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Medial and Lateral Meniscus

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What is Medial and Lateral Meniscus ?

Our knee joint has two semi-lunar or half-moon or C-shaped fibro-cartilage structure  known as menisci. This cartilage which lie on the medial (inside) of upper surface of leg (tibia)  is  known as medial meniscus and which lie on lateral (outside) of the upper surface of the leg (tibia) is known as lateral meniscus.

They are important structures of the knee joint as menisci of the knee joint are two pads of cartilaginous tissue which serve to distribute friction in the knee joint between the lower leg (tibia) and the thigh (femur ). Even stress distribution during weight bearing activities decreases load on articular  cartilage ,Menisci acting as shock absorbers and controller of knee joint . As a result, injury to either meniscus can lead to critical impairment of  function of the knee joint..

What is a Meniscus Injury?

The medial (inner)meniscus has function of shock absorber but on any unplanned or sudden abnormal movement it gets stretched and torn in between thigh and leg bone. The medial (inner)meniscus has more chances of injury than the lateral(outer) meniscus as it is less mobile as medial meniscus is attached to  tibial collateral ligament and the joint capsule .  Injury to medial meniscus occur when knee is in flexed weight bearing  position and knee  is twisted which leads to shear forces generation  and  tear of meniscus.This injury can occur while playing games  like football,rugby .

 Traumatic injury and Degenerative processes are the  two most common causes of a meniscus tear . Meniscus tears can occur in all age groups.

 Traumatic tears are most common in active young  people between 10-50 yrs of age. Traumatic meniscal tears are usually radial or vertical in the meniscus which produce a mobile fragment that can catch in the knee  which require surgical treatment. The mechanism of a traumatic meniscus tear occurs when the knee joint is bent and the knee is then twisted. Oftenly medial meniscal injury is associated with injury to ACL and medial collateral ligament  known as unhappy triad. which is seen while playing sports such as football when the player is hit on the outer side of the knee joint.

Degenerative tears are most common in  elderly people after  age of  50yrs. Degenerative meniscal tears occur as part of the aging process when the break down  of collagen fibers within the meniscus start taking place and produce less support to the structure of the menicus. They are less likely to produce mechanical symptoms of catching or locking as degenerative tears are usually horizontal in the meniscus, producing both an upper and lower segment of meniscus and they  don't move out of place .

What are the Symptoms?

  • Patient gives  history of injury or twisting of the knee joint.

  • Pain on the inner surface of the knee joint.

  • Ballooning out  or swelling of the knee  particularly  within 48 hours of injury.

  • Unable to bend his  knee fully

  •  H/o of pain or a clicking noise on moving his affected knee.

  • H/o of "Locking" i.e inability to straighten the knee of  his affected  knee.

  • Patient is unable to bear weight  on the affected side.

Types of Meniscal Tear:  Classification

A Meniscus tear can be classified  on basis of its blood supply and pattern of tears

Based on blood supply-

1 “red-red,” zone-vascular zone

2 red-white,” –partially vascular  zone

3 white-white” zones.-avascular zone               

Based on  Pattern of tears-

        Longitudinal Tears: This is a tear which  occurs along the length of the meniscus and can vary in length

  • Radial Tears: These tear which  from the edge of the cartilage inwards.

  • Bucket-Handle Tears: This is an high grade form of a longitudinal tear where a portion of the meniscus becomes detached from the tibia forming a flap that resembles like a bucket handle .

  • Degenerative Changes: This may lead to edges of the menisci becoming frayed and jagged.

How to Assess Meniscal tear

  1. Palpation
    By feeling the knee joint with palmar aspect of right hand fingers  by doctor  at A+ clinic  on medial and lateral aspect of knee joint depending upon which menisci is affected.

  2. Range of motion
    The doctor will check  range of movements of knee joint which will be restricted and painful.

  3. McMurrays test –special test  +ve

  4. Apley's test  - special test  +ve



 Radiograph(X-ray images normally during weightbearing) can be done to see if the patient also has osteoarthritis.  In Xrays menisci are not visible.

MRI scan ( magnetic resonance imaging). This technique has been found very useful in diagnosing meniscal injury

Treatment for medial meniscus injury

In Acute injury

  • Give rest to injured knee.

  • Apply ice to affected knee.

  • Wear a knee compression support.

  • Elevate the injured limb.

  • Try to keep the knee moving using our mobility exercises and quadriceps excercise.

  • Consult a Sports Injury Specialist at A+ clinic.

A sports injury specialist at AClinic may:

  • Assess the knee to confirm the injury.

  • Refer you for an MRI scan.

  • Decide whether conservative treatment will be effective or surgery may be required.

1. Conservative Treatment
This may be indicated in the case of a small tear or a degenerative meniscus and may involve:

  • Advice Rest to that part .

  • Apply Ice on that knee.

  • Apply knee Compression support .

  • Elevate the affected limb to decrease swelling.

  • Anti inflammatory drugs .

  • Massage to decrease swelling and relax surrounding muscular tension.

  • Manual therapy

  • Once pain has subsided, physiotherapy  to restore the range of movement, improve balance and maintain quadriceps strength .

2. Surgical Intervention
Failure of  conservative treatment , severe meniscal tears such as a bucket handle tear are the indication of  arthroscopic surgical procedures . Aim  of surgery is to preserve as much of the meniscus cartilage as possible so as to avoid  chances of  arthritis later on..  

Based  on the location of the tear  doctor can decide whether to go  for meniscal repair or meniscal sacrifice partially or totally.

If tear is in  the peripheral third of the meniscus, which has an adequate blood supply , stitching of the torn cartilage is possible.

But in majority of cases, where tear is central part ( far away from the meniscus' blood supply) and a repair is unlikely going  to heal. In these cases arthroscopic partial meniscectomy should be done, which we remove  the torn tissue and allowing the knee to function with remaining meniscus .

Meniscal replacement is one other option available for those who .but only few centres are doing it .

Results- It has been found that Meniscal Repair  in  younger patients,those who are presenting early, usually  are more resilient and respond well to this treatment, while elderly patients with sedentary life style do not have a favorable outcome after a repair.

Rehabilitation- Following surgery a rehabilitative exercise program will be  required for the patient which may include mobility excercises,quadriceps strengthening and balance training. For  maximising recovery of the patient, his   full cooperation is required.

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