This movement can produce a traction injury of the medial meniscus, tearing it from its peripheral attachment and producing a longitudinal tear of the substance of the meniscus. The primary function of the articular cartilage is to provide. In fact, a meniscal tear is one of the most frequently occurring cartilage injuries. The medial and lateral menisci play an important role in absorbing force and assisting in the role of nourishing the knee joint. Pdf meniscal ramp lesion repair using an allinside. The word menisci are derived from the greek work meniskos, which means crescent. The meniscus is a wedge shaped cartilage ring found on both the inside and outside of the knee between the femur thigh bone and tibia shin bone. Kissing cartilage lesions of the knee caused by a bioabsorbable meniscal repair device a case report article pdf available in the american journal of sports medicine 327. When the knee is symptomatic, arthroscopic partial meniscectomy has been practised for a long time with many case series reporting improved patient outcomes. Meniscus tears usually take place when an athlete twists or turns their upper leg while their foot is planted and their knee is bent. Insideout repair of meniscal ramp lesions arthroscopy. The medial meniscus sits on the inside of the knee and the lateral meniscus sits on the outside of the knee.
If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a pdf plugin installed and enabled in your browser. Patients andmethods a prospective study was undertaken at the university hospital kuala lumpur, from january 1983 to june 1984. All patients underwent repair of the posterior horn ramp lesion of the medial meniscus, using a suture hook device with pds no. A tear of a meniscus is a rupturing of one or more of the fibrocartilage strips in the knee called menisci. We describe a case of acute buckethandle tear of the medial and lateral menisci with intact anterior and posterior cruciate. Detection at the time of arthroscopy can be accomplished based upon clinical suspicion and careful evaluation without the use of an accessory posteromedial portal. The majority of meniscal injuries occur without adequate trauma 3, 4, 9. The state of the literature in the nonoperative management of meniscus and articular cartilage lesions is rapidly evolving and will be explored and presented in the next iteration of this cpg. Meniscal ramp lesions have been reported to be present in 9% to 17% of patients undergoing anterior cruciate ligament reconstruction. Bucket handle tear of the menisci is a common type of lesion resulting from injury to the knee joint. Menisci rests between the thigh bone femur and the tibia and there are two knee joint ligaments. Articular cartilage is made up of collagen, proteoglycans and water and lines the end of the bones that meet to form a joint.
When the acl has been reconstructed and a meniscal lesion is present, the choice of treatment method will, whenever possible, preserve the meniscus grade c. Review article clinical practice guidelines for the. Meniscal tears can cause pain or locking of the knee joint and prevent those affected from participating in sporting activities, while at the same time reducing their quality of life 1 5. The cshaped medial meniscus lies in the inner edge of the superior surface of the tibial bone.
If you do not have it you can download adobe reader free of charge. They can also be torn by traumatic force encountered in. At knee joint the menisci plays a major role in congurency of the joint. Therefore the medial meniscus is crushed on the tibial rim in deep flexion injury 3. A meniscus tear was designated when intrasubstance signal intensity in the meniscus prop er extended to an articular surface or abnormal. Development of the menisci of the human knee joint. Withaging,themeniscaltissuedegenerates and can delaminate, thus making it more susceptible to splitting. When the knee is symptomatic, arthroscopic partial meniscectomy has been practised for a long time with many case. This technique is suitable for all peripheral tears located in the redred zone or ramp lesions of the mm posterior segment. Menisci forms the concavity in which the femoral condyles sits. But only about 10 percent of all meniscus tears are repairable in this manner. Delamination between the different layers of collagen occurs resulting in separation of the superior from the inferior surface of the meniscus.
Current concepts on posterior meniscal root lesion. Proposition of a useful tool for its radiologic analysis meniscal ramp lesions. Other experimental and clinical studies, also showed the interest of. Compared to the medial meniscus, the lateral meniscus covers a wider portion of. Radiological studies have shown that osteoarthritis can be a longterm consequence of meniscal injury 2, 6 8. The lesion can occur at the meniscocapsular junction or within the peripheral zone of the meniscus. Patient guide to meniscus injuries what is the meniscus. Department of orthopedics, maanshan peoples hospital, maanshan, anhui province, china 2 department of sports trauma and arthroscopy. Like a lot of knee injuries, a meniscus tear can be painful and debilitating. Ligaments and meniscus of the knee flashcards quizlet.
The medial meniscus is injured much more often than the lateral menis cus, with the posterior horn being the most afflicted component. The clinical diagnosis was correct in 85%, arthrographic in 54%. Rarely, it has also been shown to affect the medial side. Anatomy and biomechanics there are four meniscal root anchors that firmly attach the medial and lateral menisci to the anterior and posterior tibial intercondylar region.
The menisci act as shock absorbers in the knee, and provide stability to the joint. Epidemiology meniscus lesion meniscus laesion meniscus injuries. Simultaneous bicompartmental buckethandle meniscal tears. There are two fibrocartilaginous menisci in the knee joint. Meniscal tears are the most common lesions followed by the meniscal cyst. Efficacy of arthroscopic surgery for discoid lateral meniscus injury in knee joint. When doctors and patients refer to torn cartilage in the knee, they actually may be referring to an injury to a meniscus at the top of one of the tibiae. Aug 08, 2016 data from anterior cruciate ligament acl registries show that 47% to 61% of acl tears are associated with meniscal lesions. Approach to meniscal tear by clinical examination and its.
These files will have pdf in brackets along with the filesize of the download. The meniscus especially the posterior horn of the medial meniscus can be a secondary stabilizer in an acl deficient knee. Classification and surgical repair of ramp lesions of the. Bucket handle injury of both menisci in almost all cases is associated with a lesion to either the anterior or the posterior cruciate ligament of the knee joint. Raveendran summary in a prospective study of 50 patients with suspected tear of the meniscus of the knee, the clinical diagnosis, arthrographic and arthroscopic findings were compared at arthrotomy. We would like to show you a description here but the site wont allow us. A meniscal lesion associated to a chronic anterior laxity, even if the meniscal symptoms are predominant, should raise the possibility of ligament reconstruction professional agreement. Meniscus ramp lesion ramp lesions of the medial meniscus mm are associat ed with 9 to 17% of acl t ears and ar e seldom recognized on preopera tive magnetic resonance imaging mri scans. A meniscal cyst is a rare disorder in the knee occurring in about 1% to 7. Methods a degenerative meniscus lesion was defined as a lesion occurring without any history of significant acute trauma in a patient older than 35 years. Options for surgical treatment include arthroscopic repair using an allinside or insideout. Medial meniscus, ramp lesion, repair, healing, anterior cruciate ligament, knee. A degenerative meniscus lesion is a slowly developing process typically involving a horizontal cleavage in a middleaged or older person. The discoid meniscus is an anatomic variant that primarily affects the lateral meniscus.
Learn vocabulary, terms, and more with flashcards, games, and other study tools. A treatment algorithm will also be recommended based on the currently available evidence. Under compressive loads, the medial porcine meniscus and its attachments undergo signi. Racgp meniscal tear presentation, diagnosis and management.
Meniscus rehab exercises the physical therapy advisor. Because of the strong fixation of the medial meniscus, tears of the meniscotibial or the coronary ligaments, especially of the posterior horn, are more frequently compared to the lateral meniscus. Disruption of the posterior horn of the medial meniscus could lead to excessive forces within the knee joint and surrounding structures. This guide focuses on the normal meniscal mechanism body and function. Originally, a ramp lesion was defined as a longitudinal tear of the peripheral attachment of the posterior horn of the medial meniscus at the meniscocapsular junction of less than 2. Surgical management of degenerative meniscus lesions. A meniscus repair involves suturing the torn edges of the meniscus back into place and letting the meniscus mend itself. The orthopedic surgeon may modify the time frames and weight bearing status, as necessary, to allow adequate healing time. Meniscal lesions of the posterior horn of medial meniscus mm are very often associated with an acl rupture 16,32,49. The protocol may be modified depending on the location and extent of the meniscal tear and subsequent repair. Management of traumatic meniscal tear and degenerative. This last type is located in the plane of the meniscus and may be a manifestation of degeneration. Menisci can be torn during innocuous activities such as walking or squatting. The lateral meniscus is smaller in diameter, thicker in periphery wider in body, and more than the medial meniscus.
These usually extend to the inner margin of the meniscus, i. This video demonstrates a possible method for resolving a lateral meniscus lesion. The lateral meniscus found on the outer edge of the knee is almost circular in shape. Meniscus repair rehabilitation the following protocol is a guideline for rehabilitation following meniscus repair. This video describes an arthroscopic approach to repair a ramp lesion of the medial meniscus. Between 2007 and 2008, 104 lateral meniscus lesions on stable knee were recruited prospectively in 10 centers. To open a pdf file you will need compatible software such as adobe reader. Lesion type and topography were recorded and patients were assessed by knee osteoarthritis outcome score koos and subjective and objective international knee documentation committee ikdc scores, preoperatively and at 6 months fu. Our knowledge and understanding of the anatomy and function of the. Cshape tight and closed off more like an incomplete circle, i. This disparity in motion contributes to the frequency in which each meniscus is injured. Efficacy of arthroscopic surgery for discoid lateral meniscus. Alternatively, you can download the file locally and open with any standalone pdf reader. Pdf kissing cartilage lesions of the knee caused by a.
Pdf most of the documents on the racgp website are in portable document format pdf. Pdf meniscal ramp lesion repair using an allinside technique. Be sure to rotate your leg outward laterally slightly to gain a better activation of the medial inner side of the quadriceps. Diagnostic accuracy of sequential arthroscopic approach for. Occasionally menisci can develop as a block or disk shape, which is called a discoid meniscus. Aug 14, 2017 the medial meniscus is most commonly injured, particularly where the tibial collateral ligament attaches to it. Each meniscus is cshaped in the transverse plane and consists of the following connected parts. Posteromedial approach in the case of a tear of the posterior segment, a posteromedial approach is. The healing process depends on debridement or abrasion of the walls of the tear, especially in chronic lesions. Does this patient have a torn meniscus or ligament of the.
Menisci bertindak sebagai peredam kejut dan jika terjadi. This was a prospective consecutive study of 195 primary acl reconstructions with arthroscopic exploration for ramp lesion in 4 steps. The anterior and posterior cruciate ligaments, located in the center of the knee joint, stabilize the joint and help to prevent forward or backward sliding of the tibia as well as prevent hyperflexion bending and hyperextension. Radial tears run from the meniscus margin towards the periphery. The bones in the knee joint comprise the thigh bone femur, shin bone tibia and the knee cap patella. Jul 26, 2016 originally, a ramp lesion was defined as a longitudinal tear of the peripheral attachment of the posterior horn of the medial meniscus at the meniscocapsular junction of less than 2. Lesions of the meniscus are commonly encountered in the practice of knee surgery. This page will explore how and what happens when the menisci become injured a tear and or a rupture. Since 2002, several randomised clinical trials demonstrated no additional benefit of arthroscopic. Anterior cruciate ligamen acl merupakan salah satu dari 4 ligamen utama di lutut yang menghubungkan tulang femur tulang paha dan tibia. In a medical report concerning problems with a knee.
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