his post talks about the importance of balance training and strengthening-, Muscle mass.. or larger muscles are associated with longevity and better health. (2012). When diagnosing a meniscus tear, a doctor will carry out a detailed medical history and a thorough examination of the knee joint. Furthermore, they performed an open MTL repair in 15 patients with meniscal tear and medial ME through a mini-incision with three interconnecting suture anchors (Fig. 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. 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. We also explore recovery and when to contact a doctor. Cant fully bend or straighten your leg without knee pain. 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? Finally, meniscal allografts often result in extrusion, thus potentially reducing the clinical benefits of transplantation. These are the knee compression sleeves we recommend for stability during exercise. To the best of our knowledge, the exact clinical significance of ME after ACLR has not yet been clearly elucidated, although efforts are continuously being made to minimize this phenomenon. We, Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. J Orthop Res 35(8):16251633, Shefelbine SJ, Ma CB, Lee KY, Schrumpf MA, Patel P, Safran MR et al (2006) MRI analysis of in vivo meniscal and tibiofemoral kinematics in ACL-deficient and normal knees. Therefore, proper placement of the posterior horn is critical to the anatomical repair of the meniscus [125,126,127]. Although there is a need for longer follow-up periods, the currently available data suggest a benefit of concomitant ACLR with the repair of longitudinal, radial, posterior horn and posterior root tears of the menisci, because the combination can even better reduce their shape and extrusion [92, 98,99,100]. Several strategies have been proposed to reduce allograft extrusion. A novel technique has been developed based on a measurement grid in order to determine the precise aperture of the tibial tunnel. https://doi.org/10.1177/2325967120961368, Paletta GA, Crane DM, Konicek J, Piepenbrink M, Higgins LD, Milner JD et al (2020) Surgical treatment of meniscal extrusion: a biomechanical study on the role of the medial meniscotibial ligaments with early clinical validation. X-rays are useful in finding other causes of knee pain, but they will not show a meniscus tear. Surgical versus conservative interventions for treating meniscal tears of the knee in adults. 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]. More importantly, it leads to rapid progression of the degenerative process of the knee as well as substantial morbidity and pain [25,26,27,28]. Therefore, ultrasound (U/S) was recently introduced as a reliable alternative to MRI for the evaluation of ME, which also offers the possibility for dynamically assessing ME in various positions, as well as in a weight-bearing state, in an inexpensive and feasible manner [20,21,22]. However, further investigation is needed to evaluate the effect of the ACLR on the restoration of the MM function [88]. Acta Med Okayama 70(6):441448, Narazaki S, Furumatsu T, Tanaka T, Fujii M, Miyazawa S, Inoue H et al (2015) Postoperative change in the length and extrusion of the medial meniscus after anterior cruciate ligament reconstruction. A person may feel a pop when they tear the meniscus. Rehabilitation following meniscal repair: A systematic review. Nevertheless, there is still controversy in the literature regarding the optimal threshold, as a few studies have proposed a value lower than 3mm [9, 10], whereas other researchers suggest that a cutoff value higher than 3mm is optimal [11,12,13]. 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]. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 25(2):335346, Kopf S, Beaufils P, Hirschmann MT, Rotigliano N, Ollivier M, Pereira H et al (2020) Management of traumatic meniscus tears: the 2019 ESSKA meniscus consensus. Meniscus tears are the most frequently treated knee injuries. If your injury doesnt improve with RICE, NSAIDs and physical therapy, your healthcare provider may recommend arthroscopic surgery. The early results of MAT are encouraging, as pain relief and improved knee function are reported [15,16,17, 62, 104,105,106,107,108,109]. 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/. Int Orthop 43(11):25492556, Figueroa F, Figueroa D, Calvo R, Vaisman A, Espregueira-Mendes J (2019) Meniscus allograft transplantation: indications, techniques and outcomes. Conservative treatment constitutes the first line of therapy in mild or moderate knee OA [46, 47]. Treatment with glucosamine, chondroitin sulfate and licofelone has been found beneficial in patients with knee OA and ME, as it may lead to alleviation of symptoms and reduce cartilage volume loss over time. The time of recovery varies depending on: The meniscus is a C-shaped band of cartilage that goes around the knee joint and cushions the junction of your thighbone (femur) and shinbone (tibia). A hip labral tear is an injury to the labrum, the soft tissue that covers the acetabulum (socket) of the hip. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. 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. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7359983/, https://orthoinfo.aaos.org/en/recovery/knee-arthroscopy-exercise-guide/, https://orthoinfo.aaos.org/en/diseases--conditions/meniscus-tears/, https://www.ncbi.nlm.nih.gov/books/NBK431067/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5444079/, New clues to slow aging? 2017;12(1):e0170710. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. Home treatment, If you've been sidelined by a common sports injury like an ACL tear, you're likely wondering how long it will take to heal. MPRT are defined as an avulsion fracture or a radial lesion occurring within 1cm of the bony tibial attachment [56]. 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. Putting ice on your knee for 10 to 15 minutes It is known that ACL and meniscal function cannot be fully restored even after surgical repair [86, 90]. As you get older, the cartilage in your knees wears down and gets weaker. 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. An intermediate This cartilage is the meniscus. (2018). In this review, we delineate the clinical significance of ME in various knee pathologies, as well as when, why and how it should be managed. During this procedure, your doctor will remove the 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%). Moreover, it has been shown that allograft extrusion does not correlate with clinical outcomes and tends to be stable postoperatively during follow-up [62, 108, 113]. https://doi.org/10.1186/s43019-022-00163-1, DOI: https://doi.org/10.1186/s43019-022-00163-1. Another successful strategy is osteophyte resection. One way to reduce postoperative ME is by early intervention, specifically within 3months after the MPRT [70,71,72]. People with arthritis in their knees are also more prone to meniscus tears. Shiraev T, et al. However, efforts to standardize or optimize the treatment for MMPRT are much needed. A tear that gives you a lot of pain or impairs use of your knee may require surgery to remove or repair the torn part of the meniscus. A threshold of 3mm, which was initially introduced, is most commonly used to define a significant ME [8]. Ann Rheum Dis 64(4):556563, Driban JB, Ward RJ, Eaton CB, Lo GH, Price LL, Lu B et al (2015) Meniscal extrusion or subchondral damage characterize incident accelerated osteoarthritis: data from the osteoarthritis initiative. meniscus Perhaps even more important is that once your knee feels better, and it Meniscal tear | Radiology Reference Article [54] showed that varus alignment factors, and specifically medial proximal tibial angle (MPTA), were significantly related to the extent of MME, especially as the knee OA grade progressed. A small 2018 randomized controlled study comparing conventional to Ayurvedic treatment in 151 people found that Ayurvedic treatments were beneficial in reducing osteoarthritis knee symptoms at 3, 6, and 12 months. Prepatellar bursitis is a common complaint of people who work on their knees or who engage in activities that risk blows to the knee. 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. Your doctor will bend your knee, then straighten and rotate it. Posterior Horn Medial Meniscus Tears Howard J. Luks, 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. Severe Meniscus Tear: Treatment Options These tests include: However, these may not have the best accuracy. Several studies also argue that the presence of ME is predictive of knee OA progression [32,33,34]. At the time the article was created Yuranga Weerakkody had no recorded disclosures. 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. Currently, MPRT repair constitutes the treatment of choice, since it restores the hoop tension and the joint kinematics [65], halts the progression of OA and lowers the rate of arthroplasty [66, 67]. Recovery time can be lengthy with either one. Knee Surg Sports Traumatol Arthrosc 20(1):4861, Kashihara N, Furumatsu T, Kodama Y, Tanaka T, Ozaki T (2016) Concurrent lateral meniscal repair with anterior cruciate ligament reconstruction induces the extrusion of the lateral meniscus: assessments of magnetic resonance images. 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. On the other hand, the suture-only technique has its own advantages and is therefore chosen by many surgeons [104, 111]. RICE stands for rest, ice, compression and elevation. (C) After the suture has been passed through the meniscus with free limbs su-perior and inferior to the meniscus tear. National Center for Biotechnology Information Meniscus Tear Recovery Time Without Surgery: What to However, several studies showed that partial meniscectomy, particularly when the ME was profound [62, 63], failed to prevent the progression of OA, as it creates a meniscus-deficient state, and leads to significant functional impairment with high rates of arthroplasty [24, 60]. The term meniscal extrusion (ME) is used to describe the radial meniscal body displacement beyond the peripheral tibial plateau margin [7, 8]. Arthroscopy 36(4):11351141, Article WebMedial compartment osteoarthritis is a type of arthritis in your knee. Meniscus tears are very common. Causes of the injury include trauma and degenerative changes to the knee joint. https://doi.org/10.1186/s43019-019-0019-x, Article Arthritis (a breakdown of cartilage in the joints) can also lead to a meniscus tear. Kessler CS, et al. (ACLR+LM tears left in situ) showed narrowing of 1.0mm at 10-year follow-up [96, 97]. A doctor can do physical and imaging tests, such as an X-ray or MRI, to determine what kind of damage you have and discuss possible treatment options with you. PubMed WebDamage to the medial meniscus root, for example by a complete radial tear, destroys the ability of the knee to withstand hoop strain, resulting in contact pressure increases and kinematic alterations. The medial meniscus covers 5060% of the medial tibial plateau, and the lateral meniscus covers 7080% of the lateral tibial plateau. Meniscal maceration is a finding sometimes used on MRI imaging to describe the wasting away of the meniscus or cause it to become soft or separated into constituent elements. Experts say choosing between knee repair and knee reconstruction surgery isn't a simple decision. A physical therapist can provide a daily routine of exercises and stretches to improve your muscle strength, flexibility, range of motion, and stability. 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. The primary site of destruction is the soft tissue fibers which couple the deep layers of the ACL to the LM and the LM to the tibial plateau. Our website services, content, and products are for informational purposes only. For a simple tear here, doctors may advise a short course of rest and physical therapy to see whether spontaneous healing occurs. To perform this exercise, a person should do the following: The red zone has a blood supply, and therefore, a meniscus injury in this area may heal on its own. In the days following your injury, you should also follow the RICE protocol. 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. Therefore, improvements in surgical techniques are necessary [102, 109]. [76] showed that induction of MTL lesions in cadaveric knees resulted in ME after only a few cycles of loading and that repair of the lesion led to a significant reduction of ME. As a result, post-traumatic transposition and degeneration of the MM may not be completely prevented by ACLR alone. What is a meniscus injury, and how common is it? First, surgery is rarely necessary for degenerative meniscus tears. ME is found in several knee pathologies and is well correlated with rapid knee OA progression as well as increased morbidity. [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. 60 patients were performed arthroscopic meniscus repairs Your doctor may give you a joint injection of glucocorticoids to reduce swelling. Meniscus repair involves stitching torn pieces of a meniscus back together. Meniscus tear surgery is very common, with about 850,000 surgeries performed each year in the United States. Using the back of a chair for support, stand upright. They may also share some exercises you can do at home. Correspondence to A persons initial exercise routine may include an exercise called hamstring contractions. An MRI will confirm a suspected diagnosis. 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. [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. This can provide pain relief for 2 to 4 weeks. It can be hard to prevent an accidental injury. Orthopaedic knee surgeons use Mordecai SC, et al. Arthrosc Tech 9(10):e1511e1517, Tsujii A, Yonetani Y, Kinugasa K, Matsuo T, Yoneda K, Ohori T et al (2019) Outcomes more than 2 years after meniscal repair for radial/flap tears of the posterior lateral meniscus combined with anterior cruciate ligament reconstruction. Generally speaking, the treatment options for meniscus tears include: rest, physical therapy, activity modification, and occasionally a surgery we refer to as an This puts tension on a torn meniscus. However, data on this is limited and shouldnt replace talking with your doctor about your treatment options. 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. 2a), and found that postoperative ME was significantly reduced. 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 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]. Orthop J Sports Med 8(7):2325967120936672, Koga H, Muneta T, Watanabe T, Mochizuki T, Horie M, Nakamura T et al (2016) Two-year outcomes after arthroscopic lateral meniscus centralization. On imaging, it is often seen as a meniscal loss with the destruction of expected architecture. 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). TK and DG designed the manuscript and helped to draft the manuscript and review it. 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]. It has been shown from studies that the risk for TKA after ACLR is seven timesgreater than in normal individuals [88]. 2023 Healthline Media UK Ltd, Brighton, UK. 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. Lie on the back and bend both knees at a 10-degree angle. Note that meniscectomy may cause osteoarthritis in the long term. 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]. Am J Sports Med 44(9):23302338, Parkinson B, Smith N, Asplin L, Thompson P, Spalding T (2016) Factors predicting meniscal allograft transplantation failure. Meniscal tears are grossly divided into degenerative and traumatic [3]. Today, in general, doctors recommend conservative treatment, not surgery, when meniscus tears result from degeneration. Knee Surg Sports Traumatol Arthrosc. However, its posterior extrusion progressed significantly regardless of the healing status [90]. The goal of the anatomic reconstruction of the ACL rupture is to replicate the normal knee anatomy. CAS Clinical significance and management of meniscal extrusion in different knee pathologies: a comprehensive review of the literature and treatment algorithm. Wear athletic shoes that are appropriate for the sport youre doing. Orthop J Sports Med 9(3):2325967121989678, Koga H, Watanabe T, Horie M, Katagiri H, Otabe K, Ohara T et al (2017) Augmentation of the pullout repair of a medial meniscus posterior root tear by arthroscopic centralization. Last reviewed by a Cleveland Clinic medical professional on 04/17/2021. The results as to which technique is superior to the others remain controversial. CAS Therefore, with this article we aim to provide an up-to-date review of the literature with an emphasis on the clinical significance and new concepts in the treatment and reduction of ME in the different knee pathologies in which it is encountered. Knee Surgery & Related Research Last medically reviewed on February 8, 2022, The knee is one of the body's more complicated joints and is susceptible to various injuries. Provided by the Springer Nature SharedIt content-sharing initiative. Here, find nine gentle exercises that may help strengthen and heal a torn meniscus. 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. Meniscus Tear All rights reserved. Without nutrients from blood, tears in this "white" zone cannot heal. However, more research with high-quality studies is needed in order to refine the technique and validate its long-term results in reducing ME. [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. Knee Surg Sports Traumatol Arthrosc 25(2):383389, Pache S, Aman ZS, Kennedy M, Nakama GY, Moatshe G, Ziegler C et al (2018) Meniscal root tears: current concepts review. Try to rest your knee for a few days and keep pressure off it. If the repaired meniscus failed to heal, lateral extrusion progressed significantly [92]. Orthopaedics, University General Hospital of Alexandroupolis, St. Niarhos 1, Dragana, 68100, Alexandroupolis, Greece, Konstantinos G. Makiev,Ioannis S. Vasios&Paraskevas Georgoulas, Orthopaedics, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece, Konstantinos Tilkeridis,Georgios Drosos&Athanasios Ververidis, You can also search for this author in 2023 Healthline Media LLC. 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. Knee arthroscopy versus conservative management in patients with degenerative knee disease: A systematic review. How can you tell whether you have a meniscus tear? Adv Orthop. 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. The inner two-thirds of the meniscus, however, lacks a blood supply. See additional information. Your provider may recommend knee arthroscopy to better view and accurately diagnose your injury. if you have sudden pain from a knee injury. medial meniscal extrusion is associated with MAT is a potential surgical procedure for young, active patients with symptomatic meniscal insufficiency that does not respond to conservative treatment [102, 103].