When the knee is symptomatic, arthroscopic partial meniscectomy has been practised for a long time with many case series reporting improved patient outcomes. Seventyfive lesions 60% located in the meniscal body were diagnosed at the first stage of the arthroscopic exploration. We present the arthroscopic remplissage technique originally described by koo and burkhart et al. Does the location of placement of meniscal sutures have a. Meniscal ramp lesions have been reported to be present in 9% to 17% of patients undergoing anterior cruciate ligament reconstruction. The medial meniscus is injured much more often than the lateral menis cus, with the posterior horn being the most afflicted component. All of these structures are surrounded by cartilage and ligaments that support the knee joint and protect it from injury. May 02, 2020 the menisci of the knee joint are fibrocartilaginous cshaped disks that occupy the joint space between the femur and the tibia. Normal mr imaging anatomy of the knee saifuddin vohra, do, george arnold, md, shashin doshi, md, david marcantonio, md there are several keys to successfully interpreting mr imaging examinations. This disparity in motion contributes to the frequency in which each meniscus is injured. However, valid evidence of the efficacy of apm is lacking. Width of lesion border is the most important factor. Chondral injury after insideout meniscal suture repair using.
Insideout repair of meniscal ramp lesions arthroscopy. Arthroscopic examination revealed subluxation of the anterior horn of the medial meniscus due to detachment from its anterior tibial insertion. May 07, 2020 lesions of the meniscus are commonly encountered in the practice of knee surgery. 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. Congenital lesions, traumatic meniscus tears and degenerative lesions occurring in young patients, especially in athletes, were excluded. Jul 26, 2016 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. Classification and surgical repair of ramp lesions of the medial. Mri has a lower specificity in the medial meniscus than in the lateral meniscus.
The chondral lesion of the femoral medial condyle and the tibial medial plateau were found at the weightbearing portion. To assess anatomic risk factors for meniscal lesions in association with acute acl rupture. Vertical lesion of lateral meniscus, with small extension, associated with acl tear, left in situ during reconstruction. A ramp lesion consists of meniscosynovial or meniscocapsular tears, which can be difficult to. The meniscus is a cartilaginous tissue in the knee joint that cushions and spreads pressure between the ends of the femur and tibia bones. Embryologically, the menisci form from mesenchymal tissue and. Anatomy, incidence, diagnosis, and treatment orthopaedic journal of sports medicine, jul 2016. Proposition of a useful tool for its radiologic analysis meniscal ramp lesions. Mri has a high sensitivity in the medial meniscus, where it was accurate in detecting a tear in 91. Given the potential for healing, conservative management is indicated for stable osteochondritis dissecans in patients who are skeletally immature.
Simultaneous bicompartmental buckethandle meniscal tears. When doctors and patients refer to torn cartilage in the knee, they actually may be referring to an injury to a meniscus at the top of one of the tibiae. The lesions of the menisci are often associated with lesions such as ligamentary. Magnetic resonance imaging versus arthroscopy in the.
The lateral meniscus posterior root lmpr lesion further. 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. The aim of this study was to investigate which of the different side applications of allinside mcs repair of the meniscus was better in respect of clinical and functional results. Meniscal lesions of the posterior horn of medial meniscus mm are very often associated with an acl rupture 16,32,49. Ramp lesions of the medial meniscus are commonly associated with anterior cruciate ligament ruptures and. A meniscus repair involves suturing the torn edges of the meniscus back into place and letting the meniscus mend itself. Surgical management of degenerative meniscus lesions. Introduction arthroscopic partial meniscectomy apm to treat degenerative meniscus injury is the most common orthopaedic procedure. Arthroscopic remplissage for moderatesize hillsachs lesion. 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.
However, patients with osteochondritis dissecans of the lateral femoral condyle combined. 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. Detached anterior horn of the medial meniscus mimicking a. Anatomic risk factor for meniscal lesion in association with. Disruption of the posterior horn of the medial meniscus could lead to excessive forces within the knee joint and surrounding structures. But only about 10 percent of all meniscus tears are repairable in this manner. Humeral bone loss has been shown to be a risk factor for failure after arthroscopic treatment of instability. We percutaneously place 2 suture anchors, which require no additional suture. 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. Data from anterior cruciate ligament acl registries show that 47% to 61% of acl tears are associated with meniscal lesions.
Hidden lesions of the posterior horn of the medial meniscus. Article information, pdf download for lateral meniscus posterior root lesion influences. Alternatively, you can download the file locally and open with any standalone pdf reader. The clinical diagnosis was correct in 85%, arthrographic in 54%. An injury can cause altered biomechanics of the knee joint and pain. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a pdf plugin installed and enabled in your browser. Posterior meniscosynovial lesion of medial meniscus. The lesions found in the medial meniscus were the following. Arthroscopic repair of ramp lesion of medial meniscus vumedi. This video describes an arthroscopic approach to repair a ramp lesion of the medial meniscus. Bucket handle injury of both menisci in almost all cases is associated with a lesion to either the anterior or the posterior cruciate ligament of the knee joint. 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. Arthrex,d meniscal staple arthotek,e bio stinger linvatec,f meniscus arrow bionx implants, g clearfix. Ramp lesions, which are commonly associated with acl injuries and are often misdiagnosed, 1 disrupt the meniscotibial ligament and the posteromedial meniscus in the meniscocapsular zone.
Preoperative magnetic resonance images of the knee were initially interpreted as a parameniscal cyst. Our knowledge and understanding of the anatomy and function of the meniscus has evolved significantly over the. Proprioception of knee joints with a lesion of the medial meniscus. Options for surgical treatment include arthroscopic repair using an allinside or insideout. The menisci of the knee joint are fibrocartilaginous cshaped disks that occupy the joint space between the femur and the tibia. A medial meniscal tear was diagnosed in 125 of the 302 patients 41. Lateral meniscus posterior root lesion influences anterior tibial. We describe a case of acute buckethandle tear of the medial and lateral menisci with intact anterior and posterior cruciate. 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. Lesions of the meniscus are commonly encountered in the practice of knee surgery.
Meniscus injury khairul nizam abdul rahman 4262143008 2. The medial meniscus is a cshaped cartilage structure that is attached to the tibia and acts as a shock absorber for the knee. Is it necessary to repair stable ramp lesions of the medial. In knee flexion and internal rotation of the knee, the medial meniscus is more susceptible to injury, whereas in flexion and external rotation the. Sports injury medicine department 9250 sw hall blvd. In particular, evaluation of meniscal lesions, whether of degenerative or traumatic origin, accounts for a large proportion of the knee examinations performed with magnetic resonance imaging mri. In the posterior portion of the lateral meniscus, a horizontal tear remained fig. A tear of a meniscus is a rupturing of one or more of the fibrocartilage strips in the knee called menisci. Bucket handle tear of the menisci is a common type of lesion resulting from injury to the knee joint. Introduction the semilunar cartilages are commonly called menisci and form an important shockabsorbing mechanism, which helps in the gliding movement of the tibia on the femur. This page will explore how and what happens when the menisci become injured a tear and or a rupture. The chondral lesion appeared thin and cleftlike fig. Pain and swelling are the most common signs of an injury to your meniscus. Meniscocapsular separation mcs is a lesion of the area which is attached from the peripheral section of the meniscus to the capsule and is seen less often than other meniscus injuries.
Osteochondritis dissecans of the lateral femoral condyle is relatively rare, and it is reported to often be combined with a discoid lateral meniscus. A degenerative meniscus lesion is a slowly developing process typically involving a horizontal cleavage in a middleaged or older person. The meniscus glides slightly in knee flexion and extension. We report a case of a detached anterior horn of the medial meniscus with anterior knee pain. Com meniscal cartilage tear top view femur thighbone tibia shinbone medical meniscus front view of knee lateral meniscus torn what are the symptoms. Arthroscopic fixation with a suture anchor was successful.
Meniscal tears are the most common lesions followed by the meniscal cyst. The medial and lateral menisci play an important role in absorbing force and assisting in the role of nourishing the knee joint. 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. Aug 08, 2016 data from anterior cruciate ligament acl registries show that 47% to 61% of acl tears are associated with meniscal lesions. Management of meniscal lesions of the knee encompasses nonoperative care, partial or total meniscectomy, and meniscus repair or grafting 1, 2. The primary hypothesis was that tibiofemoral anatomic measures will be different in those with and without concomitant meniscus tears. Insideout repair of meniscal ramp lesions sciencedirect. Patients andmethods a prospective study was undertaken at the university hospital kuala lumpur, from january 1983 to june 1984. Initially, constructing a solid foundation consisting of a good understanding of basic mr imaging principles and imaging protocols as well as the. Detection at the time of arthroscopy can be accomplished based upon clinical suspicion and careful evaluation without the use of an accessory posteromedial portal. Several treatment options have been reported, including nonsurgical management, insideout meniscal repair, or allinside meniscal repair.
Association of meniscal lesion and cranial cruciate ligament. Our knowledge and understanding of the anatomy and function of the. Lesion stability is an important criterion in deciding whether to resect, repair, or leave alone a meniscal lesion 3, 4 and is best determined by direct visualization and palpation at arthroscopy 2, 5, 6. 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. Development of the menisci of the human knee joint. Meniscal root tears are defined either as an avulsion of the insertion of the meniscus attachment or complete radial tears that are located within 1 cm of the meniscus insertion.
Torn knee cartilage generally produces pain in the region of the tear and swelling in the knee joint. Pdf meniscal ramp lesions are more frequently associated with anterior cruciate. Raveendran summary in a prospective study of 50 patients with suspected tear of the meniscus of the knee, the clinical diagnosis, arthrographic and arthroscopic findings were compared at arthrotomy. All anatomical descriptions were clearly illustrated by mri, arthroscopy, andor drawings. Arthroscopic partial meniscectomy for degenerative meniscal. Management of traumatic meniscal tear and degenerative. Methods trial design we conducted this parallelgroup study at five orthopedic clinics in finland during the period from december 2007 through january 20.
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. Medial meniscus, ramp lesion, repair, healing, anterior cruciate ligament, knee. Knee pathology is one of the most common indications for musculoskeletal imaging. However, patients with osteochondritis dissecans of the lateral femoral condyle combined with a. Classification and surgical repair of ramp lesions of the.
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