Short description: Oth meniscus derang, post horn of medial meniscus, l knee The 2023 edition of ICD-10-CM M23.322 became effective on October 1, 2022. When appropriate, tears that appear to involve the periphery, or red zone of the meniscus, should be described as such (9a), thereby alerting the surgeon to the fact that the tear is more amenable to repair. Arthroscopy. The posterior horn of the medial meniscus is especially likely to develop tears as we get older. Know why a new medicine or treatment is prescribed, and how it will help you. Adjunctive measures to promote vascularity and healing at the repair sites are also recommended. If you have a follow-up appointment, write down the date, time, and purpose for that visit. Harrison BK, Abell BE, Gibson TW. 1165 Dunlawton Ave., Suite 102 Port Orange, FL 32127, Port Orange East & Walk-In Clinic Prospective evaluation of 1485 meniscal tear patterns in patients with stable knees. Jul 2000;31(3):419-36. Radial tears, because they are oriented perpendicular to the c-shaped fibers of the meniscus, have a devastating effect upon meniscal function. Medial and lateral menisci are crescent-shaped fibrocartilage structures that provide joint congruity, stabilization and lubrication and act as shock absorbers for joint preservation. Tell your doctor of any recurrent swelling or of your knee repeatedly giving way. 1. 3 Thornton DD, Rubin DA. It is caused by direct impact in contact sports or twisting. 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. Meniscal tear incidence may be as high as six per 1000 population6 with a 2.5 to 4 times male predominance. The skilled interpreter of MR of the knee must do more than simply identify the presence of a meniscal tear. The younger population, particularly males with knee instability, is most commonly affected by this type of tear [56]. Of note, drilling tibial tunnels may improve healing of the meniscus-bone interface due to the presence of progenitor cells and growth factors derived from the bone marrow. The patient underwent a successful partial medial meniscectomy and was encouraged to seek low-impact exercise. New advances in musculoskeletal pain. or ? AJSM 1999; 27:242-250. It is therefore quite important in treatment planning for the pre-operative MR to provide information that can be used to determine whether meniscal repair rather than partial meniscectomy is to be performed. For information:Questions and Answers for Patients Regarding Elective Surgery and COVID-19. 1 article features images from this case Rimington T, Mallik K, Evans D, Mroczek K, Reider B. Sports-related meniscus injuries often occur along with other knee injuries, such as anterior cruciate ligament (ACL) tears. This most often happens when the tear develops over a period of time. Submission to the Department of Health and Ageing. The kneecap (patella) sits in front of the joint to provide some protection. You can tear a meniscus during any activity which involves forcefully twisting or rotating the knee. Lim HC, Bae JH, Wang JH, Seok CW, Kim MK. Develop pain gradually along the meniscus and joint line when you put stress on your knees (usually during a repeated activity). Characterization of the red zone of knee meniscus: MR imaging and histologic correlation. Bull NYU Hosp Jt Dis 2010;68:8490. (14a) A 3D depiction of a flap tear of the posterior body of the medial meniscus illustrates displacement of the upper component of the flap (arrow) from its site of origin. (11a) A 3D illustration of a bucket handle tear demonstrates that these tears actually are longitudinal in nature (arrows), coursing parallel to the c-shaped fibers of the meniscus. Orthop Clin North Am. This is a large horizontal tear of the meniscus. Illustration and photo show a camera and instruments inserted through portals in a knee. Historically, medial meniscal root tears have been treated conservatively or by partial meniscectomy. Results: Medial meniscus posterior horn longitudinal tears in ACL-deficient knees resulted in a significant increase in anterior-posterior tibial translation at all flexion angles except 90 (P < .05). for a 22 year old severe pain. Pain is typically medial and activity-related (e.g. and oblique tear . Age of injury peaks at 2029 years.7 Partial meniscectomy (removal of the torn section) is one of the most commonly performed orthopaedic surgical procedures.8. In cases where a torn meniscus has locked the knee, walking will be affected. This extrusion should disappear without stress. Meniscal tears are categorised as traumatic or non-traumatic (degenerative) on the basis . All rights reserved. The tear results in a vertical signal abnormality on sagittal MR images. Indications for meniscal root repair are acute, traumatic root tears in patients with nearly normal or normal cartilage (Outerbridge grade 0 to 2) and chronic symptomatic root tears in active patients without significant pre-existing osteoarthritis (OA). Jarit G, Bosco J. Meniscal repair and reconstruction. We have two menisci in either knee. (redirected from Oblique Tear) The most common meniscal tear, a type of radial tear which begins at the free (inner) edge like other radial tears, but then curves into a longitudinal orientationsimilar to longitudinal meniscal tearsas the tear extends toward the meniscal periphery. McMurray test: The patient lies supine on the bed with the hip and knee both flexed. What to Do If Your Orthopaedic Surgery Is Postponed. A gradient-echo T2*-weighted sagittal image demonstrates a tear within the posterior horn of the medial meniscus (arrow). A meniscus tear can occur when the knee is suddenly twisted while the foot is planted on the ground. MR is also able to assess the stability of meniscal tears,6 an important factor, as unstable tears require operative treatment for symptom relief. History, clinical findings, magnetic resonance imaging, and arthroscopic correlation in meniscal lesions. Even better would be to describe a peripheral longitudinal tear extending to the tibial surface within the posterior horn of the medial meniscus! The Royal Australian College of General Practitioners. Knowing where and how a meniscus was torn helps the doctor determine the best treatment.. In cases where surgery is required, this time frame increases to somewhere around three to four months. Treatment of meniscal tears includes simple observation, meniscectomy, and meniscal repair. Complex or degenerative tears are where two or more tear patterns exist. The primary objective is to control the disease process to avoid the complications . The one towards the back of leg is the posterior horn. Perhaps the best know of these is the bucket-handle tear. 6 Vande Berg BC, Poilvache P, Duchateau F. Lesions of the menisci of the knee: value of MR imaging criteria for recognition of unstable lesions. As orthopaedic surgeons increasingly consider meniscal repair, accurate pre-operative assessment with MR becomes more important, allowing proper planning on the part of both the surgeon and the patient. In case of an open or unstable fracture, the bone may protrude out of the skin surface and be exposed to environmental contaminants. Meniscal pain occurs during torsional, weight bearing knee movements (classically pivoting on the knee while walking) as a sharp stab lasting several seconds, often followed by a dull ache for several hours. We have also seen complete meniscal root avulsions in the cruciate ligament-injured knee with complete injury of the medial ligament and posterior oblique ligament that opens in full extension. Because there is no supply, there is little capacity for these tears to heal on their own. Performing activities that involve aggressive pivoting and twisting of the knee puts you at a significantly higher risk of tearing your meniscus. Apley test (grinding) test: The patient lies prone, with their knee flexed to 90 degrees and their hip extended. This is termed the 'red-red zone' (denoting area of vascularity).2,4 repair of the 'red-white zone' (watershed area between vascular and avascular meniscus) is controversial25 with many different surgical techniques.26 tears in the 'white-white zone' (avascular zone) are rarely repaired rather the damaged segment is resected (meniscectomy). Note: the cartilage deficit more anteriorly on the medial femoral condyle and altered subchondral cortical bone interface, Figure 5. 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. M23.322 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The difference in tear type between these populations is explained by the three-dimensional fibrous structure of the meniscus: horizontal delamination occurs in degenerative injuries, while the fibrous structure is ruptured in a vertical fashion in younger patients. Meniscal repair surgeries do the best when the meniscal tear extends into the middle 50% of meniscal substance. Physical therapy should start immediately after surgery and include early passive range of motion from 0 to 90 for the initial 2 weeks and progress to full range of motion thereafter. Arthroscopic total meniscectomy Occasionally, a large tear of the outer meniscus can best be treated by arthroscopic total meniscectomy, a procedure in which the entire meniscus is removed. Am J Sports Med 2008;36:12839. A magnetic resonance imaging (MRI) scan is often used to diagnose meniscal injuries. Meniscal root tears are a form of radial tear that involves the central attachment of the meniscus (12a). Fat suppressed proton density-weighted (15a) coronal and (15b) sagittal images reveal a tibial sided flap tear of the body of the medial meniscus, with displacement of the undersurface component (arrows) into the inferior gutter. 14 Marzo JM, Kumar BA. growth factors) on meniscus tissue is being investigated.2 These are currently only being trialled in younger patients7 and the routine use of most of these technologies is some time away. The parrot beak shape of an oblique tear (arrow) is readily apparent on (7a) a proton density-weighted axial image of the menisci. what is the treatment? The anterior horn of the medial meniscus demonstrates half of the normal anatomic 'bow-tie configuration'. Krych AJ, McIntosh AL, Voll AE, Stuart MJ, Dahm DL. A medial meniscus tear on the inside of the knee is more common. Because a torn meniscus is made of cartilage, it won't show up on X-rays. I have been diagnosed with a subtle oblique tear involving the posterior horn of the medial meniscus and extends to the inferior articular surface of the meniscus. Explains when surgery is done. How can I tell if I have an oblique fracture? The relationships among MM radial/oblique tears, MM extrusion (MME), and the effect of arthroscopic meniscal repair are not established. The ghost sign or absence of an identifiable meniscus anterior to the posterior cruciate ligament is also indicative of a root tear (Figure 2). These are often 'bucket-handle tears', in which there is a vertical or oblique tear in the posterior horn running toward the anterior horn,5 forming a loose section which remains attached anteriorly and posteriorly.1 In older patients, tears are generally due to degeneration associated with ageing and tend to be horizontal tears. Operative Arthroscopy, 3rd Edition, 2002, Lippincott Williams and Wilkins. Non-anatomic placement of a PCL reconstruction tibial tunnel is a reported cause of iatrogenic medial meniscal posterior root tears. Most people can still walk on their injured knee, and many athletes are able to keep playing with a tear. During the exam, your doctor will look for signs of tenderness along the joint line. Normal knee anatomy. (13a) A coronal image from another patient with a medial meniscal root tear demonstrates associated severe medial subluxation of the meniscal body (arrow). a feeling that your knee is catching or locking, usually when it's bent - you may notice it clicking. I read on a medical site that it is difficult to get to the posterior horn of the meniscus and sometimes there is a need to make an incision or the knee becomes dislocated. Clin Sports Med 2010;29:81106. They may not even be apparent with an arthroscopic examination. However, anyone at any age can tear the meniscus. Treatment varies on a case-by-case basis. Henning C, Lynch M, Clark J. Vascularity for healing of meniscus repairs. When small, conservative therapy or simply rasping the meniscus may result in healing of these tear types. Aging is also a risk factor due to general wear and tear of the knees. This "C" shaped cartilage helps disperse impact and displace force exerted upon the knee while walking, running, and other mild to high-energy and impact motions. How is Oblique Fracture Treated? The McMurray test (shown here) will help your doctor determine if you have a meniscus tear. Meniscus Repair. If the tear is associated with arthritis it will typically improve over time as the arthritis is treated. Bernstein J. In this case, a portion may break off, leaving frayed edges. Bring someone with you to help you ask questions and remember what your provider tells you. Knee Surg Sports Traumatol Arthrosc 2009;17:11026. Copyright 1995-2021 by the American Academy of Orthopaedic Surgeons. The absolute indication for specialist referral is the locked knee loss of joint function necessitates surgical intervention. 2013. Superior and inferior branches of the medial and lateral geniculate arteries supply the peripheral third of the menisci via the perimeniscal capillary plexus.3,4, Meniscal tears occur due to a shear force between the femur and tibia. The anatomic landmark for repair is anterior to the PCL footprint on the tibia. (386) 255-4596 2010. J Fam Pract 2001;50:93844. Tears of the posterior medial meniscal root have shown to disrupt the normal motion of the knee, resulting in degenerative arthritis. Although surgical repair has led to improved patient-reported function, there are conflicting reports on the progression of cartilage degeneration. The degenerative aetiology and reduced vascularisation secondary to ageing also means that meniscal tears in the elderly population are less likely to be amenable to surgical management;7 only about 6% of patients over 40 years of age have operable lesions.24 To prevent re-injury of the meniscus, activity modification is important for example, ceasing sports such as soccer or netball. The test is positive if symptoms are reproduced on rotation 10. . Common tears include bucket handle, flap, and radial. Most oblique meniscus tears are happen in the posterior third of the medial meniscus. Guides you through the decision to have surgery for a torn meniscus. The arthroscope is inserted near the knee via a tiny incision. A tear can also develop slowly as the meniscus loses resiliency. Magnetic resonance imaging (MRI) scans. The menisci are "wedge-shaped" pieces of cartilage that rest between the thigh bone ("femur") and lower leg bone ("tibia") in the knee joint. https://www.verywellhealth.com/types-of-meniscus-tears-3862073, https://www.webmd.com/pain-management/knee-pain/meniscus-tear-injury, https://orthop.washington.edu/patient-care/articles/sports/torn-meniscus.html, A sensation that the knee is locked in place. The meniscus is a piece of C-shaped cartilage that helps cushion the knee. My husband has complex tear of the body and posterior horn of the medial meniscus with flap components, horizontal oblique tear of the body and posterior horn lateral meniscus. Surgery is most likely needed to resolve your problem. Meniscal tears are common sports-related injuries in young athletes and can also present as a degenerative condition in older patients. Horizontal cleavage, oblique, and complex meniscal tear patterns have traditionally been poor candidates for meniscal repair. At The Orthopedic Clinic, we want you to live your life in full motion. Longitudinal tears do not disrupt the circumferential architecture of the meniscus, and thus repair of longitudinal tears leads to a meniscus with relatively normal biomechanical function. The preferred nomenclature for this tear pattern is: A gradient-echo T2*-weighted sagittal image, A. 2nd ed. Surgery is typically the only option and works to trim the damaged portion of the meniscus. AJR 2001; 176:771-776. A loose piece of cartilage can get stuck in the joint, causing the knee to temporarily lock, preventing full extension of the leg. Severe pain and swelling may occur up to 24 hours afterward. Rehabilitation time for a meniscus repair is about 3 to 6 months. Your doctor might move your knee and leg into different positions, watch you walk, and ask you to squat to help pinpoint the cause of your signs and symptoms. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website. . what is the treatment for that? The operative equipment needs and post-operative rehabilitation process markedly differ between meniscal repair and partial meniscectomy.