2. •Medial and lateral menisci are two semilunar plates
of fibrocartilage that are placed on the condylar
surface of the tibia
•They are tibial extension that creates conformity b/w
the relatively flat tibial surface and round femoral
condyles
•Made up of type 1 collagen with some type 2 and
some elastin fibers
•Arranged in circumferential hoops and radial

3. •Medial menisci is three fifth of a ring; semicircular
•Asymmetrically larger posteriorly than anteriorly and
fixed to tibia and femur thru the coronary ligaments
•Bld supply : medial superior and inferior geniculate
arteries
•Nerve innervation accompanies peripheral vascularity
•Less mobile
•Antr horn attached to tibial intercondylar eminence
(infront of ACL)
•Postr horn attached to intercondylar area (in front of PCL)

4. •More circular,makes four fifth of a ring with
symmetrical antr and postr horns
•It has got a hypovascular zone in the area of popliteus
tendon hiatus.
•In this area it has no peripheral/capsular attachments
•Hence greater mobility to lateral meniscus
•Antr horn attached to intercondylar eminence of tibia
lateral to ACL
•Posterior horn attached to intercondylar eminence

5. L
M

6.  Vascular supply good in the most
peripheral 20% of the fibers
 Supplied by the geniculate arteries
 Inner 1/3 of the ring is avascular
 Relatively thin
 Nourished through synovial fluid
 Middle 1/3 of the ring is
combination

7. • joint stabilization
•Tibio-femoral stress reduction
•Joint nutrition
•Wt transmission –abt 40-70 % across the knee joint
•As a shock absorber
•Increase the tibiofemoral contact area by 40 %
•Helps knee in locking mechanism
•Prevents impingement of synovial membrane,capsule etc
•Assists and control gliding and rolling motion of knee

8. Medial meniscus is more commonly injured than
lateral meniscus and is usually associated with other
ligament injuries
Seen in abt 71 % of cases,and 5% its bilateral
Lateral meiscus is less injured because:
oSmaller in diameter
oThicker in periphery
oWide
oMore mobile
oAttached to both cruciate lig
oStabilised postiorly to the femoral condyle by
popliteus

10. •Rotational force when a flexed knee extends
•Twisting strain when knee is flexed ;young
active athlets are more prone
•In middle aged: fibrosis decreases the mobility
and hence tear occurs with less force

11.  An acute twisting injury from impact during a
sport
 Usually the foot stays fixed on the ground and the rest of
body rotates
 .Rotational force while jt is partially flexed
 Getting up from a squatting or crouching
Position.

12. Associated injuries
 In acute knee injuries with ACL intact, medial
meniscal injury is 5 times more likely than lateral
 In acute knee injuries with ACL ruptured, lateral
meniscus more likely to be involved
 If ACL is previously disrupted, lateral meniscal injury
is more likely than medial
 In repetitive deep squatting, medial meniscus most
likely to be injured

13. symptoms
 Not all meniscal tears are symptomatic
 Swelling
 Pain along the joint line (tenderness)
 Pain when squatting, kneeling or pivoting
 Locking of the knee
 Giving way snaps, clicks, catches in knee.
 Atrophy of quadriceps
 Instability of joint

14.  Locking positive :
Restriction of the last few terminal degrees of extension
of the knee
 Mc murray’s test positive
Hip and knee flexed at 90 degree,with examiner’s hand
over the knee internal and external rotation of knee is
done for lateral and medial menisci resp.positive test
requires both pain and click to be felt by the examiner

16.  Joint line tenderness positive
medial joint line tenderness is elicited when knee
flexed to 60 degrees and leg externally
rotated.positive in 74 % cases of medial meniscal
injuries
 Quadriceps atrophy positive
 Steinmanns sign
Meniscal pathology may be suspected if medial
pain is elicited on lateral rotation
And lateral pain on medial tibial rotation

17.  Apley’s compression test positive
Pt in prone position,fixing the thigh against the table,the
examiner presses the foot and leg downward while
rotating the tibia,pain implies meniscal lesion.pain on
lateral rotation indicates a medial meniscal tear

18. Apley’s Distraction Test
 Here the examiner pulls the foot and leg upward to
distract the joint while again rotating the tibia.pain
noted during axial distraction of joint implies a
ligamentous lesion

19. Based on appearance on arthroscopy :
1. Radial/parrot beak tears
2. Flap tears
3. Degenerative tears
4. Bucket handle tears(vertical)
5. Horizontal tears

20. L R H
B P S

21. Initial plain xray :
To R/O ass. #,ligamentous avulsion, or arthritic change,soft
tissue swelling
MRI
cuts usually proceed from medial to lateral
lateral meniscus is symmetrical in sagital view and has
appearance of a bowtie
Arthroscopy

22. o Grade 1 tear has an increased signal in the meniscal
substance
o Grade 2 change involves a more pronounced and
frequently linear signal that does not break the surface of
the meniscus.
grade 1 and 2 appears normal on arthroscopic evaluation
o Grade 3 change is a signal that traverses through the
meniscal surface and will be noted as tear on arthroscopy
in 80% of cases
o There is extension of tear through both the tibial and
femoral surfaces of the meniscus

23.  locked bucket handle tear usually involves
medial meniscus and is seen as
‘double PCL sign’ on sagittal images

25. Depends on age, presence of arthritis, damage or
deformity of meniscus, and association of cruciate
ligament tear etc
Conservative
in patient’s soon after injury with no locking and with
infrquent attacks of pain and in tears less than
10mm,partial thickness tears
Surgery
if joint cannot be unlocked and if symptoms are
recurrent

26. 1. Abstinence from weight bearing
2. Rest,ice packs,compressive bandage
3. Buck’s skin traction
4. Joint aspiration
5. Quadriceps exercises
6. If symptoms persists,a cylindrical cast may be
considered

27.  Total meniscectomy
 Partial meniscectomy
 Meniscal repair
 Inside out
 Outside in
 All inside

28. Partial Meniscectomy
 Done when tear involves interior 70%
 May be done when athlete wants to resume activity
ASAP
 Done with mobile fragments
 10-35 minute arthroscopic procedure under regional or
general anesthetic
 Mobile areas removed
 Edges contoured to “prevent further tears”
 Immediate partial weight bearing allowed
 Crutches for 1-2 days

29. Total meniscectomy
 Irreparably torn meniscus
 Not a treatment of choice in young athlets
 Steps:
 anteromedial incision medial to patella upto upper
tibia.
 Incise capsule and fascia.
 Lift the synovium and make a small opening.
 Extent the opening proximally and distally and
examine the structures of joint

30.  Palpate the meniscus on both surface entirely with
meniscal hook.
 Mobilise anterior 1/3 with scalpel.
 Middle 1/3 by retracting tibial collateral ligament.
 Then mobilise posterior 1/3 of menisci.
 Check the medial and antr stability of knee joint.

31. Consequences of Meniscectomy
 increased osteophyte formation and femoral cartilage
deterioration in meniscectomized knee
 In medial meniscectomy, load bearing surfaces are
halved, doubling stress on tibial plateau

32. •Infection
•Nerve palsy (saphenous,tibial,peroneal)
•Vascular injury
•Post op effusion : sign of hyaline cartilage injury.
Trt:ice,anti inflammatory agents,chondroprotective agents
•Reflex sympathetic dystrophy –decrease range of
motion with pain
Trt: aggressive pain control,rehabilitation, sympathetic blocks
,continued limitation of motion,arthroscopy,manipulation and
post operatively continuous epidural block can effectively manage
RSD

33.  Post op hemarthrosis
 c/c synovitis
 Injury to popliteal vessels
 Painful neuromas of infra patellar branch of
saphenous nerve
 Thrombophlebitis

34. Meniscus Repair
 Arthroscopically aid repair
Used in longitudinal tears,vascularised zone
Through posteromedial arthrotomy multiple
interrupted sutures placed vertically through
periphery of meniscus and tied outside joint capsule.
 Outside in, inside out, and all inside technique

36. •Patient’s who underwent partial meniscectomies can
be allowed immediate wt bearing,range of motion
exercises,functional strengthening and quick returns
to daily activities
•Presence of degenerative changes slows recovery
and return to full activity must be individualised