Acute avulsion of the root attachment of the posterior horn of the medial meniscus with mild meniscal extrusion Treatment The patient underwent right knee arthroscopy with posterior horn medial meniscus root repair. The patient was placed supine with a single-shot femoral nerve block and general anesthesia.
Full Answer
What is a posterior medial meniscal root repair?
Aug 29, 2014 · Most MMPRT repairs involve suturing around the region of tear where the sutures are pulled out and fixed around the tibia through simple stitches 8, 9, 40, 41). Shino et al. 42) first introduced the idea of pull-out repair of the posterior attachment of the lateral meniscus by making a 5-mm trans-tibial hole.
What are the treatment options for posterior horn medial meniscus root tear?
Apr 16, 2015 · Acute avulsion of the root attachment of the posterior horn of the medial meniscus with mild meniscal extrusion Treatment The patient underwent right knee arthroscopy with posterior horn medial meniscus root repair. The patient was placed supine with a single-shot femoral nerve block and general anesthesia.
What does the meniscus root attachment do?
Treatment of a Posterior Horn Medial Meniscus Root Tear Surgery is often required to repair a posterior horn medial meniscus root tear and slow down any progression of osteoarthritis. The two most common surgical procedures are suture anchor repair and transtibial pullout repair.
What does truncation of the posterior horn of the medial meniscus mean?
Mar 10, 2017 · Historically, medial meniscal root tears have been treated conservatively or by partial meniscectomy. With advances in surgical techniques and instrumentation, meniscal root repair is a viable ...
How do you treat a medial meniscus extrusion?
What does extrusion of the medial meniscus mean?
Do root meniscus tears require surgery?
How is medial meniscus posterior horn treated?
Will walking on a torn meniscus make it worse?
What is a meniscus root tear?
How painful is a meniscus root repair?
How long does it take to recover from a meniscus root tear?
What causes meniscus extrusion?
Does posterior horn medial meniscus tear require surgery?
Tears that are 1.5 cm to 4 cm usually require surgery. The size of the tear becomes important because if the tear in the tissue is too large it will not heal without the help of your surgeon.
What causes a posterior horn medial meniscus tear?
Can a posterior horn medial meniscus tear heal?
What is the pain in the back of the knee?
Pain in the back of the knee with deep squatting. Because the posterior horn of the medial meniscus absorbs most of the weight of the medial compartment, it is also by far the most frequent area that a meniscus tear occurs in. This is especially true in patients who have an ACL tear, where this portion of the meniscus then acts as ...
How long after knee surgery can you use a bike?
The use of a stationary bike may be initiated at 6 weeks after surgery and patients are allowed to perform leg presses at ¼ body weight to a maximum of 70 degrees of knee flexion.
What are the three parts of the knee?
It is generally divided into 3 separate portions, the anterior horn, the mid-body and the posterior horn. The posterior horn is the thickest and most important for overall function of the knee.
What is the difference between pain in the front and back of the knee?
It is important to differentiate between pain in the front and the back part of the knee. Pain in the front of the knee may indicate swelling or kneecap-related problems, whereas pain in the back of the knee is most commonly associated with a meniscus tear or a Baker’s cyst.
Where is the posterior horn of the medial meniscus?
The posterior horn of the medial meniscus is that portion of the medial meniscus in the back part of the knee. It varies from the main weightbearing portion of the meniscus up to where it attaches on the tibia at its lateral aspect, called the root attachment.
Which part of the meniscus absorbs the most weight?
The posterior horn of the medial meniscus is the most important weightbearing portion of the meniscus. While the medial meniscus absorbs 50% of the weight transmitted across the medial compartment, the posterior horn of the medial meniscus is the most important portion of the meniscus that provides the shock absorbing capacity.
Can meniscus tears be repaired?
It is well recognized that only about 10% meniscal tears are repairable. Thus, all efforts should be made to try to repair a medial meniscus tear of the posterior horn to prevent the further development of osteoarthritis.
How to repair a meniscus root?
The two most common surgical procedures are suture anchor repair and transtibial pullout repair. Both are performed arthroscopically and are done by either suturing the meniscus root back in place or tunneling through the bone to tie the meniscus back to the tibia. Another surgical option is to partially or completely remove the meniscus.
What is posterior horn medial meniscus root tear?
What is a Posterior Horn Medial Meniscus Root Tear? The meniscus is a thin, fibrous cartilage in the knee that softens the contact between the leg’s tibia and femur bones – it attaches to ligaments of the tibia. It plays a key role in absorbing the shock and stress your knee takes doing regular tasks throughout the day.
Can a posterior horn medial meniscus root tear cause knee pain?
Someone who experiences a posterior horn medial meniscus root tear may feel joint line pain (located horizontally from inside to outside knee along where the joint sits) or even hear a popping sound. They may also feel pain with full flexion of the knee and have a positive McMurray test after visiting an orthopaedic surgeon.
What are the three zones of the meniscus?
The three “zones” of the meniscus are called the (1) posterior horn, (2) body, and (3) anterior horn. The meniscal root connects each horn to the bones. Root tears occur within a centimeter of the meniscal attachment and prevent the meniscus from doing its job of converting loading forces into hoop stress. Cartilage defects are bad news ...
What is the cartilage that attaches to the femur?
The meniscus is a thin, fibrous cartilage in the knee that softens the contact between the leg’s tibia and femur bones – it attaches to ligaments of the tibia. It plays a key role in absorbing the shock and stress your knee takes doing regular tasks throughout the day.
What is the meniscal root?
The meniscal roots represent the attachment sites of the menisci to the medial tibial eminence. The posterior meniscal root of the medial meniscus attaches immediately anterior to the posterior cruciate ligament (PCL). The posterior meniscus should be seen on every sagittal image up to the one that shows the PCL (figure 3a).
What is considered an extruded meniscus?
The meniscus is considered “extruded” when it extends beyond the margin of the tibia (figure 5a). 1 Meniscal extrusions of greater than 3mm are associated with tears of the posterior meniscal root. 1,5 Meniscal extrusion is caused by disruption of the collagen fibers within the meniscus that resist hoop stress.
What are the functions of meniscus?
Important functions of the meniscus include load distribution, force absorption, proprioception, lubrication, and stabilization. The meniscus is responsible for supporting between 40% and 70% of the axial load across the knee; the remainder is transmitted by direct contact of articular cartilage. 1 Any alteration in the meniscus that reduces its ability to resist hoop stress will therefore lead to altered biomechanics, with increased load across the articular cartilage.
Can MRI show tears in medial meniscus?
Conclusion. Tears or avulsions of the posterior root of the medial meniscus are an infrequent finding on MRI examinations of the knee. However, it is important to diagnose these tears as several complications can result, including meniscal extrusion, secondary osteoarthritis, and subchondral insufficiency fracture.
What is the role of the meniscus in the knee?
The meniscus is responsible for supporting between 40% and 70% of the axial load across the knee; the remainder is transmitted by direct contact of articular cartilage. 1 Any alteration in the meniscus that reduces its ability to resist hoop stress will therefore lead to altered biomechanics, with increased load across the articular cartilage.
Can a radiograph show medial meniscal root tear?
Radiographs may or may not show medial joint space narrowing.
Why is it so hard to diagnose a medial meniscal root tear?
Making a medial meniscal root tear diagnosis is difficult because the typical history of locking, catching or giving way is less likely to be present. More often, the patient will complain of joint line pain with a minor traumatic event, such as squatting.
What is medial meniscus root tear?
Medial meniscal root tears are “radial” tears within 1 cm of the meniscal root insertion or an avulsion of the insertion of the meniscus. These injuries have been reported to change joint loading due to failure of the meniscus to convert axial loads into hoop stresses. This leads to decreased contact area and increased contact pressure and ultimately results in joint overloading and degenerative changes in the knee similar to a total meniscectomy state. This tear pattern was historically unrecognized, although more recently it has been suggested this “hidden” pathology may account for nearly 80% of the total knee replacements in patients younger than 60 years. Biomechanical studies have demonstrated that repair of medial meniscus posterior root tears leads to improved contact mechanics. Studies have also reported that patients who underwent a repair of the posterior root in the medial meniscus slowed the progression of arthritic changes compared with those who had a meniscectomy; although, this did not completely prevent the arthritic changes.
Can a medial meniscal root tear be degenerative?
Posterior medial meniscal root tears are often times degenerative, but these can also occur with multi-ligament knee injuries in the acute setting. In addition, focal chondral lesions occur more commonly with medial than lateral-sided injuries.
Why is medial meniscus tear important for ACL reconstruction?
As such, it is critical to repair medial meniscal root tears during ACL reconstruction to help stabilize the knee, as well as to decrease stresses that the graft experiences.
What is the medial meniscus?
The medial meniscus is an important structure that provides stability, dissipates force and assists to provide normal kinematics of the knee. Tears of the posterior medial meniscal root have shown to disrupt the normal motion of the knee, resulting in degenerative arthritis.
What are the medial and lateral menisci?
Medial and lateral menisci are crescent-shaped fibrocartilage structures that provide joint congruity, stabilization and lubrication and act as “shock absorbers” for joint preservation. During weight-bearing activities, the menisci dissipate axial loads and contain hoop stresses.
Where is the most common place for a meniscus tear?
Meniscus tears occur frequently. The most common location for a meniscus tear is the posterior horn of the medial meniscus. You’ve read your MRI report, and naturally, you’re concerned. Many Orthopedic Surgeons consider certain posterior horn meniscus tears to be a normal age-appropriate change.
Where do meniscus tears occur?
Meniscus tears occur frequently. The most common location for a meniscus tear is the posterior horn of the medial meniscus. You’ve read your MRI report, and naturally, you’re concerned. Many Orthopedic Surgeons consider certain posterior horn meniscus tears to be a normal age-appropriate change. Wait? What? Yes, certain meniscus tears are simply part of the wear and tear process. These tears are found in people without knee pain. But some meniscus tears do cause pain. How do we try and determine which meniscus tears may need surgery and which can be observed? This post will dive deeper to answer your questions about tears of the posterior horn of the medial meniscus.
Can meniscus tears cause knee pain?
Despite being considered a common age-appropriate change, meniscus tears can be a common cause of knee pain. All meniscus tears are not viewed in the same manner.
Where are the tears of the meniscus?
Tears of the meniscus can vary by location, type, size and the amount of pain they produce . The meniscus is a C-shaped cartilage disk that is found in the knee. We have two menisci in either knee. We have the medial meniscus on the inner side of the knee and the lateral meniscus on the outer side of the knee.
Where is the meniscus located?
The meniscus is a C-shaped cartilage disk that is found in the knee. We have two menisci in either knee. We have the medial meniscus on the inner side of the knee and the lateral meniscus on the outer side of the knee. See this post to learn more about how a meniscus functions .
What is the function of menisci?
The menisci serve a critical function in the knee as a shock absorber or cushion. This helps to minimize the stress on another type of cartilage that we have in the knee which we call the articular cartilage. If you look at the image below you see the meniscus in light blue.
What is the purpose of the meniscus?
This is how the meniscus protects the articular cartilage. The articular cartilage coats the ends of our bones within a joint. If the articular cartilage wears away, arthritis will occur. By protecting the articular cartilage, the meniscus helps prevent the onset of arthritis.
What is the function of meniscus root attachment?
The meniscus root attachment aids meniscal function by securing the meniscus in place and allowing for optimal shock-absorbing function in the knee. With root tears, meniscal extrusion often occurs, and the transmission of circumferential hoop stresses is impaired.
What is a meniscus root tear?
Meniscal root tears, less common than meniscal body tears and frequently unrecognized, are a subset of meniscal injuries that often result in significant knee joint disorders. The meniscus root attachment aids meniscal function by securing the meniscus in place and allowing for optimal shock-absorbing function in the knee.
What is a meniscal root tear?
There are two types of meniscal root tears. The first is a traumatic tear that typically occurs in younger patients in association with a knee ligament injury. The second is a degenerative tear resulting from a low-energy injury mechanism in older patients, such as getting up from a deep-seated position.
What is degenerative tear?
The degenerative tears are usually full-thickness radial tears near the root junction, but not a true avulsion of the meniscal attachment to bone (Figure 2). These tears can be associated with early knee arthritis. Indications for repair in this setting are evolving and the optimal candidate has not yet been defined.
Can meniscus root repair heal?
Contraindications to meniscus root repair include subchondral bone collapse, radiographic joint space narrowing of the affected compartment, varus or valgus malalignment, and obesity. Meniscal repair in this setting is unlikely to heal or restore function.
How to perform a reverse notchplasty?
In addition, a reverse notchplasty may be performed by removing a small amount of bone from the wall of the notch and shaving down the medial tibial spine.
How long after knee surgery can you use a brace?
During the first 4 weeks after surgery, full extension toe-touch weight-bearing in a brace and knee flexion to 90° are allowed. After 4 weeks, the brace is discontinued and the patient may begin full weight-bearing and full knee range of motion as tolerated.
Structure
Causes
- There are multiple different injuries that can cause tears of the posterior horn of the medial meniscus. One of the most common causes is when one tears their ACL, the knee continues to slide forward and secondarily tears the posterior horn of the medial meniscus. Deep knee flexion also places significant stress on the posterior horn of the meniscus and can result in a posterio…
Clinical significance
- Increased MRI signal within the posterior horn of the medial meniscus may mean that there is some intrasubstance degeneration of the medial meniscus. Commonly, at the time of arthroscopy, we can probe the meniscus in these areas and not find meniscus tears. Thus, we feel the majority of these do not cause any symptoms until the meniscus completely tears to the sur…
Treatment
- A horizontal tear of the meniscus happens when there is a split between the upper and lower parts of the meniscus. Sometimes these can be quite large, while other times they can involve smaller portions in the meniscus. In older patients, commonly the lower portion of the meniscus horizontal tear can have other tearing within which makes it not repairable. Therefore, trimming t…
Mechanism of action
- A meniscocapsular separation occurs when the meniscus tears away from the joint lining. These have the best blood supply. Smaller tears that are stable on probing have a good chance of healing, whereas those that are unstable, especially in the face of an ACL tear, should be repaired.
Symptoms
- Most patients who have pain with a posterior horn medial meniscus tear will have pain along the joint line and along the back part of their knee and will also have pain when they squat down in the back part of their knee. It is important to differentiate between pain in the front and the back part of the knee. Pain in the front of the knee may indicate swelling or kneecap-related problems, wh…