In joints with intact menisci, the force was applied through the menisci and articular cartilage; however, a lesion in the peripheral rim disrupted the normal mechanics of the menisci and allowed it to spread when a load was applied.
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The load now was distributed directly to the articular cartilage. In light of these findings, it is essential to preserve the peripheral rim during partial meniscectomy to avoid irreversible disruption of the structure's hoop tension capability. After noting symptoms, a physician can perform clinical tests to determine if the pain is caused by compression and impingement of a torn meniscus. The knee is examined for swelling. In meniscal tears, pressing on the joint line on the affected side typically Produces tenderness.
The McMurray test involves pressing on the joint line while stressing the meniscus using flexion — extension movements and varus or valgus stress. Bending the knee into hyperflexion if tolerable , and especially squatting, is typically a painful maneuver if the meniscus is torn. The range of motion of the joint is often restricted. It is a subjective symptom of pain in the affected knee when turning over in bed at night. Osteoarthritic pain is present with weightbearing, but the meniscal tear causes pain with a twisting motion of the knee as the meniscal fragment gets pinched, and the capsular attachment gets stretched causing the complaint of pain.
X-ray images normally during weightbearing can be obtained to rule out other conditions or to see if the patient also has osteoarthritis. The menisci themselves cannot be visualised with plain radiographs.
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If the diagnosis is not clear from the history and examination, the menisci can be imaged with magnetic resonance imaging an MRI scan. This technique has replaced previous arthrography , which involved injecting contrast medium into the joint space.
In straightforward cases, knee arthroscopy allows quick diagnosis and simultaneous treatment. Recent clinical data shows that MRI and clinical testing are comparable in sensitivity and specificity when looking for a meniscal tear. A meniscal tear can be classified in various ways, such as by anatomic location or by proximity to blood supply. Various tear patterns and configurations have been described. The functional importance of these classifications, however, is to ultimately determine whether a meniscus is repairable. The repairability of a meniscus depends on a number of factors.
These include:. Tear of a meniscus is a common injury in many sports. Regardless of what the activity is, it is important to take the correct precautions to prevent a meniscus tear from happening.
There are three major ways of preventing a meniscus tear. The first of these is wearing the correct footwear for the sport and surface that the activity is taking place on. This means that if the sport being played is association football , cleats are an important item in reducing the risk of a meniscus tear. The second way to prevent a meniscus tear is to strengthen and stretch the major leg muscles. One popular exercise used to strengthen the hamstrings is the leg curl. It is also important to properly stretch the hamstrings ; doing standing toe touches can do this.
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Seated leg extensions strengthen the quadriceps and doing the quadriceps stretch will help loosen the muscles. Toe raises are used to strengthen and stretch the calves. The use of the parallel squat increases much needed stability in the knee if executed properly. Execution of the parallel squat will develop the lower body muscles that will strengthen the hips, knees, and ankles.
The last major way to prevent a tear in the meniscus is learning proper technique for the movement that is taking place. It is important to take the time out to perfect these techniques when used. These three major techniques will significantly prevent and reduce the risk of a meniscus tear. Presently, treatments make it possible for quicker recovery.
If the tear is not serious, physical therapy, compression, elevation and icing the knee can heal the meniscus. Surgery, however, does not appear to be better than non-surgical care. Initial treatment may include physical therapy , bracing, anti-inflammatory drugs, or corticosteroid injections to increase flexibility , endurance, and strength.
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Exercises can strengthen the muscles around the knee, especially the quadriceps. Stronger and bigger muscles will protect the meniscus cartilage by absorbing a part of the weight. The patient may be given paracetamol or anti-inflammatory medications.
For patients with non-surgical treatment, physical therapy program is designed to reduce symptoms of pain and swelling at the affected joint. This type of rehabilitation focuses on maintenance of full range of motion and functional progression without aggravating the symptoms. Recently, accelerated rehabilitation programs have been used and shown to be as successful as the conservative program. The less conservative approach allows the patient to apply a small amount of stress and prevent range of motion losses.
Arthroscopy is a surgical technique in which a joint is operated on using an endoscopic camera as opposed to open surgery on the joint. The meniscus can either be repaired or completely removed; this is described in further detail below. If the injury to the meniscus is isolated, then the knee would be relatively stable. However, if another injury such as an anterior cruciate ligament injury torn ACL was coupled with a torn meniscus, then an arthroscopy would be performed. A meniscal repair has a higher success rate if there is an adequate blood supply to the peripheral rim.
Therefore, meniscus tears that occur near the peripheral rim are able to heal after a meniscal repair. The amount of rehabilitation time required for a repair is longer than a meniscectomy, but removing the meniscus can cause osteoarthritis problems.
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If the meniscus is removed, the patient will be in rehab for about four to six weeks. If a repair is conducted, then the patient will need four to six months. If physical therapy does not resolve the symptoms, or in cases of a locked knee, then surgical intervention may be required.
Depending on the location of the tear, a repair may be possible. In the outer third of the meniscus, an adequate blood supply exists and a repair will likely heal. Meniscus transplants are accomplished successfully regularly, although it is still somewhat of a rare procedure and many questions surrounding its use remain. Another treatment approach in development is a meniscus implant or "artificial meniscus.
The first to be implanted in humans is called the NUsurface Meniscus Implant. Scientists are also working to grow an artificial meniscus in the lab. Scientists from Cornell and Columbia universities grew a new meniscus inside the knee joint of a sheep using a 3-D printer and the body's own stem cells. Animal testing will be needed before the replacement meniscus can be used in people, and then clinical trials would follow to determine its effectiveness.
Currently, there's no timeline for the clinical trials, but it is estimated it will take years to determine if the lab-grown meniscus is safe and effective. After a successful surgery for treating the destroyed part of the meniscus, patients must follow a rehabilitation program to have the best result. The rehabilitation following a meniscus surgery depends on whether the entire meniscus was removed or repaired.
watch If the destroyed part of the meniscus was removed, patients can usually start walking using a crutch a day or two after surgery. Although each case is different, patients return to their normal activities on average after a few weeks 2 or 3. Still, a completely normal walk will resume gradually, and it's not unusual to take 2—3 months for the recovery to reach a level where a patient will walk totally smoothly. If the meniscus was repaired, the rehabilitation program that follows is a lot more intensive. After the surgery a hinged knee brace is sometimes placed on the patient.