2. ANATOMY
⢠Meniscus is a cushion structure made of
cartilage which fits within the knee joint
between tibia and femur.
⢠Each Menisci has
- Two ends
- Two borders
- Two surfaces
3.
4. MEDIAL MENISCUS
⢠C- Shaped structure and
lateral meniscus is more
circular.
⢠Anterior horn : Attached to
the tibia anterior to the
intercondylar eminence to
the ACL.
⢠Posterior horn : Anchored
immediately in front of the
attachment of PCL posterior
to the intercondylar
eminence.
5. Medial Meniscus
⢠Peripheral border
attached to the
medial capsule
through the coronary
ligament to the upper
border of tibia.
⢠Most of the weight
borne on the
posterior portion of
meniscus
6. LATERAL MENISCUS
⢠Circular shaped
⢠The anterior and posterior
horns are closer to each
other & near insertion of ACL
⢠Anterior Horn : Attached to
the tibia in front of the
intercondylar eminence.
⢠Posterior Horn : Attached to
the posterior aspect of the
intercondylar eminence in
front of posterior attachment
of medial meniscus.
7. Lateral Meniscus
⢠The lateral meniscus is mobile and medical
meniscus is more fixed -> causing more tears to
occurs in medical meniscus
⢠Lateral meniscus is associated with discoid
meniscus and meniscal cysts
⢠Lateral meniscus is also assoc. with acute injury
to ACL
Medial Meniscus
⢠Tears of medical meniscus occurs more with
degenerative tears
⢠Associated with a bakerâs cyst.
8. BLOOD SUPPLY
⢠The blood supply of meniscus
decides the healing potential of the
meniscus
⢠The outer one-third of meniscus is
vascular. It will heal if repaired
⢠The inner one-third is not vascular
and is nourished by synovial fluid.
⢠The middle third is red/white and it
is avascular.
⢠The blood supply of meniscus
originates from medial and lateral
genicular arteries
9. FUNCTIONS OF MENISCUS
⢠Shock Absorber: Provides load
sharing across knee by increasing
the contact area and decreasing
the contact stress.
⢠Act as joint filler : Compensates
for the gross incongruity
between tibial and femoral
articulating surfaces.
⢠Joint Lubrication: help to
distribute Synovial fluid through
the joint and aiding the nutrition
of articular cartilage.
10. OVERVIEW of MENISCAL INJURY
⢠Epidemiology:
- Most common indication for knee surgery
⢠Location:
ďź Medial Tears
- More common
- Degenerative tears in older patients usually
occur in posterior horn of medial meniscus.
ďź Lateral Tears
- More common in acute ACL tears
11. CLINICAL FEATURES
⢠Pt is usually a young person who sustain
twisting injury to the knee
⢠Knee pain (often severe)
⢠Swelling of the knee within 48hours
⢠âLockingâ : Sudden inability to extend the knee
fully â suggest a âbucket-handle tearâ.
⢠Popping or clicking within the knee.
⢠Limited motion of knee joint.
⢠Tenderness when pressing on the meniscus
(Knee joint line)
12. CLASSIFICATION OF MENISCAL TEAR
⢠Based on Location
ď Red Zone: Outer third, vascularized
ď Red-White Zone : Middle Third
ď White Zone : Inner third, Vascularized
13. Based On Pattern
⢠Vertical/Longitudinal
- Common, esp. with
ACL tears
⢠Bucket Handle
- Vertical tear which
may displace into
notch
⢠Horizontal
- More common in
older population
- May be associated
with meniscal cysts
14. PHYSICAL EXAMINATION
⢠The joint may be held slightly flexed and there
is often an effusion.
⢠In late presentations, the quadriceps will be
wasted.
⢠Tenderness is localized to the joint line,
particularly the medial line.
⢠Flexion is usually full but extension is often
limited.
15. SPECIAL TESTS
1) Thessaly Test
⢠Standing at 20 degrees of knee flexion on
affected limb
⢠Patient twists with knee external and internal
rotation.
⢠Positive Test: Clicking, pain or discomfort on
joint line.
16.
17. 2) McMurrays Test
⢠Principle: To trap the meniscus
between the tibia and femur.
⢠Pt needs to be relaxed.
⢠One hand on knee joint line.
Other hand holds the foot &
ankle.
⢠Flex the knee as far as possible
(Hyperflexion)
⢠Externally rotate(Medial Me.) or
internally rotate (Lateral Me.) the
tibia and then extend the knee.
⢠Positive McMurrayâs : Clicking or
popping felt associated with
pain.
18.
19. 2) Apleyâs Grinding test
⢠Patient is in prone
position
⢠Knee flexed to 90 degrees
⢠The leg is rotated from
side to side
⢠Compression force
applied
⢠A painful response
signifies a torn or
degenerate meniscus.
20.
21. IMAGING
Radiographs
⢠Should be normal in young patient with acute
meniscal injury
MRI
⢠Most sensitive diagnostic test
⢠Findings
- MRI Grade III signal is indicative of a tear
- Parameniscal cyst indicates presence of meniscal
tear
- May see âDouble PCLâ sign that indicates bucket-
handle meniscal tear.
22.
23. MANAGEMENT
NON-OPERATIVE TREATMENT
Indication: First line of treatment for degenerative
tears
: Acute episode without locking but with
acute synovitis
⢠Immediate abstinence from weight bearing
⢠Rest
⢠Ice pack application
⢠Compression dressing
⢠NSAIDS
⢠Rehabilitation exercises
25. OPERATIVE TREATMENT
1) Partial Meniscectomy
⢠Indication: Tears not amenable to repair (complex,
degenerative, radial tear patterns)
: Repair failure > 2 times
⢠Objective: Remove the torn meniscal fragment and
contour the peripheral rim, leaving a balanced, stable rim
of meniscal tissue.
⢠Outcomes
- >80% satisfactory function
⢠Partial is preferred over total meniscectomy
- Shorter operating time, Faster recovery, better
post-op function.
26. Anthroscopic Meniscal Repair
3 important steps:
- Appropriate patient selection : should have
documented tear that is able to heal
- Tear debridement and local synovial, meniscal
and capsular ablation to stimulate a
proliferative fibroblastic response
- Suture placement to reduce and stabilize the
meniscus