However, despite advances in imaging, mr imaging continues to have inherent limitations, particularly for detection of small posterior horn tears and tears that. Because of this, it is less prone to tears than the medial meniscus just because it is more mobile. Development of the menisci of the human knee joint. It is more often that a partial meniscectomy will be needed. This technique is suitable for all peripheral tears located in the redred zone or ramp lesions of the mm posterior segment. Such meniscus lesions are frequent in the general population and often incidental findings on knee mri. Our knowledge and understanding of the anatomy and function of the. Physiopathology of the meniscal lesions request pdf.
Lesion is a broad term, including wounds, sores, ulcers, tumors, cataracts, and any other tissue damage. Classification and surgical repair of ramp lesions of the. The lateral meniscus is on the outer side of the knee and is attached to the tibia but not to the corresponding lateral collateral ligament. This page will explore how and what happens when the menisci become injured a tear and or a rupture. Only one study had poor results in all three scores 28. When this happens, a pocket at the front of the glenoid forms that allows the humeral head to dislocate into it. The greater a patients age and longer time from initial acl injury are predictive factors of the severity of chondral lesions, and time from initial acl injury is significantly associated with the number of chondral lesions. Longitudinal meniscal tear radiology reference article. Meniscal ramp lesion repair by a transseptal portal technique. Ramp lesion hidden lesion meniscus meniscocapsular tear.
The meniscus lesion is rather a complication of medial knee osteoarthritis 30, 31. In cases of isolated ramp lesions, a standard meniscal repair rehabilitation protocol should be. Meniscal ramp lesions are more frequently associated with anterior cruciate ligament acl injuries than previously. Meniscal ramp lesions were studied by hamberg and colleagues1 in the 1980s but at that time were described.
A meniscus repair involves suturing the torn edges of the meniscus back into place and letting the meniscus mend itself. Mr imagingbased diagnosis and classification of meniscal. Meniscectomy remains one of the most frequent orthopedic procedures, despite meniscal sparing having been advocated for several decades now. The state of the literature in the nonoperative management of meniscus and articular cartilage lesions is rapidly evolving and will be explored and presented in. Overall, 155 patients 42% had a ramp lesion of the medial meniscus. On plain radiographs, meniscal tears are not visible. Detached anterior horn of the medial meniscus mimicking a. Meniscal injury knee anatomy knee injuries are fairly common problems, not just in athletes.
Rehabilitation exercises appendix topic images meniscus tears quad sets straightleg raise to the front straightleg raise to the back hamstring curls heel raises heel dig bridging shallow standing knee bends meniscus tear. The medial and lateral menisci play an important role in absorbing force and assisting in the role of nourishing the knee joint. Symptomatic giant bone island of the tibia mimicking. To assess anatomic risk factors for meniscal lesions in association with acute acl rupture. Athletes, particularly those who play contact sports, are at risk for meniscus tears. Ramp lesions of the medial meniscus are commonly associated with anterior cruciate ligament ruptures and consist of longitudinal peripheral tears of the. This study analyzed the efficacy and safety of arthroscopic outsidein repair of the anterior horn of the lateral meniscus that includes covering the lesion with. On arthroscopic examination, the knee was found to have a detached anterior horn of the medial meniscus figure 2a. Epidemiological studies showed that all meniscal lesions, in different sports athletes, involves 24% of medial meniscus, while 8% of lateral meniscus and about 2030% of meniscal lesions are.
The anterior onethird of the meniscus was hypermobile and was displaced below the medial tibial plateau with the knee flexed about 45 degrees. Embryologically, the menisci form from mesenchymal tissue and. The primary hypothesis was that tibiofemoral anatomic measures will be different in those with and without concomitant meniscus tears. Meniscus tears are among the most common knee injuries. They range from the skin sores associated with eczema to the changes in lung tissue that occur in tuberculosis. Therefore, to rule out a ramp lesion, an arthroscopic evaluation with probing of the posterior horn of the medial meniscus should be performed. A sensor inserted below the medial meniscus recorded contact pressures in association with 1 an intact meniscus, 2 a radial tear involving 30% of the meniscal rim width, 3 a radial tear. Surgical management of degenerative meniscus lesions. Only when associated with more complex injuries plain film may suggest a meniscal tear, e. Management of traumatic meniscal tear and degenerative. P oct 16, 2015 the meniscus lesion is rather a complication of medial knee osteoarthritis 30, 31.
Patients were significantly more likely to have a ramp lesion if they sustained a contact injury to the knee odds ratio or, 1. The knee is a hinge joint, formed by the ends of two bones. Pdf meniscal ramp lesions are more frequently associated with anterior cruciate ligament acl injuries than previously recognized. Pdf ramp lesions of the medial meniscus mm are associated with 9 to 17% of acl tears and are seldom recognized on preoperative. Classification and surgical repair of ramp lesions of the medial. Jan 25, 2020 to demonstrate mri appearances and arthroscopic findings of the different types of meniscal ramp lesions, in the hopes of improving their detection on preoperative imaging. A degenerative meniscus lesion is a slowly developing lesion, typically involving a horizontal cleavage of the meniscus, generally in a middleaged or older person. Management of traumatic meniscal tear and degenerative meniscal. May 02, 2020 the menisci of the knee joint are fibrocartilaginous cshaped disks that occupy the joint space between the femur and the tibia. Mri of the left knee shows edema surrounding the tumour.
The medial meniscus is on the inner side and is attached to the tibia and the medial collateral ligament. Finnish degenerative meniscal lesion study fidelity. They are heavily associated with anterior cruciate ligament injuries, and because of their potentially important biomechanical role in knee stabilization, injuries to. Mri appearance of the different meniscal ramp lesion types. Lesions of the meniscus are commonly encountered in the practice of knee surgery. Mr imagingbased diagnosis and classification of meniscal tears. However, a thin buckethandle lesion may be missed owing to the inconspicuous loss of substance in the parent meniscus. Several treatment options have been reported, including nonsurgical management, insideout meniscal repair, or allinside meniscal repair. Meniscus ramp lesion ramp lesions of the medial meniscus mm are associat ed with 9 to 17% of acl t ears and ar e seldom recognized on preopera tive magnetic resonance imaging mri scans. In rare cases secondary signs can be seen, such as a soft tissue swelling next to the meniscus when a meniscal cyst is present 4. Anatomic risk factor for meniscal lesion in association with. The patient underwent arthroscopy of her right knee under general anesthesia through routine medial and lateral infrapatellar portals.
When people talk about torn cartilage in the knee, they are usually referring to a torn meniscus. Ramp lesions of the medial meniscus in patients undergoing. Methods a degenerative meniscus lesion was defined as a lesion occurring without any history of significant acute trauma in a patient older than 35 years. Disruption of the posterior horn of the medial meniscus could lead to excessive forces within the knee joint and surrounding structures. It is well established that meniscal damage predisposes the adjacent articular cartilage to increased axial and sheer stress, resulting in early degenerative osteoarthritis. The purposes of this study were to determine the prevalence of altered mri appearances of posterior medial meniscus root ligament pmmrl lesions, introduce a classification of lesion types, and report associated findings. The state of the literature in the nonoperative management of meniscus and articular cartilage lesions is rapidly evolving and will be explored and presented in the next iteration of this cpg. Arthroscopic repair of chronic tears of the anterior horn of. To demonstrate mri appearances and arthroscopic findings of the different types of meniscal ramp lesions, in the hopes of improving their detection on preoperative imaging. Insideout repair of meniscal ramp lesions arthroscopy. Posteromedial approach in the case of a tear of the posterior segment, a posteromedial approach is. Options for surgical treatment include arthroscopic repair using an allinside or insideout. Accurate and timely diagnosis of a meniscal tear is critical for reducing morbidity and planning treatment. Meniscal lesions of the posterior horn of medial meniscus mm are very often associated with an acl rupture 16,32,49.
Medial meniscus, ramp lesion, repair, healing, anterior cruciate ligament, knee. Longitudinal meniscal tears sometimes called a vertical tear are a morphological subtype of meniscal tear where a component of the tear is seen extending in a vertical orientation parallel to the circumference of the meniscus. It is an indication for surgery and often accompanied by a hillsachs lesion, damage to the posterior humeral head. Intercondylar fragments may also present as displaced flaps, which remain attached to either the posterior or anterior horn, and likely represent the loss of continuity within a previous buckethandle tear. Meniscal ramp lesions have been reported to be present in 9% to 17% of patients undergoing anterior cruciate ligament reconstruction. Incidence is excessive in the light of scientifically robust studies demonstrating the interest of meniscal repair or of nonoperative treatment for traumatic tear and of nonoperative treatment for degenerative meniscal lesions. Patients andmethods a prospective study was undertaken at the university hospital kuala lumpur, from january 1983 to june 1984. But only about 10 percent of all meniscus tears are repairable in this manner. Originally, a ramp lesion was defined as a longitudinal tear of the peripheral attachment of the posterior horn of the medial meniscus at the meniscocapsular junction of less than 2. Rehabilitation exercises a meniscus tear is a common knee joint injury.
Congenital lesions, traumatic meniscus tears and degenerative lesions occurring in young patients, especially in athletes, were excluded. The identification of meniscal ramp lesions can be quite difficult or even impossible with conventional anterior. Controlling for the placebo effect of any medical intervention is important, but seems particularly pertinent for the assessment of apm, as the symptoms commonly attributed to a degenerative meniscal. The prevalence of asymptomatic tears, which typically are horizontal tears, increases with age 1,2. This video describes an arthroscopic approach to repair a ramp lesion of the medial meniscus. In the past, lesions of the meniscal roots were underdiagnosed and often unrecognized, but now they are better understood and have been biomechanically proven to be a source of overload in the knee joint. This study analyzed the efficacy and safety of arthroscopic outsidein repair of the anterior horn of the lateral. Leaving the meniscus alone may be an option in asymptomatic lesions of the lateral meniscus during anterior cruciate ligament acl reconstruction. Meniscal ramp lesions have been defined as longitudinal vertical peripheral tears of the medial meniscus involving the posterior meniscocapsular ligament, meniscotibial ligament, andor the redred zone of the posterior horn. Introduction arthroscopic partial meniscectomy apm to treat degenerative meniscus injury is the most common orthopaedic procedure. However, valid evidence of the efficacy of apm is lacking.788 1127 1043 1590 427 957 459 1570 428 1621 1122 54 768 408 314 856 1318 879 651 13 299 1080 726 1168 1588 1354 865 1305 94 607 1165 402 217 1367 1156 1049 422 545 552 942 642