofemoral articulation. Therefore, care should be taken to manage it appropriately and successfully reduce it. Doctors may use additional clinical tests that assess range of motion in the knee from various positions. Last medically reviewed on February 8, 2022, The knee is one of the body's more complicated joints and is susceptible to various injuries. J Orthop Surg Hong Kong 28(1):2309499020906745, McCormack DJ, Puttock D, Godsiff SP (2021) Medial compartment osteoarthritis of the knee: a review of surgical options. Manage cookies/Do not sell my data we use in the preference centre. We link primary sources including studies, scientific references, and statistics within each article and also list them in the resources section at the bottom of our articles. Its best to see a doctor for diagnosis of knee pain and a treatment plan. This can provide pain relief for 2 to 4 weeks. EFORT Open Rev 4(4):115120, Gonzlez-Lucena G, Gelber PE, Pelfort X, Tey M, Monllau JC (2010) Meniscal allograft transplantation without bone blocks: a 5- to 8-year follow-up of 33 patients. The concurrent ACLR with repair of the menisci has shown good clinical and functional results and less risk of reoperation during the follow-up periods [83, 87]. Meniscal injury decreases their functional properties, resulting in degeneration of the knee joint [2]. 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. Careful preoperative planning for correct sizing and accurate placement of the allograft is critical for preventing ME. Brignardello-Petersen R, et al. 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. (2012). However, to date there is still no well-designed clinical trial available to ascertain the effectiveness of centralization in reducing ME. They will test your range of motion. Your doctor may also recommend conservative measures as a first step if the tear is caused by injury to the knee. Comparative studies between normal knees and knees with ACL rupture demonstrated that the posterior extrusion of the MM during knee flexion is almost the same [83, 94]. Winkler et al. Exercises Initial routine. Policy. Older people are likely to have meniscus damage related to degeneration from wear-and-tear. Clin Anat N Y N 28(6):792799, Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA et al (2019) OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. It should be highlighted that the clinical significance of meniscal allograft extrusion has not yet been clearly elucidated, since it is difficult to draw firm conclusions. The survival of the graft depends substantially on the condition of the articular cartilage [117,118,119]. Nguyen J, De Smet A, Graf B, Rosas H. MR Imaging-Based Diagnosis and Classification of Meniscal Tears. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. At the time the article was last revised Yahya Baba had 2a), and found that postoperative ME was significantly reduced. It will also help stabilize your balance and help prevent another knee injury. Correct estimation of the allograft size is also important. It can be hard to prevent an accidental injury. 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]. People whose cartilage wears down (due to age or arthritis) can tear a meniscus from a motion as simple as stepping on an uneven surface. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. For a meniscus tear to heal, it needs three things: Healthy tissue Good blood supply Stability If you are having surgery for a symptomatic torn meniscus, a Google Scholar, Ozeki N, Seil R, Krych AJ, Koga H (2021) Surgical treatment of complex meniscus tear and disease: state of the art. A torn or strained meniscus is generally treated with rest, ice, over-the-counter anti-inflammatory medicines and physical therapy. As you get older, the cartilage in your knees wears down and gets weaker. Your doctor will likely recommend physical therapy. J Orthop Res 38(11):24952504, Roemer FW, Kwoh CK, Hannon MJ, Green SM, Jakicic JM, Boudreau R et al (2012) Risk factors for magnetic resonance imagingdetected patellofemoral and tibiofemoral cartilage loss during a six-month period: the Joints On Glucosamine study. (ACLR+LM tears left in situ) showed narrowing of 1.0mm at 10-year follow-up [96, 97]. Osteoarthritis Cartilage 20(12):15071513, Bevers K, Bijlsma JW, Vriezekolk JE, van den Ende CH, den Broeder AA (2014) Ultrasonographic features in symptomatic osteoarthritis of the knee and relation with pain. Learn about the most common knee injuries from falling, as well as which ones you can treat at home and which ones require medical attention. This thinner cartilage can tear more easily. This suggests that if patients with minimal degeneration and accurate indications undergo MAT with a well-placed graft, the graft extrusion will be minimal and the results will remain unchanged. Meniscus tears are very common. 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. MAT is a potential surgical procedure for young, active patients with symptomatic meniscal insufficiency that does not respond to conservative treatment [102, 103].
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