Meniscus Injury

Presented By Siti Nur Rifhan Kamarudin

 ANATOMY
Meniscus is a cushion structure made
of cartilage which fits within the knee
joint between tibia and femur.
Each Menisci has
- Two ends
- Two borders
- Two surfaces
 MEDIAL MENISCUS
C- Shaped structure and
lateral meniscus is more
circular.
Anterior horn : Attached
to the tibia anterior to the
intercondylar eminence
to the ACL.
Posterior horn :
Anchored immediately in
front of the attachment of
PCL posterior to the
intercondylar eminence.
 Medial Meniscus
Peripheral border
attached to the
medial capsule
through the
coronary
ligament to the
upper border of
tibia.
Most of the
weight borne on
the posterior
portion of
LATERAL MENISCUS
Circular shaped
The anterior and posterior
horns are closer to each
other & near insertion of
ACL
Anterior Horn : Attached
to the tibia in front of the
intercondylar eminence.
Posterior Horn :
Attached to the posterior
aspect of the intercondylar
eminence in front of
posterior attachment of
medial meniscus.
Lateral Meniscus
The lateral meniscus is mobile and
medical meniscus is more fixed ->
causing more tears to occurs in medical
meniscus
Lateral meniscus is associated with
discoid meniscus and meniscal cysts
Lateral meniscus is also assoc. with acute
injury to ACL
Medial Meniscus
Tears of medical meniscus occurs more
with degenerative tears
Associated with a bakers cyst.
 BLOOD SUPPLY
The blood supply of meniscus
decides the healing potential of
the meniscus
The outer one-third of meniscus
is vascular. It will heal if repaired
The inner one-third is not
vascular and is nourished by
synovial fluid.
The middle third is red/white and
it is avascular.
The blood supply of meniscus
originates from medial and
lateral genicular arteries
 FUNCTIONS OF

MENISCUS
Shock Absorber: Provides
load sharing across knee by
increasing the contact area and
decreasing the contact stress.
Act as joint filler :
Compensates for the gross
incongruity between tibial and
femoral articulating surfaces.
Joint Lubrication: help to
distribute Synovial fluid
through the joint and aiding
the nutrition of articular
cartilage.
 OVERVIEW of MENISCAL
INJURY
Epidemiology:
- Most common indication for knee surgery
Location:
Medial Tears
- More common
- Degenerative tears in older patients
usually occur in posterior horn of
medial meniscus.
Lateral Tears
- More common in acute ACL tears
 CLINICAL FEATURES
Pt is usually a young person who sustain
twisting injury to the knee
Knee pain (often severe)
Swelling of the knee within 48hours
Locking : Sudden inability to extend
the knee fully suggest a bucket-handle
tear.
Popping or clicking within the knee.
Limited motion of knee joint.
Tenderness when pressing on the meniscus
(Knee joint line)
 CLASSIFICATION OF MENISCAL
TEAR

Based on Location
Red Zone: Outer third, vascularized
Red-White Zone : Middle Third
White Zone : Inner third, Vascularized
Based On Pattern
Vertical/Longitudin
al
- Common, esp.
with ACL tears
Bucket Handle
- Vertical tear which
may displace into
notch
Horizontal
- More common in
older population
- May be associated
with meniscal cysts
PHYSICAL EXAMINATION
The joint may be held slightly flexed
and there is often an effusion.
In late presentations, the quadriceps
will be wasted.
Tenderness is localized to the joint
line, particularly the medial line.
Flexion is usually full but extension is
often limited.
 SPECIAL TESTS
1) Thessaly Test
Standing at 20 degrees of knee
flexion on affected limb
Patient twists with knee external and
internal rotation.
Positive Test: Clicking, pain or
discomfort on joint line.
2) McMurrays Test
Principle: To trap the meniscus
between the tibia and femur.
Pt needs to be relaxed.
One hand on knee joint line.
Other hand holds the foot &
ankle.
Flex the knee as far as possible
(Hyperflexion)
Externally rotate(Medial Me.) or
internally rotate (Lateral Me.)
the tibia and then extend the
knee.
Positive McMurrays :
Clicking or popping felt
associated with pain.
2) Apleys Grinding test
Patient is in prone
position
Knee flexed to 90
degrees
The leg is rotated
from side to side
Compression force
applied
A painful response
signifies a torn or
 IMAGING
Radiographs
Should be normal in young patient with
acute meniscal injury
MRI
Most sensitive diagnostic test
Findings
- MRI Grade III signal is indicative of a
tear
- Parameniscal cyst indicates presence
of meniscal tear
- May see Double PCL sign that
 MANAGEMENT
NON-OPERATIVE TREATMENT
Indication: First line of treatment for degenerative
tears
: Acute episode without locking but with
acute synovitis
Immediate abstinence from weight bearing
Rest
Ice pack application
Compression dressing
NSAIDS
Rehabilitation exercises
SURGICAL MANAGEMENT

1)Meniscectomy
2)Meniscal Repair
3)Meniscal
Transplantation
 OPERATIVE TREATMENT
1) Partial Meniscectomy
Indication: Tears not amenable to repair (complex,
degenerative, radial tear patterns)
: Repair failure > 2 times
Objective: Remove the torn meniscal fragment and
contour the peripheral rim, leaving a balanced,
stable rim of meniscal tissue.
Outcomes
- >80% satisfactory function
Partial is preferred over total meniscectomy
- Shorter operating time, Faster recovery, better
post-op function.
Anthroscopic Meniscal Repair
3 important steps:
- Appropriate patient selection : should
have documented tear that is able to
heal
- Tear debridement and local synovial,
meniscal and capsular ablation to
stimulate a proliferative fibroblastic
response
- Suture placement to reduce and
stabilize the meniscus
Meniscal Repair
Risks:
Saphenous Nerve and Vein damage
Peroneal Nerve
Popliteal Vessels
3) Meniscal
Transplantation
Attempts at meniscal replacement
with
- Allograft meniscus
- Autograft fascial material
- Synthetic meniscus
 REFERENCES
Apley and Solomons Concise System
of Orthopedic and Trauma, 4th Edition