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Knee Meniscus Tear

What is the meniscus in the knee?

The meniscus acts as a cushion in the knee between the femur or thigh bone and the tibia or lower leg bone. There are actually two menisci in each of your knees. There is a medial and lateral meniscus in the knee. The menisci help the movement of the knee and help protect the joint. Previous studies have shown that the menisci play an important role in distributing forces across the knee joint. In this manner, they help protect the joint cartilage in the knee. Damage to the menisci can associated with damage to the articular cartilage of the joint.

TYPES OF MENISCUS TEARS

INTACT MENISCUS

Femur
Tibia
Meniscus

A meniscus tear can happen from almost any activity involving your knee. It is usually associated with hyperflexion, hyperextension, and twisting movements about the knee. The tear can also occur from contact sports, falls, or or any other high energy trauma.

How does a meniscus tear occur?

How is a meniscus tear treated?

Some patients with a meniscus tear can be treated without surgery. With a period of rest and physical therapy they can return to activities as tolerated. For other patients, the meniscus tear can cause mechanical problems and pain in the joint. In most cases we try to repair the meniscus if possible, however, many times the meniscus is not in a repairable state and it must be partially surgically removed to decrease the mechanical symptoms. This is known as a menisectomy procedure.

A video demonstrating a menisectomy surgery can be found here.

Bucket Handle Meniscus Repair:

Remaining Meniscus
Torn Bucket Meniscus
Femur
Torn Bucket Meniscus
Femur
ACL
Femur
Tibia
Meniscus

Image 1: Bucket Handle Meniscus tear with the menisucs wrapped around the femoral condyle.

Femur
Tibia

Image 3: The meniscus is reduced (pushed) back into place. 

Image 2: The meniscus is trapped in the middle of the knee joint next to the Anterior Cruciate Ligament. 

Femur
Femur
Tibia
Tibia
Meniscus

Image 4: Meniscus repair device in the back of the knee. 

Image 5: Outside-In meniscal repair for anterior meniscus repair. 

Image 6: Repaired bucket handle meniscus tear. 

Meniscectomy:

Image 1: Complex degenerative meniscus tear that is not amenable to suture repair.

Image 2: Several arthroscopic tools are used to remove the tear.

Image 3: The meniscus is trimmed to a stable border.

Image 4: An arthroscopic shaver removes debris, loose tissue, and creates a smooth border to the remaining meniscus.

Image 5: The menisucs after meniscectomy with the loose and fragmented pieces removed.

References

1. Makris EA, Hadidi P, Athanasiou KA. The knee meniscus: structure-function, pathophysiology, current repair techniques, and prospects for regeneration. Biomaterials. 2011;32(30):7411. doi:10.1016/j.biomaterials.2011.06.037.

2. Anetzberger H, Birkenmaier C, Lorenz S. Meniscectomy: indications, procedure, outcomes, and rehabilitation. Orthopedic Research and Reviews. doi:10.2147/ORR.S54669.

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