Meniscal pathology

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Close up old man knee pain

One of most common injuries to the knee joint involves damage to the one of the meniscal tissues. The knee joint has a medial (U-shaped) and lateral (S-shaped) meniscus which is made up of various materials to be recognized as a type of fibrocartilage. While these tissues absorb shock and help with load bearing forces while increasing the bony fit of the knee joint, each meniscus also assists protecting, lubricating and allowing for nutrition of the underlying articular cartilage. Hence, the most vital function of the meniscal tissues is to prevent damage to the articular cartilage and early onset of osteoarthritis. Most of the meniscal tears occur at the “posterior horn” region at the medial meniscus.

However, due to the lack of blood supply of the inner part of each meniscus, the opportunity for healing remains limited to the outer aspect.

The types of meniscal tears can be defined as:

  • bucket handle or vertical-longitudinal (usually associated with acute, traumatic tears)
  • flat/oblique
  • radial/transverse
  • horizontal/complex (usually associated with degenerative meniscal tears)

Usually, meniscal injuries occur in two types of mechanisms of injury which correspond with two different age groups.

Typically, an acute, “sharp”, traumatic injury to the meniscus involves a younger person (under 30 years old) engaged in a sports-related activity when their foot remains planted in the ground as they could feel a “pop” during a twisting, cutting or rotational motion. 

On the other hand, the other group consists of middle-aged to elderly individuals who are > 60 years old, but do not seem to have any particular cause of discomfort. However, these persons could have a greater amount of kneeling or squatting and excessive stair climbing as their injury stems more from a degenerative condition. This older group tends to have more symptoms associated with osteoarthritis than the meniscal lesion.

However, in both cases, the meniscal lesion can cause the person to experience a variety of symptoms such as swelling, limited motion, tenderness at the joint line and a “popping” sensation. Furthermore, individuals with meniscal tears could complain of catching, locking, buckling or giving way symptoms.

In the examination, a high likelihood of damage to the meniscus involve having:

  • Mechanism of injury (traumatic vs insidious onset)
  • Swelling
  • Tenderness to palpation on the joint line (inside/medial joint line or outside/lateral joint line)
  • Discomfort with limited motion during flexion or extension
  • Positive meniscal testing such as the McMurray’s

Treatment of meniscal injuries usually initiate with conservative management with the P.R.I.C.E. formula (Protection, Rest, Ice, Compression, Elevation) and engaging in physical therapy to reduce the swelling, advance the knee mobility-ROM, increase muscular control (especially of the quadriceps) and progressing to more functional activities as dictated by response to conservative care.

Here are some suggested exercises to attempt but these exercises should be relatively pain-free. However, as always, consult with your physician prior to initiating an exercise program (disclaimer). Disclaimer: This program provides exercises related to your condition that you can perform at home. As there is a risk of injury with any activity, use caution when performing exercises. If you experience any pain or discomfort, discontinue the exercises and contact your health care provider.

At Home Meniscal Exercises

Current literature suggests participating in 3-6 months of conservative care prior to surgical intervention as the orthopedic surgeon “should strive not to operate in most cases, but to protect, repair or reconstruct, in order to prevent early development of osteoarthritis by restoring the native structure, function, and biomechanics of the meniscus.” (Doral et al).

If symptoms continue to persist, surgical options can be used as it ranges from partial menisectomy (debridement and cleaning of the meniscus), meniscal repair (techniques designed to suture tear) or meniscal reconstruction (advanced surgical procedures such as allograft transplant).

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Arnoczky SP, Warren RF. Microvasculature of the human meniscus. Am J Sports Med. 1982;10:90–5.

Anderson AF, Irrgang JJ, Dunn W, et al. Interobserver reliability of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification of meniscal tears. Am J Sports Med 2011;39:926-932.

Cameron HU, Macnab I. The structure of the meniscus of the human knee joint. Clin Orthop Relat Res. 1972;89:215–9. 

Daniel D, Daniels E, Aronson D. The diagnosis of meniscus pathology. Clin Orthop Relat Res. 1982;163:218–24.

Danso EK, Oinas JMT, Saarakkala S, et al. Structure-function relationships of human meniscus. J Mech Behav Biomed Mater 2017;67:51-60.

DeHaven KE, Collins HR. Diagnosis of internal derangements of the knee. The role of arthroscopy. J Bone Jt Surg Am. 1975;57:802–10. 

DeHaven KE. Meniscus repair. Am J Sports Med. 1999;27:242–50.

Doral et al. Modern treatment of meniscus tears. EFFORT Open Rev. 2018 May; 3(5): 260-268.

Englund M, Guermazi A, Gale D, et al. Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med 2008;359:1108-1115.

Fox AJ, Wanivenhaus F, Burge AJ, Warren RF, Rodeo SA. The human meniscus: a review of anatomy, function, injury, and advances in treatment. Clin Anat 2015;28:269-287.

Greis PE, Bardana DD, Holmstrom MC, Burks RT. Meniscal injury: I. Basic science and evaluation. J Am Acad Orthop Surg. 2002;10:168–76

Makris et al. The knee meniscus: structure- function, pathophysiology, current repair techniques, and prospectus for regeneration. Biomaterials 2011 Oct; 32(30):7411-7431.

Metcalf MH, Barrett GR. Prospective evaluation of 1485 meniscal tear patterns in patients with stable knees. Am J Sports Med 2004;32:675-680.

Morgan CD, Wojtys EM, Casscells CD, Casscells SW. Arthroscopic meniscal repair evaluated by second-look arthroscopy. Am J Sports Med. 1991;19:632–7. 

Newman AP, Anderson DR, Daniels AU, Dales MC. Mechanics of the healed meniscus in a canine model. Am J Sports Med. 1989;17:164–75. 

Noyes FR, Barber-Westin SD. Repair of complex and avascular meniscal tears and meniscal transplantation. J Bone Jt Surg Am. 2010;92:1012–29.

Proctor CS, Schmidt MB, Whipple RR, Kelly MA, Mow VC. Material properties of the normal medial bovine meniscus. J Orthop Res. 1989;7:771–82.

Salata MJ, Gibbs AE, Sekiya JK. A systematic review of clinical outcomes in patients undergoing meniscectomy. Am J Sports Med. 2010;38:1907–16.

Snoeker BAM, Bakker EWP, Kegel CAT, Lucas C. Risk factors for meniscal tears: a systematic review including meta-analysis. J Orthop Sports Phys Ther 2013;43:352-367.

Terzidis IP, Christodoulou A, Ploumis A, Givissis P, Natsis K, Koimtzis M. Meniscal tear characteristics in young athletes with a stable knee: arthroscopic evaluation. Am J Sports Med. 2006;34:1170–5.

Tissakht M, Ahmed AM, Chan KC. Calculated stress-shielding in the distal femur after total knee replacement corresponds to the reported location of bone loss. J Orthop Res. 1996;14:778–85.

Turman KA, Diduch DR. Meniscal repair: indications and techniques. J Knee Surg. 2008;21:154–62. 

Verdonk R, Madry H, Shabshin N, et al. The role of meniscal tissue in joint protection in early osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2016;24:1763-1774. 

Wadhwa V, Omar H, Coyner K, et al. ISAKOS classification of meniscal tears-illustration on 2D and 3D isotropic spin echo MR imaging. Eur J Radiol 2016;85:15-24.

Zhu W, Chern KY, Mow VC. Anisotropic viscoelastic shear properties of bovine meniscus. Clin Orthop Relat Res. 1994;306:34–45. meniscal images