Module 4 Meniscus

A bucket handle tear is a variant of a ________ tear resulting in disruption of the _______ fibers as the tear travels from the innermost aspect of the meniscus toward the periphery. As a result, bucket handle tears are ____ amenable to repair.

A bucket-handle tear is a variant of a longitudinal tear resulting in disruption of the circumferential fibers as the tear travels from the innermost aspect of the meniscus toward the periphery. As a result, bucket-handle tears are less amenable to repair.

A partial _________ is the most common surgical procedure performed by Orthopedic Surgeons in the United States. An arthroscope is used to visualize the meniscus and the torn area cut away with the remaining tissue smoothed down. The surgeon is careful to remove as _____ of the meniscus as possible due to the _______ of the meniscus to the function and _____ of the knee

A partial meniscectomy is the most common surgical procedure performed by Orthopedic Surgeons in the United States. An arthroscope is used to visualize the meniscus and the torn area cut away with the remaining tissue smoothed down. The surgeon is careful to remove as little of the meniscus as possible due to the importance of the meniscus to the function and health of the knee

the combination of _ _ _ , _ _ _ and ______ meniscus tears is known as the Triad of O'Donaghue

ACL, MCL, medial meniscus

The lateral meniscus is _______ and the medial meniscus is _ ______

Circular, C-shaped

________ management is conducted using impairment based rehabilitation with progressive exercise. The only consideration is to avoid deep knee ______, especially with load as this position places the _____ stress on the meniscus with ______ loads as this may______ the chance of further damage

Conservative management is conducted using impairment based rehabilitation with progressive exercise. The only consideration is to avoid deep knee flexion, especially with load as this position places the most stress on the meniscus with vertical loads as this may increase the chance of further damage

________ management may be tried prior to _______ management or the patient my choose to start with _______ management. Surgical management of a meniscal tear is dependent upon the ______ and the ____. The meniscus is characterized by 3 zones. The red red zone is _____ vascularized and tears in this area have very _____ healing potential. The red white zone has _____ vascular supply and thus _____ healing capability. The white white zone is _______ and tears in this region are ______ to heal. Surgeons may therefore recommend _______ to prevent further extension of the tear

Conservative management may be tried prior to surgical management or the patient my choose to start with conservative management. Surgical management of a meniscal tear is dependent upon the location and the type. The meniscus is characterized by 3 zones. The red-red zone is fully vascularized and tears in this area have very good healing potential. The red- white zone has some vascular supply and thus some healing capability. The white-white zone is avascular and tears in this region are unlikely to heal. Surgeons may therefore recommend surgery to prevent further extension of the tear

Longitudinal meniscal tears occur ______ to the direction of the circumferential fibers and are _____ for repair due to little disruption of the _______ fibers

Longitudinal meniscal tears occur parallel to the direction of the circumferential fibers and are ideal for repair due to little disruption of the circumferential fibers

Mensical tears are classified as _______, ______, and ____ by the direction they run

Longitudinal, horizontal and radial

Special tests for meniscal injuries include the __________'_ test and the _______ test

McMurray's and Thesaly

Meniscal injuries may be ______ and occur _____ ______ due to repeated wear and tear. This type of degenerative tear is usually observed in _____ individuals but can be present after a previous knee injury resulting in _____ ______.

Meniscal injuries may be degenerative and occur over time due to repeated wear and tear. This type of degenerative tear is usually observed in older individuals but can be present after a previous knee injury resulting in ligamentous laxity

Radial meniscal tears disrupt the ________collagen fibers are better treated with _______ than _____

Radial meniscal tears disrupt the circumferential collagen fibers are better treated with debridement than repair

The outer third of the meniscus is ________ making it able to _____ in response to injury. More inward tears are______ likely to heal due to a ______ blood supply

The outer third of the meniscus is vascular making it able to heal in response to injury. More inward tears are less likely to heal due to a decreasing blood supply

Traumatic injury after an identifiable event frequently occurs in ______ individuals. Subjectively, patients may report a ______ movement of the knee resulting in their pain (weight bearing with rotation or extending from a fully flexed position) and at times will report a ______ sensation at the time of injury. Traumatic injury with rotation may also be accompanied by ACL or PCL injury

Traumatic injury after an identifiable event frequently occurs in younger individuals. Subjectively, patients may report a twisting movement of the knee resulting in their pain (weight bearing with rotation or extending from a fully flexed position) and at times will report a tearing sensation at the time of injury. Traumatic injury with rotation may also be accompanied by ACL or PCL injury

T/F The Triad of O'Donaghue is a common occurrence

True, due to the attachments of the MCL and ACL to the medial meniscus.

T/F In medicine today care is taken to preserve as much of the meniscus as possible during surgical procedures

True. The menisci were previously thought to serve no function and were completely removed following injury. In fact, some European soccer players would have their menisci removed prophylactically. The importance of the menisci became obvious in response to these procedures as these individuals developed severe knee osteoarthritis at very young ages.

During a meniscus repair, the meniscus and synovial junction are abraded to stimulate ______ in order to promote ______ and loose fragments removed. Sutures are then applied to repair the tear. The surgeon will know whether the tear is _______ during the surgery and will provide guidelines for _____ _____ and ______ precautions after the surgery based on their judgement of the stability of the tear

During a meniscus repair, the meniscus and synovial junction are abraded to stimulate bleeding in order to promote healing and loose fragments removed. Sutures are then applied to repair the tear. The surgeon will know whether the tear is stabilized during the surgery and will provide guidelines for weight bearing and movement precautions after the surgery based on their judgement of the stability of the tear

Effusion, may be present _________ in the presence of major damage including a bone bruise or other ligament injury or ___ ____ be noticeable until 24 hours following the injury. This is in part related to whether the injury is _______ or ______, but at least ___ level effusion is typically present. The patient may or may not have difficulty with _____ contraction. Patients may report a history of "catching" or "locking" of their knee which can occur as a ____ flap or loose body from the meniscus _______ into the joint and impairs motion. If the meniscus is displaced such as with a _____ ______ tear, there may be limited knee _____ or ______. During the objective examination pain may also be provoked with _____ _______ and/or forced ______. Joint line _____ may be present.

Effusion, may be present immediately in the presence of major damage including a bone bruise or other ligament injury or may not be noticeable until 24 hours following the injury. This is in part related to whether the injury is traumatic or degenerative, but at least low level effusion is typically present. The patient may or may not have difficulty with quadriceps contraction. Patients may report a history of "catching" or "locking" of their knee which can occur as a torn flap or loose body from the meniscus migrates into the joint and impairs motion. If the meniscus is displaced such as with a bucket- handle tear, there may be limited knee extension or flexion. During the objective examination pain may also be provoked with hyper- extension and/or forced flexion. Joint line tenderness may be present.

T/F All patients with a meniscus tear will have symptoms?

False Some patients may not have symptoms with a meniscus tear.

T/F Younger patients are less likely to have repairs

False they are more likely to have repairs due to the need to prevent OA, while large tears or large flaps may require menisectomy.

Similar to the meniscus repair surgery, _______ is performed to formally diagnose the problem and to ensure the person is appropriate for a meniscal _______. Once confirmed, a portion of the meniscus is maintained as a "bed" for the transplant and the bed and adjacent synovium are abraded to stimulate ________ and promote _______. An allograft meniscus (cadaver graft) is used which must be carefully sized and shaped to match the recipient. The graft is fixated through sutures and _____ attachments

Similar to the meniscus repair surgery, arthroscopy is performed to formally diagnose the problem and to ensure the person is appropriate for a meniscal transplant. Once confirmed, a portion of the meniscus is maintained as a "bed" for the transplant and the bed and adjacent synovium are abraded to stimulate bleeding and promote healing. An allograft meniscus (cadaver graft) is used which must be carefully sized and shaped to match the recipient. The graft is fixated through sutures and bone attachments

The McMurray's test can be used to rule __ a meniscal tear. The patient is positioned in _____ and the examiner grasps the _____ with one hand and the ____ with the other using the thumb and middle finger to palpate the _____ and _____ joint line. First, the knee is taken into maximum______ and the tibia _____ and ______ rotated through full range. A positive test is a _____ or _____ thud or click. If this is not positive, the tibia may be ______ rotated, a _____ stress applied, and the knee moved from ____ to extension. If this is not positive, the same is done with a _____ stress applied. If this is not positive, the tibia may be ______ rotated and moved from full ______ into ______ with a _____ stress applied. If this is not positive, the same is done with a ______ stress applied.

The McMurray's test can be used to rule in a meniscal tear. The patient is positioned in supine and the examiner grasps the ankle with one hand and the knee with the other using the thumb and middle finger to palpate the medial and lateral joint line. First, the knee is taken into maximum flexion and the tibia internally and externally rotated through full range. A positive test is a palpable or audible thud or click. If this is not positive, the tibia may be externally rotated, a valgus stress applied, and the knee moved from flexion to extension. If this is not positive, the same is done with a varus stress applied. If this is not positive, the tibia may be internally rotated and moved from full flexion into extension with a valgus stress applied. If this is not positive, the same is done with a varus stress applied.

The Thessaly test is another test to rule __ or ____ a meniscal tear. The patient _____ on the ______ side and may hold the clinician's hand for support. The patient is instructed to rotate his knee and body _______ and ______ 3 times with the knee in _° and __° of flexion. A positive test is indicated by ____ or a sensation of ______ or ______ within the medial or lateral joint line

The Thessaly test is another test to rule in or out a meniscal tear. The patient stands on the involved side and may hold the clinician's hand for support. The patient is instructed to rotate his knee and body internally and externally 3 times with the knee in 5° and 20° of flexion. A positive test is indicated by pain or a sensation of locking or catching within the medial or lateral joint line

The decision for surgical management is based on multiple factors such as ____, _______ goals, amount of ______ involved and ____ or _____ of the tear. If the tear is located in the red zone, meniscus repair is ____ likely. Most tears in the inner ring are treated with ________ as the tear is in the white zone and _____ to heal. Any tear in the red zone is usually treated with a ______.

The decision for surgical management is based on multiple factors such as age, functional goals, amount of tissue involved and shape or location of the tear. If the tear is located in the red zone, meniscus repair is more likely. Most tears in the inner ring are treated with menisectomy as the tear is in the white zone and unlikely to heal. Any tear in the red zone is usually treated with a repair.

The medial meniscus is attached to multiple structures including the _ _ _, the ______ _______, and the ________ tendon making it ______ mobile than the lateral meniscus and thus _____ prone to injury and vulnerable with injury to other structures such as the MCL

The medial meniscus is attached to multiple structures including the MCL, the joint capsule, and the semimembranosus tendon making it less mobile than the lateral meniscus and thus more prone to injury and vulnerable with injury to other structures such as the MCL

The menisci are fibrocartilage structures covering the superior aspect of the tibia and acting to 1) _______ stress across the knee during weight bearing, 2) provide ______ absorption, 3) serve as ______ joint stabilizers, 4) facilitate joint ______, 5) prevent ______, and protect the joint _____

The menisci are fibrocartilage structures covering the superior aspect of the tibia and acting to 1) distribute stress across the knee during weight bearing, 2) provide shock absorption, 3) serve as secondary joint stabilizers, 4) facilitate joint gliding, 5) prevent hyperextension, and protect the joint margins

The menisci serve an important function in _______ the joint. Removal of the menisci results in a decreased ______ area of the tibio femoral joint and large _______ in contact force

The menisci serve an important function in protecting the joint. Removal of the menisci results in a decreased contact area of the tibio- femoral joint and large increases in contact force