Meniscal tears are among the most common knee injuries. Find out the symptoms, why it tears and why you have pain

1. The Knee:
Common Problems and Current
Treatments
David D Bullek, M.D.
Orthopedic Surgery
Surgery of the Knee and Shoulder
Summit Medical Group
Orthopedic Office of Westfield-

2. Knee Anatomy
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Orthopedic Office of Westfield

3. Knee Anatomy
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Orthopedic Office of Westfield

4. Knee Anatomy
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Orthopedic Office of Westfield

5. Anatomy of the Meniscus
Lateral
meniscus
Medial
meniscus
Summit Medical Group
Orthopedic Office of Westfield

6. What does the meniscus do?
• Shock absorber of the knee
• Meniscus absorbs 50% of
load when standing
Forces Redirected by Meniscus
Summit Medical Group
Orthopedic Office of Westfield

7. Meniscus Function
• Enhance articular conformity
femur
tibia
Summit Medical Group
Orthopedic Office of Westfield
meniscus

8. Meniscus Tears
Why do they happen?
Mostly circumferential
fibers, few radial “ties”
Tears like a cheap
shirt!!!
Summit Medical Group
Orthopedic Office of Westfield

9. Meniscal Tears
Most common source of mechanical knee pain
Meniscal fragment is “abnormally
mobile”
Hang nail of the
knee!!

10. Meniscus Tear
=
Cartilage Tear
Summit Medical Group
Orthopedic Office of Westfield

11. Clinical History of Meniscal Tears
Younger patients usually are injured
with a significant TRAUMA
Summit Medical Group
Orthopedic Office of Westfield

12. Clinical History of Meniscal
Tears
Older Patients- do not
need significant trauma
Kneeling, squatting
or simple twist
Many do not recall any
traumatic event
Summit Medical Group
Orthopedic Office of Westfield

13. Symptoms
Clicking
Knee Swelling
Locking
Giving Way
Increased pain with twisting,
squatting or change of direction
Summit Medical Group
Orthopedic Office of Westfield

14. Examination
 Joint line tenderness
 Positive Apley’s or McMurray’s sign
Summit Medical Group
Orthopedic Office of Westfield

15. Radiographic Evaluation
• Xrays- Standing AP, 45 degree PA, lateral and
Merchant view
Summit Medical Group
Orthopedic Office of Westfield

16. MRI
MRI is 93%
accurate in
diagnosis of
medial meniscus
tears
Accuracy in
diagnosis of
lateral
meniscus tears
is 90%
Summit Medical Group
Orthopedic Office of Westfield

17. Treatment Options
• Resect or Repair
Summit Medical Group
Orthopedic Office of Westfield

18. Meniscal Repair
Red-red tear
Indications




Tears in the vascular zone
Intact body of the meniscus
> than 1cm in size or unstable
Stable knee or in conjunction with an anterior
cruciate reconstruction
Summit Medical Group
Orthopedic Office of Westfield

19. Meniscal Repair Techniques
Sutures
arrows
Summit Medical Group
Orthopedic Office of Westfield

20. Results of Meniscal Repair
• 70% success in isolated tears
• 90 % success in tears repaired in
conjunction with ACL
reconstructions
Summit Medical Group
Orthopedic Office of Westfield

21. Meniscal Resection
• Indicated in the symptomatic mobile
meniscus tear not amenable to repair
(the majority of tears in adults)
Knee arthroscopy
Summit Medical Group
Orthopedic Office of Westfield

22. Technique of Meniscal Resection
 Remove all of mobile fragment
 Contour the rim
 Preserve the rim (barrel hoops)
 Avoid excessive resection
Summit Medical Group
Orthopedic Office of Westfield

23. Results of Partial Menisectomy
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Orthopedic Office of Westfield

24. Causes of Failure in Arthroscopic Partial
Menisectomy
Summit Medical Group
Orthopedic Office of Westfield

25. Arthritis and Meniscal Tears
Results directly related to degree
of arthritis
No arthritis -95% satisfactory results @
3years
Ahlback I(50% jt space narrowing) 65%
satisfactory results @ 3 years
Ahlback II and III- poor results
Summit Medical Group
Orthopedic Office of Westfield

26. Recommendations
Standing xrays of
knee determine
preexisting OA and
need for surgery!
• MRI alone is not
sufficient
•
Summit Medical Group
Orthopedic Office of Westfield

27. The End
Thank You
Summit Medical Group
Orthopedic Office of Westfield