horizontal meniscus tear treatment

A review[53] of sixty two meniscal repairs has shown that early repair within 3 mo of injury had better results than late repair (91% vs 58% success rate) and traumatic tears fared better than chronic tears (73% vs 42%). Microvasculature of the human meniscus. These are unstable tears which cause mechanical symptoms or true locking of the knee. doi:10.1114/1.133, Messner, K., Fahlgren, A., Ross, I., and Andersson, B. However, most reported studies, including the present study, were basically static analyses, and whether an HTMM in the dynamic state increases joint stress and accelerates joint degeneration needs further research. Yim et al[22] compared non-operative strengthening exercises with meniscectomy for degenerative horizontal tears of the posterior horn of the medial meniscus. DeHaven KE, Lohrer WA, Lovelock JE. Arthroscopic resection of flap tears from the posterior horn of the medial meniscus was also shown to have less favourable outcomes in the presence of chondromalacia in a review of 93 patients[41]. 29 (3), e44e50. There is no similar reported finite element study to simulate the resting state (45) of the rabbit knee joint. However care of neurovascular structures in particular the saphenous nerve medially and the common peroneal nerve laterally must be taken when making the accessory incisions[59]. A preliminary report. Considering the anatomical characteristics of the rabbit knee joint, the femur flexion was 45 (Mansour et al., 1998), and the load was 40N, which was approximately the weight of a whole rabbit (Anderson et al., 1990). Other more commonly used techniques include inside-out, outside-in and all inside repairs. doi:10.1007/s00167-019-05363-z, Civitarese, D., Donahue, T. L., Laprade, C. M., Saroki, A. J., Laprade, R. F., Schon, J. M., et al. Neural Syst. Bernstein J, Bartolozzi AR. Therefore, additional simulations were performed, one of which followed the study of Tan et al. Authors found a clinical success rate of 76%. Rep. 8 (1), 9041. doi:10.1038/s41598-018-27016-w, Kani, K. K., Porrino, J. Surg. Exercise has been shown to improve knee function and reduce joint pain[16,17]. This review explores the evidence for managing meniscal tears and when to consider each treatment option based on current available evidence. After the STM, the maximum von Mises stress was 2.2 MPa, which decreased by 57.9% compared with the IMM. Horizontal tears split the meniscus into an upper and lower part and can exist without clinical symptoms. An all-inside suture repair technique without bone tunnels has been proposed to treat LMRT. WebThe lateral meniscus plays a very important role in the stability of your knee. Transl. Mechanical changes in the knee after meniscectomy. Historically it was believed that the menisci served no functional purpose and they were often excised with open total meniscectomy[2]. 23 (2), 711. doi:10.1016/0021-9290(90)90171-X, Beamer, B. S., Walley, K. C., Okajima, S., Manoukian, O. S., Viloria, M. P., DeAngelis, J. P., et al. All rights reserved. An experimental study in the dog. Cartil. It was also noted that acute repairs within 8 wk of injury did better than the more chronic repairs. doi:10.2106/JBJS.I.00539, Bedrin, M. D., Kartalias, K., Yow, B. G., and Dickens, J. F. (2021). Jrgensen U, Sonne-Holm S, Lauridsen F, Rosenklint A. However in a follow-up study[61] at 6.6 years, this success had declined to just 71.4%. Injury to the meniscal root may cause meniscal extrusion, joint space narrowing, inadequate conversion of axial loads into hoop stresses within the joint, laxity, and eventual progression to advanced-staged osteoarthritis. Meniscus repair and replacement. Bucket handle tear: A large type of horizontal tear. However, one third of the patients from the exercise group still had disabling knee symptoms after exercise therapy but improved to the same level as the rest of the patients after arthroscopic surgery with partial meniscectomy. Arthroscopic partial meniscectomy: a long-term follow-up. Figure 3A also shows little difference in the von Mises stress distribution on the LTC and LM. Satisfactory clinical results were found in each group at 2 years follow up with no significant difference in terms of pain, function and patient satisfaction. Suture based devices consisting of an anchor component and a sliding knot were the next generation to be developed in an attempt to avoid the complications associated with rigid devices and to allow and more flexible fixation of the meniscal fragments. Table Table11 summarises the factors influencing the risk of developing arthritis based on the evidence previously discussed. Gill SS, Diduch DR. Outcomes after meniscal repair using the meniscus arrow in knees undergoing concurrent anterior cruciate ligament reconstruction. 23 (1), 119125. In the absence of a meniscus there is greater tendency to point loading. XZ, QY, and PW: Methodology, Investigation, Data curation. The microvasculature of the meniscus and its response to injury. A superior leaf partial meniscectomy (SLPM) showed a minimal effect on joint stress among all resection strategies under a resting state. A meniscus can become damaged due to sudden trauma. Med. doi:10.1007/978-3-642-02450-4_15, Shanmugaraj, A., Tejpal, T., Ekhtiari, S., Gohal, C., Bhandari, M., Hanson, B., et al. Meniscus root tears are associated with chondral injury, early degenerative change, and a high conversion rate to total knee arthroplasty. More recent studies have shown that function of the knee was directly related to the amount of meniscal tissue that remained[5]. After a subtotal meniscectomy (STM), the axial load, the maximum von Mises stress, and the maximum contact pressure on the tibial cartilage increased compared with a partial meniscectomy with root retention. 219 (5), 337347. Tibiofemoral contact mechanics with horizontal cleavage tear and resection of the medial meniscus in the human knee. Here are the highlights: Meniscus repair has good to excellent results in young pediatric and adolescent athletes at a 17-year follow-up. 107, 103855. doi:10.1016/j.medengphy.2022.103855, Mansour, J. M., Wentorf, F. A., and Degoede, K. M. (1998). doi:10.1016/j.arthro.2012.11.016, Sweigart, M. A., and Athanasiou, K. A. Effect of degenerative and radial tears of the meniscus and resultant meniscectomy on the knee joint: A finite element analysis. The radial displacement of the middle body of the medial meniscal was larger than any other part in all the models. FIGURE 2. Barber FA, Schroeder FA, Oro FB, Beavis RC. First, you receive anesthesia. Meniscal repair devices. Front. Further studies on static analysis or dynamic analysis of different rabbit activities in the rabbit knee joint are necessary. Am. (Tan et al., 2020). Arnoczky SP, Warren RF. Analysis of displacement and deformation of the medial meniscus with a horizontal tear using a three-dimensional computer model. A comparative study of meniscectomy and nonoperative treatment for degenerative horizontal tears of the medial meniscus. Purpose: Institution Mech. Firstly there is an element of selection bias. This included six weeks of protected weight bearing in motion limiting braces. Received: 13 February 2023; Accepted: 13 June 2023;Published: 22 June 2023. doi:10.2106/JBJS.RVW.17.00125, Lee, S. W., Chun, Y. M., Choi, C. H., Kim, S. J., Jung, M., Han, J. W., et al. J. Exp. Am. Results of open meniscus repair. These results were echoed by a multicentre randomised controlled study of 351 patients over 45 years of age with a meniscal tear and evidence of osteoarthritis[21]. Northmore-Ball et al[35] compared arthroscopic partial meniscectomy with open partial and total meniscectomy in 219 knees. Accessibility Stein et al[57]report on the long term outcome after arthroscopic meniscal repair versus arthroscopic partial repair meniscectomy for traumatic meniscal tears. Magee T, Shapiro M, Williams D. Comparison of high-field-strength versus low-field-strength MRI of the shoulder. Both inside-out and outside-in repair techniques involve passing a suture from either the inside or the outside of the knee via arthroscopy and tied beyond the joint capsule using a small incision. There were no significant differences in improvement between the groups suggesting that a combination of arthroscopic partial meniscectomy and supervised exercise does not necessarily lead to greater improvements than exercise alone in this patient group. Finally, by resecting the medial meniscal body in ABAQUS, different rabbit knee joint models of posterior root horizontal tears and different meniscectomies were established, including a horizontal tear of the medial meniscus (HTMM, Figure 1D), a superior leaf partial meniscectomy (SLPM, Figure 1E), an inferior leaf partial meniscectomy (ILPM, Figure 1F), a double-leaf partial meniscectomy (DLPM, Figure 1G), a subtotal meniscectomy (STM, Figure 1H), and a total meniscectomy (TTM). A locking or catching sensation may also be felt in the knee, and it will often become inflamed (swollen). Oblique tears give rise to flaps which are mechanical unstable and associated with mechanical symptoms. 26 (4), 160164. If these patients were subjected to total knee replacements instead this carries a five times greater cost than arthroscopy. A recent high-quality study found that exercise therapy not only provided the same improvement in symptoms as surgery, but also increased thigh muscle strength. Problems Diagnostic Radiology 51 (5), 779786. The menisci are wedge shaped fibrocartilagenous structures located between the femoral condyles and tibial plateau. WebResearch highlights Review a complete list of publications on meniscus injury and repair by Mayo Clinic Sports Medicine researchers. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Having knee pain or stiffness or a swollen knee. Nepple JJ, Dunn WR, Wright RW. Recovery of muscle strength following arthroscopic meniscectomy. This should be considered for all repairable tears provided the patient can comply with the post-operative rehabilitation. All patients were recruited from the Houston Veterans Affairs Medical Centre of which 97% were male. Biotechnol. Baratz et al[27] conducted a biomechanical cadaveric study and found that following total medial meniscectomy there is a decrease in intra-articular contact area of approximately 75% and the peak contact pressure increased by approximately 235%. After the HTMM, the axial load, maximum von Mises stress and maximum contact pressure on the medial tibial cartilage increased 1.6%, 1.2%, and 1.4%, compared with the IMM. J. Orthop. Meniscal repair shows 80% success at 2 years and is more suitable in younger patients with reducible tears that are peripheral (e.g., nearer the capsular attachment) and horizontal or longitudinal in nature. Epidemiology. Small tears (<1 cm) are initially managed conservatively. Rehabilitation Eng. Patients in the placebo group received skin incisions and simulated debridement.

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