A horizontal meniscal tear, also known as a cleavage tear , is a type of meniscal tear in which the tear is oriented horizontally, parallel to the tibial plateau. Forty-nine of them were male, and the other 110 were female. Meniscus Tear Management: Indications, Technique, and Outcomes Currently, there are three main methods of modern surgical management of meniscus tears: arthroscopic partial meniscectomy; meniscal repair with or without augmentation techniques; and meniscal reconstruction. The treatment results were dichotomized into success and failure. This is due to its detrimental effects, most importantly development of early osteoarthritis and unsuccessful long-term clinical results.10,11 Interestingly, although the rate of total knee arthroplasty due to symptomatic osteoarthritis of the knee after open total meniscectomy in adolescence was found to have increased comparatively in a prospective longitudinal 40-year follow-up study, it should also be noted that not all the patients had undergone surgery.31 Currently in the modern treatment of meniscal tears, neither open nor arthroscopic total meniscectomy are advised to be performed primarily in most cases. Traumatol. There must be numerous factors that affect the outcomes of these patients other than treatment modality, but these studies did not look into those factors in detail. Since Fairbank first described radiological changes after meniscectomy8, plenty of reports followed with similar observations9,10. In the past, despite the important functions of the meniscus, meniscectomy was considered a treatment choice, because when the meniscus was torn, the meniscus lost its functions, and the remains were considered a cause of arthritis. Am. Hypothesis: The clinical outcomes of arthroscopic meniscectomy will be better than those of nonoperative treatment for a degenerative horizontal tear of the medial meniscus. Masouros SD, McDermott ID, Amis AA, Bull AMJ. Horizontal (interstitial) tears are most often chronic from degenerative changes. Third, a retrospective design was used. National Library of Medicine participated in the study design, supervised the whole study process, and helped to draft and review the manuscript. 8600 Rockville Pike A comparative study of meniscectomy and nonoperative treatment for For example, the pain of a medial or lateral collateral ligament injury is felt directly over the affected ligament. What? The medial meniscus is on the inner side of the knee joint. The https:// ensures that you are connecting to the However, the most recent concise, reliable and valid classification system for meniscal tears is the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine classification, which takes into account the following parameters: tear depth, tear pattern, tear length, tear location/rim width, radial location, location according to the popliteal hiatus, and quality of the meniscal tissue.24 The main limitations of this classification are reported as the absence of oblique tears, root ligament injuries, lesions of discoid variants and the evaluation of previously operated menisci.22 The most common meniscal tears in active young people and in the elderly are traumatic longitudinal-vertical and degenerative tears respectively. A tendency for your knee to get "stuck" or . Repair of horizontal meniscus tears: a systematic review. Indications, technique, and results, Arthroscopic meniscus repair with a posterior incision, Combined posterior incision and arthroscopic intra-articular repair of the meniscus. Sports Traumatol. During this surgery, your surgeon uses an arthroscope (tiny . This site should be used for informational purposes only. Horizontal meniscal tear | Radiology Reference Article - Radiopaedia.org government site. Posterior Horn Medial Meniscus Tears - Howard J. Luks, MD Horizontal Cleavage Meniscus Tear Treated With All-inside Scientific Reports (Sci Rep) J. Sonnery-Cottet B, Conteduca J, Thaunat M, Gunepin FX, Seil R. Hidden lesions of the posterior horn of the medial meniscus: a systematic arthroscopic exploration of the concealed portion of the knee. Among them, 22 patients had successful results whereas 14 patients failed, which was a 61% success rate (Fig. Buldu, M. T., Marsh, J. L. & Arbuthnot, J. The pathognomonic signs are found on MRI: ghost signs (absence of posterior root on sagittal images) and meniscal extrusion.94 Three specific lesions related especially to posterior meniscal roots are present: root avulsion injuries, radial tears and degenerative changes.95 Meniscal extrusion, which is also present with posterior root tears, impairs the stability and biomechanical functions of the menisci.96 Although the management of these lesions is relatively new, a current algorithm was suggested by Bhatia et al:52 non-operative treatments (anti-inflammatory medication, activity modification, unloader bracing and intra-articular chondroprotective injections, etc.) a Extensive horizontal tears with degeneration reached the peripheral edge of the meniscus.b The Omnispan needle was inserted into the tibial (inferior) surface with the first anchor, and the second anchor was placed across the horizontal tears into the femoral (superior) surface.c The completed repair with 5- to 10-mm . Suppl. The two ends of the passing sutures were tied onto the capsule, under direct vision. J. Orthop. FOIA Patients were treated non-surgically or arthroscopically. Successful treatment of painful irreparable partial meniscal defects with a polyurethane scaffold: two-year safety and clinical outcomes, Treatment of painful, irreparable partial meniscal defects with a polyurethane scaffold. Danso EK, Oinas JMT, Saarakkala S, et al. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear, Surgery versus physical therapy for a meniscal tear and osteoarthritis, Arthroscopic partial meniscectomy versus placebo surgery for a degenerative meniscus tear: a 2-year follow-up of the randomised controlled trial, Meniscal resection may not benefit patients with traumatic meniscal tears, Partial meniscectomy provides no benefit for symptomatic degenerative medial meniscus posterior root tears, Surgical management of degenerative meniscus lesions: the 2016 ESSKA meniscus consensus, An operation for displaced semilunar cartilage. Fairbank, T. J. Knee joint changes after meniscectomy. The management decision to use non-operative or operative methods should take into consideration factors related to patients (age, expectations, activity level, lifestyle, general health status, etc.) A Biomechanical Comparison of All-Inside Versus Transtibial Meniscus Transplantation of viable meniscal allograft. Surg. and JavaScript. They only included patients with daily knee pain on the medial side with mechanical symptoms18. Patients with varus alignment and advanced cartilage lesions responded poorly to non-surgical treatment. The purpose of this review was to systematically assess the outcomes and complications for patients undergoing the surgical treatment of HCTs. And the criteria that divided success and failure were clear that improved symptoms and not seeking further treatment at 2-year follow-up were defined as success. Asymptomatic discoid meniscus is classically treated conservatively. Therefore, there are controversies regarding. It could be asymptomatic and unrelated to knee symptoms. 1 Citations Metrics Abstract Meniscus horizontal tears are usually degenerative. The study was performed in accordance with relevant named guidelines and regulations. However, when the patient has varus knee joint alignment advanced cartilage lesions, warning the patients of poor outcome would be essential. Initially, twenty-nine of these 159 patients were treated by arthroscopic surgery, which the indication was as described previously, and the other 130 patients were treated non-surgically. Complications. The interposition arthroplasty with autogenic fat pad was first reported at the beginning of the 1900s.26 Since the more recent performance of MAT by Wirth in the 1980s, the MAT procedure has evolved to be what it is now; an increasingly performed, safe, reliable and highly specialized knee procedure, rather than an experimental or investigational surgery in patients whose meniscus is lost for any reason, and who have refractory persistent symptoms.86-89, The current indications for MAT were summarized according to the recommendations of consensus statements developed from the 2015 International Meniscus Reconstruction Experts Forum, which were based on current evidence from clinical results following MAT: unicompartmental pain in the presence of total or partial functional meniscectomy; as a concomitant procedure to revision ACL reconstruction to aid in joint stability when meniscus deficiency is believed to be a contributing factor to failure; or as a concomitant procedure with articular cartilage repair in a meniscus-deficient compartment.90. By submitting a comment you agree to abide by our Terms and Community Guidelines. Fourth, the exclusion criteria of the study couldve influenced the outcome of the analysis. Arthrosc. Br. Doctors classify meniscus tears according to their shape and location. Osteoarthritis Cartil. A comparative study of meniscectomy and nonoperative treatment for degenerative horizontal tears of the medial meniscus. Currently, there are three main methods of modern surgical management of meniscus tears: arthroscopic partial meniscectomy; meniscal repair with or without augmentation techniques; and meniscal reconstruction. Meniscus Surgery: Who Needs It, What to Expect Before & After and transmitted securely. J. The pain may be felt on the inner or outer side of the knee depending on which tissues or structures are affected. Menisci are considered to act as shock absorbers, load bearers, and secondary stabilizers of the knee joint1,2. Each knee has two menisci. Arthroscopic view illustrating meniscal vascularity. Although an experienced surgeon may suspect meniscal tears following a careful history and physical examination, radiographic and arthroscopic evaluations should be made to confirm the diagnosis. Modern treatment of meniscal tears - PMC - National Center for Side knee pain is commonly caused by osteoarthritis ("wear-and-tear arthritis"), injuries to the collateral ligaments, tears to the meniscus, or sprains. Snoeker BAM, Bakker EWP, Kegel CAT, Lucas C. Risk factors for meniscal tears: a systematic review including meta-analysis, Incidental meniscal findings on knee MRI in middle-aged and elderly persons. Meniscus Tear: Symptoms, Causes and Treatment | Bupa UK Privacy PolicyThe information on this site is not intended or implied to be medical advice, diagnosis, or treatment. A meta-analysis comparing meniscal repair with meniscectomy in the treatment of meniscal tears: the more meniscus, the better outcome? The average age of the patients was 54.7years, and their ages ranged from 21 to 77years. In addition to general factors like age, sex, degree of joint arthritis, and knee alignment, factors such as widest tear gap width on the sagittal MRI, and existence of discoid meniscus were also evaluated as factors that affected the outcome in this study. Bucket Handle Meniscus Tear: What It Is, Causes & Treatment . Sports Med. You are using a browser version with limited support for CSS. In order to obtain conclusive results regarding the relative technical and clinical superiority, the relevant literature requires comparative studies with higher LoE, involving higher numbers of patients and longer follow-up periods. A p-value of<0.05 was considered significant. The complex ultrastructure of the meniscus determines its vital functions for the knee, the lower extremity, and the body. Objective results, such as radiographic changes, were not evaluated. A. 59, 480483 (1977). Joon Kyu Lee. Prognostic factors for the treatment of meniscus horizontal tear, https://doi.org/10.1038/s41598-022-21599-1. Historically it was believed that the menisci served no functional purpose and they were often excised with open total meniscectomy [ 2 ]. 65, 605609 (1994). These lie on the inside (medial) and outside (lateral) edges of the top of your tibia (shin bone). Sports Med. The malalignment, instability and limb length inequality of the patients must be corrected beforehand or concomitantly. The most common side and site for tears are the medial meniscus and the posterior horn of the menisci.25, The vital functions of the meniscus and the development of osteoarthritis reported after its resection, has forced orthopaedic surgeons to protect as much as possible, to repair or to reconstruct the meniscus. S.L. Patients who had meniscus horizontal tears were the subjects of this study. Sports Med. Acta Orthop. 13, 14 (1985). Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Does a degenerative meniscus tear need surgery? Cell-based meniscus repair and regeneration: at the brink of clinical translation? Other factors, including age, sex, joint line tenderness, combined discoid meniscus nature, and tear site also did not significantly affect the outcomes of treatments. Bonasia DE, Pellegrino P, DAmelio A, Cottino U, Rossi R. Meniscal root tear repair: why, when and how? Herrlin et al. Baratz, M. E., Fu, F. H. & Mengato, R. Meniscal tears: The effect of meniscectomy and of repair on intraarticular contact areas and stress in the human knee: A preliminary report. 58, 599604 (1976). Bucket handle tear: A large type of horizontal tear. Mac, C. M. The movements of bones and joints: The synovial fluid and its assistants. Lateral meniscus tears appear to have a better prognosis in terms of secondary partial meniscectomy than medial meniscus tears left in situ (79-100% vs. 63-100%, respectively) [19, 24, 107, 114, 130-143]. Torn Meniscus | Johns Hopkins Medicine Review of meniscal injury and associated sports, The epidemiology of musculoskeletal tendinous and ligamentous injuries. Save the meniscus! is the slogan which will probably constitute the basis for newer alternative biological treatment methods in the future. 58, 583594 (1976). These are the menisci . Their tear was firstly described by Pagnani.92 Although tears of meniscal roots are relatively less common than meniscal body tears, their biomechanical and clinical impact is more significant in terms of stability and shock absorption functions.93 Their injuries are frequently underestimated and unrecognized by inexperienced, or sometimes experienced, surgeons. Englund, M. Meniscal tear: A feature of osteoarthritis. They are not solely a separate structure; they are a part of the meniscus-meniscal ligament complex together with the surrounding ligamentous structures (menisco-tibial, menisco-femoral, menisco-patellar, intermeniscal ligaments) and bony attachments as anterior and posterior roots. Meniscus horizontal tears are usually degenerative. The expense of seeing specialists in university hospitals or private clinics is very low, so patients tend to visit several hospitals. Arthritis Rheum. Fauno, P. & Nielsen, A. 9, 452 (2020). About meniscus tears. . Meniscus Tear in Knee: Symptoms, Causes, and Treatments - WebMD These tears may be difficult to visualize on arthroscopy. Torn meniscus - Symptoms and causes - Mayo Clinic Use of porous polyurethanes for meniscal reconstruction and prosthesis. Therefore, the treatment choice for meniscus horizontal tears is controversial and requires thoughtful consideration18. Yim et al. From these assessments, the authors tried to help out the decision-making of the treatment option for meniscus horizontal tear. Your menisci act like shock absorbers, absorbing the impact of your upper leg on your lower leg. The meniscus is a C-shaped piece of cartilage attached to the knee joint from the shinbone. Albrecht-Olsen P, Kristensen G, Trml P. Meniscus bucket-handle fixation with an absorbable Biofix tack: development of a new technique. Verdonk PC, Demurie A, Almqvist KF, et al. are present, their accuracy, specificity and sensitivity are highly variable and questionable.19,20 It should be kept in mind that these above-mentioned mechanical symptoms and physical findings may also be found secondary to articular cartilage or ligamentous injuries. However, its use is limited to anteriorly placed meniscal tears. A wider tear gap could also lead to more symptoms and, therefore, arthroscopic surgery could have yielded better results. Google Scholar. The most recent concise, reliable, and valid classification system for meniscal tears is the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) Classification, which takes into account the subsequent parameters: tear depth, tear pattern, tear length, tear location/rim width, radial location, location according to the popliteal hiatus, and quality of the meniscal tissue. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Symptoms of a meniscus tear include: Pain in the knee. The principal finding of this study was that the mechanical symptom was not an adequate factor for arthroscopic surgery on meniscus horizontal tears, whereas a wide tear gap and minimal cartilage lesions were good prognostic factors for the surgery. 41, 687693 (1998). The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. It is well-established that meniscus root tears lead to decreased femorotibial contact area, increased peak contact pressures, and increased stress on the articular cartilage. Arthroscopic view of acute, traumatic, longitudinal-vertical tear of the lateral meniscus posterior horn (a). Sports Traumatol. Allaire R, Muriuki M, Gilbertson L, Harner CD. Repair of isolated horizontal meniscal tears with all-inside suture Interestingly, patients with wider tear gap width on the sagittal view of MRI showed good results after arthroscopic surgery. Application of biologics in the treatment of the rotator cuff, meniscus, cartilage, and osteoarthritis, Meniscal repair of degenerative horizontal cleavage tears using fibrin clots: clinical and arthroscopic outcomes in 10 cases, Trephination of incomplete meniscal tears, Synovial abrasion for isolated, partial thickness, undersurface, medial meniscus tears. Article 5, 157161 (1983). As a library, NLM provides access to scientific literature. Roos, H. et al. Meniscus tears are the most frequently treated knee injuries. Meniscus Tears: Symptoms, Causes, Diagnosis, Treatment - Verywell Health & Wilder, D. G. Mechanical changes in the knee after meniscectomy. Treatment for a torn meniscus often begins conservatively, depending on the type, size and location of your tear. These tears may be difficult to visualize on arthroscopy. The average follow-up period was 26.1months and ranged from 24 to 48months. Non-surgical treatment was composed of medication such as non-steroidal anti-inflammatory drugs and analgesics, recommendations of physical exercise to improve muscle strength, and some physiotherapy. Standard treatments like ice, rest, and over-the-counter pain relievers are sometimes . Acta Orthop. Because there were several studies reporting inefficient results of arthroscopic surgery for meniscus degenerative tears22,23 and degenerative arthritis24, there is little consensus yet regarding the treatment choice of meniscus horizontal tear to this day. Factors considered for failure and success of treatments were age (divided into 3 groups; under 50, 5060, over 60years), sex, joint line tenderness (JLT), mechanical symptom, widest tear gap width on sagittal MRI (Fig. The benchmark currently remains an inside-out vertical mattress suture repair.56 Successful clinical results have been reported with inside-out meniscal repair.57,58. Arthroscopic partial meniscectomy (APM) is the most frequently performed surgical procedure for the treatment of meniscal tears (Fig. Surg. Secondly, there were no significant differences in terms of anatomical and clinical failure rates, functional outcome scores and complication rates. All-inside horizontal suture of the lateral meniscal tear (b). There were far more excluded patients than included patients.
