Meniscal Lesions

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Original Editors

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Search Strategy

Database : Pubmed, google, books
Key words: meniscus injury, meniscus tear, Rehabilitation of meniscal rupture, Meniscus repair, physical therapy of meniscal tear, diagnose meniscal rupture
Time line: 2005- 2011

Definition/Description

A meniscus rupture is an injury that occurs when pieces of the meniscal cartilage are ruptured and when those pieces were injured by specific movements that rotate the knee with a lot of force, while the foot doesn’t rotate and is firmly planted on the floor. There are partial or total ruptures of a lateral or medial meniscus. (level of evidence: 2)

Clinically Relevant Anatomy

The clinical relevant anatomy is already described in Arthroscopic Meniscectomy⁸ and meniscus lesions⁷.

Epidemiology /Etiology

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Characteristics/Clinical Presentation

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Differential Diagnosis

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Diagnostic Procedures

A meniscus injury is generally caused by a torsional movement between the femur and the tibia under load without contact, or making an abrupt movement like a squat. Anything which allows the femur to slip too much forward or backward in relation to the tibia may cause some of the forces to be transmitted to the meniscus and result in a meniscus rupture.
During clinical trials, it’s important to pay attention to some specific data:
- Swelling, hydrops at the level of the knee
- Muscle atrophy
- Painful palpation zones, especially at the level of the joint space
- Limited mobility
- Positive McMurray – test⁹

When a meniscus rupture is suspected, a magnetic resonance imaging (MRI) is considered as the best medical imaging modality to confirm a meniscus rupture. This is necessary when the clinical trial and the anamnese aren’t specific enough.

Outcome Measures

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Examination

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Medical Management

Nonoperative treatment is rarely recommended for meniscal injuries. Sometimes it’s possible when there is a peripheral tear in the red-red junction. Then is healing possible without surgery because of the adequate vascularisation.
The nonoperative treatment consist of rest, ice, compression, elevation, nonsteroidal anti –inflammatory drugs, stretching and strengthening and various physical therapy modalities.

Operative:

An examination of the knee and possible arthroscopy provides a clear classification of meniscus injuries. The size and severity of the meniscus rupture are often indicative for the recovery after surgery  and for eventual later degenerative phenomena in the knee joint.
Different kinds of meniscus ruptures:
- Radial rupture
- Oblique rupture
- Longitudinal rupture
- Bucket handle
- Horizontal rupture
- Complex rupture

Arthroscopy is a small surgery. They look through a thin tube into the knee joint. The procedure can be performed to obtain information of the knee joint. In many cases, there can during the arthroscopy immediate a treatment be given. It’s possible that a larger operation is necessary. You can find more information about arthroscopy at the page Arthroscopic Meniscectomy⁸. (level of evidence : 2)

Certain meniscal tears like the bucket –handle rupture require operative treatment to prevent worsening of the rupture, to minimize additional damage to the torn portion of the meniscus and to optimize healing.
There are different kinds of operative treatment for meniscal tears as repair and partial resection.
If a rupture can’t be treated and it involves a large portion of the meniscus, or when repair failed, a significant portion of the meniscus must sometimes be removed. To avoid secondary osteoarthritis, meniscal transplantation may be the best solution.

Physical Therapy Management

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Key Research

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Resources

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Clinical Bottom Line

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Recent Related Research (from Pubmed)

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References

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MOORE K.L., DALLEY A.F., AGUR A.M.R., Clinically oriented anatomy: chapter 3: Pelvis and perineum, Wolters Kluwer health, sixth edition, 2010, pag. 451-452, level of evidence D
YU-TSAI T., LI-WEN T., CHENG-HSIU L., SHIH-WEI C., The influence of human coccyx in body weight shifting, medicine and science in sport and exercise, 2011, Volume 43, Number 5, pag. 494-496, level of evidence B
MOORE K.L., DALLEY A.F., AGUR A.M.R., Clinically oriented anatomy: chapter 3: Pelvis and perineum, Wolters Kluwer health, sixth edition, 2010, pag. 332, level of evidence D
HAARMAN H.J.Th.M., Klinische traumatologie, Elsevier gezondheidszorg, 2006, pag. 117, level of evidence D
MOORE K.L., DALLEY A.F., AGUR A.M.R., Clinically oriented anatomy: chapter 3: Pelvis and perineum, Wolters Kluwer health, sixth edition, 2010, pag. 461, level of evidence D
TEKIN L. et al., Coccyx fracture in patients with spinal cord injury, European journal of physical and rehabilitation medicine, March 2010, Volume 46, Number 1, pag. 43-46, level of evidence C
RAISSAKI M.T.,Fracture dislocation of the sacro-coccygeal joint: MRI evaluation, Pediatric radiology, March 1999, pag. 642-643, level of evidence D
LONSDALE E.F., A practical treatise on fractures, Walton and Mitchell printers, 1838, pag. 269-270, level of evidence D
MIYAMOTO K. et al., Exposure to pulsed low intensity ultrasound stimulates extracellular matrix metabolism of bovine intervertebral dosc cells cultured in alginate beads, Spine, November 2005, level of evidence B
EBNEZAR J., Essentials of orthopaedics for physiotherapist, Jaypee, 2003, pag. 174, level of evidence D
DEAN L.M. et al., Coccygeoplasty : treatment for fractures of the coccyx, J. Vasc. Interv. Radiol, 2006, pag. 909-912, level of evidence C
COOPER G., HERRERA J.E., Manual of musculoskeletal medicine, Wolters kluwer, Lippincott Williams & Wilkins, 2008, pag. 144, level of evidence D