Meniscus Tears

7/5/2020 Meniscus Tears
Lágrimas de menisco
Resumen y recomendaciones
Antecedentes
● Desgarro parcial o completo de 1 o ambos meniscos (estructuras brocartilaginosas semicirculares,

ubicadas entre los cóndilos femorales y la meseta tibial) que generalmente es causada por una lesión
relacionada con el deporte o la degeneración relacionada con la edad.
● La patomecánica más común detrás de las lágrimas meniscales:
⚬ para desgarros meniscales agudos -
– Fuerzas sin contacto que involucran aceleración o desaceleración repentina junto con un cambio
direccional
– aumento de la carga axial y fuerzas de rotación o corte en el menisco mientras se encuentra en
una posición de mayor exión de la rodilla con la cadena cinética cerrada (arrodillado y en cuclillas)
o al levantar / transportar objetos pesados
⚬ para desgarros meniscales degenerativos: fuerzas normales repetitivas en un menisco deterioradas
por el proceso de envejecimiento
● Las lágrimas de menisco tienen diferentes factores de riesgo según el tipo de lágrima.
⚬ Para las lágrimas agudas, los factores de riesgo incluyen deportes que involucran pivotar (o plantar y
cortar), como jugar fútbol, baloncesto o rugby.
⚬ Para las lágrimas degenerativas, los factores de riesgo incluyen edad avanzada (> 60 años), sexo
masculino, arrodillarse y ponerse en cuclillas (> 1 hora / día) y subir escaleras (> 30 vuelos / día).
● Las roturas meniscales a menudo se clasi can de acuerdo con la orientación de la rotura, y se delinean
las roturas del cuerpo y la raíz meniscales.
Evaluación
Lágrimas agudas del cuerpo meniscal
● La presentación clínica de desgarros meniscales agudos típicamente incluye:
⚬ Una historia de lesión traumática aguda que involucra una fuerza sin contacto, con un ajuste
repentino en la velocidad y cambio direccional
⚬ derrame de rodilla (puede empeorar con la actividad)
⚬ dolor de rodilla (especialmente con movimientos extremos, como exión profunda de la rodilla)
⚬ síntomas mecánicos como bloqueo, estallido, atrapamiento o pandeo (pueden producirse
inestabilidad de la rodilla o episodios de bloqueo debido a desgarros que se desplazan / atrapan)
⚬ ternura persistente de la línea articular focal
● Si se sospecha una rotura aguda y la evaluación es realizada por un médico bien entrenado, el
diagnóstico generalmente se puede hacer mediante la historia clínica y el examen físico solo.
⚬ La resonancia magnética (MRI) a menudo se reserva para pacientes con presentaciones complicadas o
desconcertantes, pero se puede ordenar que:
https://www-dynamed-com.bdigital.ces.edu.co:2443/condition/meniscus-tears 1/29
– con rmar una rotura del cuerpo meniscal, especialmente en casos agudos donde la historia y los
hallazgos del examen físico no son concluyentes
– Caracterizar las roturas de menisco (como ubicación, forma, longitud y profundidad)
– evaluar la integridad del ligamento cruzado anterior y otros ligamentos
– evaluar el cartílago y el hueso subcondral, y la presencia de un quiste meniscal
– evaluar el aparato extensor (rótula, tendón rotuliano y cuádriceps)
– evaluar otras patologías imitadoras asociadas (como la inestabilidad de la rótula o la artritis)
Desgarros degenerativos del cuerpo meniscal
● La presentación clínica de las roturas degenerativas del cuerpo meniscal generalmente incluye
⚬ historial de inicio insidioso de síntomas y la incapacidad de recordar un momento preciso de lesión

⚬ dolor de rodilla (especialmente con movimientos extremos, como exión profunda de la rodilla)
⚬ síntomas mecánicos (como bloqueo, estallido, atrapamiento o pandeo)
⚬ ternura persistente de la línea articular focal
⚬ derrame recurrente después de la actividad
● Si se sospecha una rotura degenerativa, a menudo se usa una resonancia magnética para con rmar el
diagnóstico.
Desgarros de raíz meniscales agudos o degenerativos
● La presentación clínica de las roturas de la raíz meniscal es generalmente más sutil que con las roturas
del cuerpo meniscal, pero los hallazgos pueden incluir:
⚬ dolor de rodilla posterior (especialmente con exión profunda de rodilla)
⚬ ternura de la línea articular
● La resonancia magnética generalmente se requiere para con rmar el diagnóstico.
administración
● Decidir entre el tratamiento conservador y la cirugía implica la consideración de los factores del paciente
(como la edad y las comorbilidades) y las características de desgarro (como la ubicación y la
reducibilidad).
● El tratamiento conservador es generalmente el enfoque inicial en la mayoría de los pacientes, si no hay

desgarros de ligamentos asociados.
● Las indicaciones para el manejo conservador inicial pueden incluir:
⚬ lágrimas meniscales degenerativas

⚬ nonsymptomatic, nondisplaced meniscal tears or minimally symptomatic tears that do not interfere
with lifestyle or activity
⚬ meniscal root tears in poor surgical candidates (such as patients with multiple comorbidities)
● Indications for surgical management may include:
⚬ failure of conservative management up to 6 weeks

⚬ symptomatic (such as pain, locking, catching, and/or buckling) and/or displaced meniscal body tears,
in knees free from severe degenerative knee osteoarthritis
⚬ symptomatic meniscal root tears, with goal of preventing/slowing progression of osteoarthritis
⚬ previous meniscectomy (absent or nonviable meniscus) with pain localized to a ected compartment
● See Management of meniscus tears for additional information.
Related Summaries
● Management of meniscus tears
● Decision rules for x-ray use in knee injuries
● Anterior cruciate ligament (ACL) injury
● Osteoarthritis (OA) of the knee
General Information
Description
● partial or complete tear of 1 or both menisci (semicircular brocartilaginous structures, located between
femoral condyles and tibial plateau) usually due to traumatic sports-related injury or degeneration 3 , 5 , 7
Normal anatomy and function
● normal anatomy and function of medial and lateral menisci
⚬ anatomy of menisci 1 , 3 , 4 , 5
– located between femoral condyles and tibial plateau

– wedge-shaped structures (triangular cross-sectional area), with lateral meniscus being more
circular and medial meniscus more crescent shaped
● lateral meniscus covers more of tibial articular surface than medial meniscus
● lateral meniscus also has increased mobility in comparison to medial meniscus, and may rotate
up to 20 degrees
– anatomically divided into 3 main segments
● anterior horn/root
● body
● posterior horn/root
– attached to tibia through insertional ligaments at anterior and posterior meniscal horns
– comprised of water (70%) and organic matter (30%), with collagen making up of three-fourths
organic matter
● collagen ber layers are distinctively arranged to transform compressive loads into hoop
(circumferential) stresses
⚬ radially traveling bers resist shearing or splitting
⚬ parallel or circumferentially traveling bers resist hoop stress during weight bearing
● Reference - J Athl Train 2001 Apr;36(2):160 full-text

⚬ vascularization and innervation of menisci
– vascularization 2 , 5 , 7
● blood supply from medial and lateral genicular arteries supply periphery of menisci (up to
25%-30% of each meniscus)
● vascularization decreases moving toward center of menisci, with innermost area being
avascular
● menisci are broken into zones based on blood supply, with important healing implications when
considering meniscal repair vs. partial meniscectomy
⚬ red-red zone
– vascular region, located in periphery of meniscus

– tears in this zone are expected to heal with repair
⚬ white-white zone
– avascular region, located in central portion of meniscus

– tears in this zone are less likely to heal after repair compared to other zones (due to lack
of blood supply)
⚬ red-white zone
– region of meniscus with attributes from red-red and white-white zone

– tears in this zone may heal after repair, but likelihood is not as great as in red-red zone
– nerve innervation
● innervation of menisci is intrinsic 7
● meniscal horns and outer two-thirds of meniscal body have 5
⚬ free nerve endings

⚬ mechanoreceptors
– Ru ni corpuscles
– Pacinian corpuscles
– Golgi tendon organs
● innervation of menisci is thought to play an important role in proprioception during knee

motion (Clin Orthop Relat Res 1992 Feb;(275):232 )
⚬ function of menisci 1 , 3 , 5 , 6
– distribute load/stress during weight bearing

– lubricate knee joint
– provide shock absorption
– act as secondary joint stabilizers
– facilitate joint gliding
⚬ meniscus root attachments support meniscal function by anchoring menisci to tibia, and enabling
optimal shock absorption during weight-bearing activities 4
Types
● classi cation systems for meniscus tears can be used to
⚬ facilitate communication between clinicians about meniscal tears, including severity and location
⚬ assist with determining appropriate treatment, based on type of tear
⚬ improve reporting of outcomes after treatment, by reporting outcomes according to tear type
⚬ Reference - Am J Sports Med 2015 Feb;43(2):363
● meniscus tears may be classi ed as stable or unstable 2
⚬ meniscal tears are labeled as unstable when the torn meniscus is displaced into the joint space
⚬ unstable tears can become trapped, and cause pain due to traction at the meniscocapsular junction
⚬ unstable tears can also cause symptoms of catching, locking, and swelling
● meniscus tears may be classi ed by orientation 2 , 3
⚬ vertical longitudinal tears
– occur parallel to long axis of meniscus, between circumferential collagen bers

– can be complete or incomplete tear
– incomplete tears may be asymptomatic as knee biomechanics may not be altered
– complete tears (known as “bucket handle” tears) often become unstable, and cause mechanical
symptoms or true locking of knee
– more common in medial meniscus
⚬ vertical radial tears
– occur perpendicular to long axis of meniscus, sectioning circumferential collagen bers

– a ect ability of meniscus to absorb tibiofemoral load
– typically not responsive to surgical repair, and accelerated degenerative changes are likely
– more common in lateral meniscus
⚬ horizontal tears
– occur parallel to tibial plateau, splitting meniscus into upper and lower portions
– can be asymptomatic
– usually mechanically stable, but may result in ap tears
– frequency increases with age
– often associated with meniscal cysts
⚬ oblique tears
– can occur anywhere, but most often between posterior and middle third of meniscus
– lead to meniscal aps, which are mechanically unstable and cause symptoms
– require operative management to prevent worsening as traction on ap will occur during knee
motion
⚬ complex/degenerative tears
– ≥ 2 tear patterns exist

– more common in older persons
– generally associated with osteoarthritic knee changes
● proposed classi cation system of meniscal root tears by morphology
⚬ type 1 - partial stable root tears

⚬ type 2 - complete radial tears within 9 mm of bony root attachment
– type 2A - located 0 to < 3 mm from root attachment

– type 2B - located 3 to < 6 mm from root attachment
– type 2C - located 6-9 mm from root attachment
⚬ type 3 - bucket-handle tears with complete root detachment

⚬ type 4 - complex oblique tears with complete root detachments extending to root attachment
⚬ type 5 - bony avulsion fractures of root attachments
⚬ Reference - Am J Sports Med 2015 Feb;43(2):363
Epidemiology
Who is most affected
● men are most commonly a ected; male to female ratio of meniscal tears reported to range from 2.5:1 to
4:1 3
● persons most commonly a ected according to type of meniscus tear 3
⚬ for acute meniscus tears
– younger persons (< 40 years old) involved in acute traumatic event

– athletes involved in sports that require cutting, decelerating, or jumping
⚬ for degenerative meniscus tears, persons > 40 years old
Incidence/Prevalence
STUDY
● SUMMARY
degenerative meniscus tears may be common and prevalence appears to increase with age
COHORT STUDY: N Engl J Med 2008 Sep 11;359(11):1108 | Full Text

Details
● meniscus root tears
⚬ medial meniscus posterior root tears reported in about 10%-20% of all arthroscopic meniscal repairs
or meniscectomies 4
⚬ lateral meniscus posterior root tears reported in 7%-12% of patients with concomitant anterior
cruciate ligament tears (Knee Surg Sports Traumatol Arthrosc 2015 Jan;23(1):119 )
Risk factors
● pivoting sports (such as basketball, soccer, and football) reported to increase risk of acute traumatic tears
(Phys Sportsmed 2011 Feb;39(1):123 )
STUDY
● SUMMARY
playing soccer and playing rugby each associated with increased risk of acute meniscal tears
SYSTEMATIC REVIEW: J Orthop Sports Phys Ther 2013 Jun;43(6):352

Details
STUDY
● SUMMARY
older age (> 60 years), male gender, work-related kneeling and squatting (> 1 hour/day), and stair
climbing (> 30 flights/day) each associated with increased risk of degenerative meniscal tears

Details
STUDY
● SUMMARY
longer interval (> 12 months) between anterior cruciate ligament injury and reconstructive surgery
associated with increased risk for medial meniscal tear

Details
STUDY
● SUMMARY
overweight and obesity associated with increased likelihood of surgery for meniscal tear
CASE-CONTROL STUDY: Am J Prev Med 2005 May;28(4):364

Details
Associated conditions
● for acute meniscal root tears 4
⚬ posterior lateral root tears reported to be commonly associated with ACL injuries
⚬ medial root tears reported to be commonly associated with multiligamentous knee injury (including
complete tear of medial collateral ligament)
Etiology and Pathogenesis
Causes
● meniscal injuries result from either mechanical or biochemical (degenerative) causes 5
● in acute meniscal tears, the mechanism of injury is most often a noncontact force involving a sudden
adjustment in speed coupled with a directional change 5
Pathogenesis
● pathomechanics
⚬ acute meniscal tears
– acute meniscal tears result from overwhelming forces in icted upon a normal knee and
meniscus 7
– mechanism of injury is most often due to noncontact forces, involving sudden acceleration or
deceleration coupled with a directional change (causing rotational forces on a trapped meniscus) 5
– injury may also occur during
● positions of increased knee exion with closed kinetic chain (kneeling and squatting), and while
lifting/carrying heavy objects due to increased axial loading, and rotational or shearing forces on
meniscus (StatPearls 2019 Mar 21 full-text )
● jumping, related to vertical forces with angular momentum (varus or valgus) upon landing 5
● contact injuries, with varus or valgus forces acting on knee 5
● tibial displacement, due to injury to anterior cruciate ligament (ACL) and/or medial collateral
ligament, leading to undue stress on meniscus 5
⚬ degenerative meniscal tears 5 , 7
– during aging process, menisci become sti er and have reduced compliance
– meniscal tears result from repetitive normal forces on a deteriorated meniscus
⚬ meniscal root tears 4
– meniscal root tears can occur as a result of acute or chronic trauma
● acute tears can occur with multiligamentous knee injuries or trauma related to hyper exion or
squatting
● chronic tears can occur with long-standing ACL instability
– detachment of meniscus root signi cantly a ects meniscus biomechanics and kinematics, and can
hasten degenerative changes within knee joint
History and Physical
History
Chief concern (CC)
● patients with acute or degenerative meniscal body tears may present with 3 , 5 , 7
⚬ knee e usion
⚬ knee pain (especially with extremes of motion, such as deep knee exion)
⚬ mechanical symptoms such as locking, popping, catching, or buckling (knee instability or locking
episodes can occur due to tears that are displaced/entrapped)
⚬ persistent focal joint line tenderness
● patients with meniscal root tear may have subtler signs and symptoms 4
⚬ most common complaints are
– posterior knee pain (especially with deep knee exion)

– joint line tenderness
⚬ mechanical symptoms (such as locking, catching, or buckling) can occur, but are not common
History of present illness (HPI)
● ask about 1 , 3 , 5 , 7
⚬ mechanism of injury
– with acute tears, most often mechanism of injury is a noncontact force involving a sudden
adjustment in speed coupled with a directional change
– with degenerative tears, patients may not be able to remember precise moment of injury, but
rather report an insidious onset of symptoms
⚬ symptoms at or around time of injury, such as
– tearing sensation
– hearing or feeling a "pop" (meniscal tears are reported to be commonly associated with anterior
cruciate ligament [ACL] injury)
– delayed e usion (6-24 hours after injury)
⚬ current symptoms, including
– knee pain
– knee e usion; swelling may reoccur or worsen with activity (Br J Sports Med 2000 Aug;34(4):252 )
– mechanical symptoms (such as knee locking, popping, catching, or buckling)
– impaired balance or walking endurance
● also inquire about history of patella pain or anterior knee pain as patella injury commonly leads to
symptoms mimicking meniscal injury; see Di erential diagnosis for other conditions that may need to be
ruled out depending on clinical presentation
Past medical history (PMH)
● ask about 6
⚬ any prior surgical procedures and timing of any recent procedures

⚬ any prior nonoperative treatment attempts including injections and/or physical therapy
Physical
Extremities
General lower extremity exam
● assess patient's gait and lower extremity alignment (including foot) 6
● carefully examine both knees during evaluation; assess for
⚬ signs of trauma during visual inspection of knees 7
⚬ joint e usion 5
⚬ focal joint line tenderness is common in patients with meniscus tears 3 , 5
⚬ impaired range of motion; may be decreased due to
– displacement of meniscal tissue 7
– joint e usion 5
– advanced knee osteoarthritis
⚬ posterior knee pain with deep exion (such as during a squat) is common with meniscal root injury 4
⚬ normal patellar tracking
– patella instability may mimic symptoms associated with a meniscus tear 1
– perform patellar apprehension test
● patient is supine with knee extended and relaxed

● apply pressure to medial border of patella, causing lateral subluxation of patella
● patient's apprehension of patellar dislocation is positive test; discomfort need not be present
● medial apprehension should also be assessed
● see also Recurrent patellar subluxation
Common special tests (physical exam maneuvers)
● physical exam maneuvers, such as McMurray test, Apley grind test, Thessaly test, and bounce home test,
are commonly used but appear to have limited utility for diagnosing meniscal tears
⚬ combining physical exam maneuvers may improve detection of meniscal tears compared to when
used in isolation (Knee Surg Sports Traumatol Arthrosc 2009 Jul;17(7):806 )
⚬ decision to perform knee arthroscopy should never be based on results of clinical tests alone (Ethiop J
Health Sci 2016 Nov;26(6):567 )
● test descriptions
⚬ McMurray test 1 , 3
– with patient in supine position, grasp ankle of a ected extremity with 1 hand
– place other hand on a ected knee with thumb over lateral joint line and middle nger over medial
joint line
– maximally ex knee, and externally rotate and slowly extend lower extremity to assess medial
meniscus
– follow by returning knee to maximal exion, and internally rotating and slowly extended lower
extremity to assess lateral meniscus
– test considered positive if painful clicking occurs
IMAGE 1 OF 1
McMurray's knee joint test
Physiotherapist performing a McMurray's knee joint

test on a patient. The McMurray test is designed to
assess injuries to the cartilage in the knee. The
physiotherapist places one hand on the knee with her
ngers aligned along the medial joint line. The foot is
grasped with the other hand, and the knee is exed
(seen here). The foot is then slightly twisted outwards,
and the knee pointed outwards as well. The knee is
then gently extended and exed. If there is an injury to
the medial meniscus (the internal pad of cartilage in the
knee), then an audible or painful click will be heard or
felt.
⚬ Apley grind test
– patient is in prone position

– with una ected leg fully extended, ex a ected knee to 90 degrees
– apply a downward axial loading force (through sole of foot), compressing a ected knee; apply
internal and external rotation with compression
– if pain or restriction with compression and internal or external rotation, test is positive
● if pain is experienced over medial aspect of knee, medial meniscus injury is suggested
● if pain is experienced over lateral aspect of knee, lateral meniscus injury is suggested
– Reference - StatPearls 2019 Jan early online full-text

⚬ Thessaly test 1
– patient is in standing position

– instruct patient to stand on a ected extremity (patient can use upper extremity support during test
for balance)
– instruct patient to rotate knee and body internally and externally 3 times with knee in 5 degrees
and/or 20 degrees of exion
– positive test indicated by discomfort over medial or lateral joint line, or feeling of locking or
catching in knee
⚬ bounce home test 3
– patient lies supine

– grasp foot and completely ex knee
– passively allow lower extremity to extend
– knee should extend completely or bounce into extension with sharp endpoint
– positive test when knee cannot be fully extended
STUDY
● SUMMARY
special tests of knee may not be accurate for diagnosing or ruling out meniscal tears in adults
DynaMed Level 2
SYSTEMATIC REVIEW: Evid Based Med 2015 Jun;20(3):88

Details
STUDY
● SUMMARY
Thessaly test alone or in combination with McMurray test has limited utility in diagnosis of
meniscal tears DynaMed Level 1
DIAGNOSTIC COHORT STUDY: J Orthop Sports Phys Ther 2015 Jan;45(1):18

Details
STUDY
● SUMMARY
composite clinical exam of knee may not be useful for diagnosis of meniscal tears in patients with
concurrent anterior cruciate ligament injury DynaMed Level 2
DIAGNOSTIC COHORT STUDY: Musculoskelet Surg 2016 Apr;100(1):31

Details
Diagnosis
Making the diagnosis

Acute meniscal body tears
● clinical presentation of acute tears typically includes 1 , 3 , 5
⚬ history of acute injury/trauma involving a noncontact force, with sudden adjustment in speed and
directional change
⚬ knee pain and e usion (may worsen with activity)
⚬ mechanical symptoms such as locking, popping, catching, or buckling
⚬ limitation of motion or deep exion
● if acute tear is suspected and assessment is performed by a well-trained clinician, diagnosis can generally
be made by history and physical exam alone
⚬ magnetic resonance imaging (MRI) is often reserved for patients with complicated or perplexing
presentations, but may be ordered to
– con rm meniscal body tear, especially in acute cases where history and physical exam ndings are
inconclusive
– characterize meniscus tears (such as location, shape, length, and depth)
– evaluate integrity of anterior cruciate ligament and other ligaments
– evaluate cartilage and subchondral bone, and for presence of a meniscal cyst
– evaluate extensor apparatus (patella, patellar tendon, and quadriceps)
Degenerative meniscal body tears
● clinical presentation of degenerative tears typically includes 1 , 3 , 5 , 7
⚬ history of insidious symptom onset and an inability to remember a precise moment of injury
⚬ knee pain
⚬ mechanical symptoms (such as locking, popping, catching, or buckling)
● if degenerative tear is suspected, MRI is often used to con rm diagnosis
Acute or degenerative meniscal root tears
● clinical presentation of meniscal root tears is generally subtler than with meniscal body tears, but ndings
may include 4
⚬ posterior knee pain (especially with deep knee exion)
⚬ joint line tenderness
● MRI is typically required to con rm diagnosis of meniscal root tears
Differential diagnosis
● clinical presentation should guide decision to seek additional testing, especially if suspicion of serious
knee pathology 1
● di erential diagnosis for knee pain based on anatomical site
⚬ anterior knee pain 1
– patellar instability (subluxation or dislocation)

– Osgood-Schlatter disease (pain/tenderness typically over tibial tuberosity)
– patellar tendinopathy (pain/tenderness typically localized to inferior pole of patella)
– patellofemoral pain syndrome
⚬ posterior knee pain 1
– popliteal cyst
– posterior cruciate ligament injury
– posterolateral corner injury
– distal hamstring injury
– proximal calf strain

– deep vein thrombosis
⚬ medial knee pain 1
– medial collateral ligament sprain

– pes anserine bursitis
– medial plica syndrome
– medial articular cartilage lesion
⚬ lateral knee pain 1
– lateral collateral ligament sprain

– iliotibial band syndrome
– lateral articular cartilage lesion
● potential causes of nonspeci c knee pain 1
⚬ knee osteoarthritis
⚬ knee fracture
⚬ arthro brosis of knee
⚬ lumbar radiculopathy
⚬ peripheral nerve entrapment
⚬ referred pain from hip, including
– hip osteoarthritis
– hip fracture (including stress fracture)
– slipped capital femoral epiphysis
⚬ neurovascular compromise
Testing overview
● magnetic resonance imaging (MRI)
⚬ may be used to
– con rm suspected degenerative tear or meniscal root tear

– con rm meniscal body tear, especially in acute cases where history and physical exam ndings are
inconclusive
– characterize meniscal tear (such as location, shape, length, and depth)
– evaluate integrity of anterior cruciate and other ligaments
– evaluate cartilage and subchondral bone, and for presence of a meniscal cyst
– evaluate extensor apparatus (patella, patellar tendon, and quadriceps)
⚬ MRI associated with 89% sensitivity and 88% speci city for medial meniscus tears and 78% sensitivity
and 95% speci city for lateral meniscus tears DynaMed Level 2
● plain x-ray may be used to rule out bony pathologies and to assess for presence of arthropathic changes;
see also Decision rules for x-ray use in knee injuries
Imaging studies
Magnetic resonance imaging (MRI)
● Canadian Academy of Sport and Exercise Medicine recommends against ordering an MRI for suspected
degenerative meniscal tears or osteoarthritis
⚬ unless associated with presence of osteoarthritis, degenerative meniscal tears are most often
asymptomatic
⚬ MRI is not recommended for degenerative meniscal tears unless patient has either of
– mechanical symptoms (such as locking)

– lack of improvement with conservative treatment (exercise/therapy, weight loss, bracing, topical or
oral analgesia, intra-articular injections)
⚬ Reference - (Choosing Wisely Canada 2017 Jan 26)
● MRI may be used to 3 , 4 , 6
⚬ con rm meniscal body tear, especially in acute cases where history and physical exam ndings are
inconclusive
⚬ con rm suspected degenerative tear or meniscal root tear
⚬ characterize meniscus tears (such as location, shape, length, and depth)
⚬ evaluate integrity of anterior cruciate ligament (ACL) and other ligaments
⚬ evaluate cartilage and subchondral bone, and for presence of a meniscal cyst
⚬ evaluate extensor apparatus (patella, patellar tendon, and quadriceps)
⚬ Reference - Radiol Res Pract 2016;2016:8329296 full-text
● MRI may also be used to assess for knee pathology in patients who are not responsive to conservative
treatment (Am Fam Physician 2011 Apr 15;83(8):883 full-text )
● diagnosing meniscal tear with MRI
⚬ diagnostic criteria include either of
– meniscal distortion in absence of prior surgery

– increased intrasubstance signal intensity unequivocally contacting articular surface
⚬ injury should be reported as meniscal tear if criteria are seen on > 2 consecutive images (two-slice-
touch rule)
– positive predictive value reported to be
● 94% for medial meniscus

● 96% for lateral meniscus
⚬ injury should be reported as possible meniscal tear if criteria are seen on only 1 image
– positive predictive value reported to be
● 43% for medial meniscus

● 18% for lateral meniscus
⚬ Reference - Radiographics 2014 Jul-Aug;34(4):981
● MRI evaluation for meniscal root tears includes 4
⚬ assessment for
– meniscal extrusion > 3 mm at level of medial cruciate ligament

– ghost meniscal sign (absence of identi able meniscus in sagittal plane, or high signal replacing
normal dark meniscal signal) on sagittal MRI
vertical linear defects on coronal MRI
–
– presence of bony edema or insu ciency fractures of the ipsilateral tibiofemoral joint
⚬ di erentiation between true root tear and posterior horn radial tear
⚬ status of cartilage
STUDY
● SUMMARY
MRI associated with 89% sensitivity and 88% specificity for medial meniscus tears, and 78%
sensitivity and 95% specificity for lateral meniscus tears DynaMed Level 2
SYSTEMATIC REVIEW: Knee Surg Sports Traumatol Arthrosc 2016 May;24(5):1525

Details
STUDY
● SUMMARY
in patients with acute concurrent ACL injury, MRI associated with 72% sensitivity and 80%
specificity for medial meniscus tears, and 70% sensitivity and 79% specificity for lateral meniscus
tears DynaMed Level 2
DIAGNOSTIC COHORT STUDY: Musculoskelet Surg 2016 Apr;100(1):31

Details
STUDY
● SUMMARY
1.5-Tesla MRI may be as accurate as 3-Tesla MRI for detection of meniscal tears and anterior
cruciate ligament tears DynaMed Level 2
DIAGNOSTIC COHORT STUDY: J Bone Joint Surg Am 2013 May 15;95(10):916

Details
X-ray
● x-ray of knee may be used to 3
⚬ rule out bony pathologies (such as fracture)

⚬ evaluate patella tracking and alignment
⚬ assess for signs of knee arthritis, with weight-bearing images potentially revealing
– reduction of width of medial joint space

– osteophytes
– subchondral bone cysts
– sclerosis
⚬ Reference - Am Fam Physician 2003 Sep 1;68(5):907 EBSCOhost Full Text
● x-ray views may include
⚬ anteroposterior view
⚬ lateral view
⚬ Merchant's view (to assess patellofemoral joint)
⚬ notch or tunnel view (to assess femoral condyles)
⚬ Reference - Am Fam Physician 2003 Sep 1;68(5):907 EBSCOhost Full Text
● European League Against Rheumatism (EULAR) recommendations on plain radiography for diagnosis of
knee osteoarthritis
⚬ plain radiography is considered ‘gold standard’ for morphological assessment of knee OA (EULAR
Level Ib-IIb)
– weight-bearing radiographs of both knees should be obtained with semi exed posteroanterior,
lateral, and skyline views
– radiographic features associated with knee OA are
● focal joint space narrowing

● osteophytes
● subchondral bone sclerosis
● subchondral cysts
⚬ radiographs are an adjunct, rather than central feature, for purposes of diagnosis; radiographs may
be normal
⚬ Reference - Ann Rheum Dis 2010 Mar;69(3):483
● see also Osteoarthritis (OA) of the knee and Decision rules for x-ray use in knee injuries
Ultrasound
● ultrasound imaging not commonly used for diagnosis of meniscal injuries
⚬ accuracy of ultrasound for detecting meniscal injuries reported to be operator dependent

⚬ ultrasound cannot assess deep knee structures with good accuracy
⚬ Reference - Radiol Res Pract 2016;2016:8329296 full-text
STUDY
● SUMMARY
ultrasound appears to have moderate accuracy for diagnosing meniscal injuries DynaMed Level 2
SYSTEMATIC REVIEW: J Sports Med Phys Fitness 2016 Oct;56(10):1179

Details
STUDY
● SUMMARY
ultrasound reported to be more accurate for detecting chronic lateral meniscus lesions (> 8 weeks
since injury) than acute lesions (< 8 weeks since injury) DynaMed Level 3
DIAGNOSTIC COHORT STUDY: J Orthop Sci 2014 Jan;19(1):71

Details
STUDY
● SUMMARY
ultrasound may be more accurate for detecting acute medial meniscus tears in patients ≤ 30 years
old than in patients > 30 years old DynaMed Level 2
DIAGNOSTIC COHORT STUDY: Eur J Orthop Surg Traumatol 2013 Dec;23(8):927

Details
Management
Management overview
● deciding between conservative management and surgery involves consideration of patient factors (such
as age and comorbidities) and tear characteristics (such as location and reducibility)
● conservative management is generally initial approach in most patients, if no associated ligament tears
⚬ indications for initial conservative management may include
– degenerative meniscal tears

– nonsymptomatic, nondisplaced meniscal tears
– poor surgical candidates (such as patients with multiple comorbidities or advanced age)
⚬ for acute traumatic meniscal body tears
– patient may initially be advised to modify activity, and utilize crutch ambulation
– simple knee sleeve may be used to manage swelling and provide support
– early-posttraumatic treatment strategies may include cryotherapy, isometric and active-assisted
range-of-motion exercises, and gait training
– based on symptomatic improvement and recovery, therapeutic strategies are progressed and may
include balance, proprioception, and advanced sport-speci c activities
⚬ for degenerative meniscal body or root tears
– therapeutic strategies may include activity modi cation, exibility and strengthening exercises,
proprioception and balance activities, and gait training
– pain-relieving strategies may also include bracing in patients with meniscal root tears
– conservative management appears to be as e ective as arthroscopic partial meniscectomy for
improving symptoms and function at 12-24 months in patients with degenerative meniscal tears
(level 2 [mid-level] evidence )
● medications for symptom relief may include
⚬ nonsteroidal anti-in ammatory drugs (oral or topical), particularly in patients with meniscal root tears
or degenerative tears
⚬ intra-articular steroid injections (in patients with more severe symptoms)
● surgical management
⚬ indications for surgical management may include
– failure of conservative management of up to 6 weeks

– symptomatic and/or displaced meniscal body tears, in knees free from severe degenerative knee
osteoarthritis
– symptomatic meniscal root tears, with goal of preventing/slowing progression of osteoarthritis
– absent or nonviable meniscus (previous meniscectomy) with pain localized to a ected
compartment
⚬ surgical options include meniscal repair, meniscectomy (partial or complete), and meniscal allograft
transplantation (MAT)
– menisci are broken into zones based on blood supply, with important healing implications to
consider when deciding between meniscal repair vs. partial meniscectomy in patients with
meniscal body tears
– meniscal repair is preferred over partial meniscectomy when able, in an e ort to preserve normal
meniscal functioning
– if indicated, partial meniscectomy is preferred over complete meniscectomy for greater

preservation of meniscal function and reduced risk of developing osteoarthritis
– MAT is reserved for patients with absent or nonviable meniscus (previous meniscectomy)
⚬ surgical e cacy
– meniscal repair associated with better long-term activity levels and knee function scores compared
to meniscectomy (level 2 [mid-level] evidence )
– arthroscopic repair of medial meniscus posterior root tear associated with superior clinical
outcomes compared to conservative management (level 2 [mid-level] evidence )
– arthroscopic repair of medial meniscus posterior root tear associated with greater improvements
in clinical and radiologic outcomes compared to arthroscopic partial meniscectomy (level 2 [mid-
level] evidence )
– arthroscopic partial meniscectomy may not be more e ective than conservative management for
improving symptoms and function at 12-24 months in patients with degenerative meniscal tears
(level 2 [mid-level] evidence )
– arthroscopic partial meniscectomy does not improve pain or function at 12 months compared to
conservative treatment in patients with nonobstructive degenerative meniscal tears (level 1 [likely
reliable] evidence )
– after MAT, 89% of 1,068 patients reported to be satis ed with outcomes (level 3 [lacking direct]
evidence )
● postoperative rehabilitation
⚬ currently, there is no widely accepted or validated rehabilitation program

⚬ generally, postoperative rehabilitation programs involve a progressive regimen of therapeutic
strategies focused on restoring normal range of motion, strength, endurance, balance, functional
mobility, and preinjury activity level
⚬ controversial factors include immobilization and weight-bearing status during protection phase of
program, and time frame for return to sports activity
⚬ protocols should be individualized; consider type and location of tear, concurrent injuries, surgical
method/procedures, and other patient-speci c factors
● see Management of meniscus tears for details
Complications and Prognosis
Complications
● almost all patients post total meniscectomy reported to develop arthritic changes over time 3
● complications of surgery for meniscus tear may include 1 , 6
⚬ arthro brosis
⚬ infection
⚬ septic arthritis
⚬ deep vein thrombosis
⚬ patella fracture
⚬ neurovascular damage, including neuroma formation
⚬ failure to heal
⚬ hardware irritation or suture irritation

⚬ cyst formation
⚬ retear
⚬ need for reoperation
⚬ Reference - Clin Orthop Relat Res 2012 Jul;470(7):2059 full-text
● with meniscal transplant, allograft rejection may occur (Clin Sports Med 2009 Apr;28(2):203 )
STUDY
● SUMMARY
increasing age and higher modified Charlson comorbidity index score each associated with
increased 90-day risk of serious complications such as myocardial infarction, stroke, or death
following arthroscopic partial meniscectomy
COHORT STUDY: Lancet 2018 Sep 24 early online | Full Text

Details
Prognosis
Prognosis after nonoperative management
STUDY
● SUMMARY
7.7% of meniscus tears left untreated at time of primary ACL reconstruction reported to require
surgical repair or excision about 2 years after primary surgery
COHORT STUDY: Am J Sports Med 2015 Nov;43(11):2688

Details
● evidence regarding meniscal damage and knee osteoarthritis
STUDY
⚬ SUMMARY
meniscal tears that are complex, extruded, or greater than one-third of radial width are each
associated with increased risk of developing radiographic findings of osteoarthritis
CASE-CONTROL STUDY: Am J Sports Med 2013 Jun;41(6):1238

Details
STUDY
⚬ SUMMARY
meniscal damage (tearing, maceration, or destruction) associated with increased risk of
developing radiographic findings of osteoarthritis
CASE-CONTROL STUDY: Arthritis Rheum 2009 Mar;60(3):831

Details
Prognosis after operative management

Meniscal repair
STUDY
● SUMMARY
meniscal repair failure rate reported to be about 23% at ≥ 5 years after meniscal repair
SYSTEMATIC REVIEW: J Bone Joint Surg Am 2012 Dec 19;94(24):2222 | Full Text
Details
STUDY
● SUMMARY
meniscus repair failure rates appear similar between patients < 40 years old and patients ≥ 40 years
old
COHORT STUDY: Am J Sports Med 2015 Sep;43(9):2222

Details
STUDY
● SUMMARY
grade ≥ 3 chondral lesions associated with unfavorable prognosis (fair or poor clinical outcomes)
following surgery for medial meniscus posterior root tear
COHORT STUDY: Arthroscopy 2016 Jul;32(7):1319

Details
Meniscectomy
STUDY
● SUMMARY
arthroscopic partial meniscectomy may be equally effective in adults with degenerative or
traumatic meniscal tears for improving symptoms, function, and quality of life DynaMed Level 2
COHORT STUDY: BMJ 2017 Feb 2;356:j356 | Full Text

Details
STUDY
● SUMMARY
lateral meniscectomy associated with longer time to return to play and greater risk of adverse
events compared to medial meniscectomy in elite professional soccer players

Details
STUDY
● SUMMARY
long duration of symptoms, radiological findings of knee osteoarthritis and resecting > 50% of
meniscus each associated with worse clinical outcomes after arthroscopic partial meniscectomy
SYSTEMATIC REVIEW: Br J Sports Med 2018 Apr;52(8):514

Details
● factors reported to be associated with increased risk of developing arthritis following meniscectomy
include 2
⚬ lateral meniscectomy
⚬ larger resection volume
⚬ radial tear (impairs hoop stress function)

⚬ pre-existing chondral damage
⚬ ACL insu ciency
⚬ varus malalignment (increased medial compartment load)
⚬ valgus malalignment (increased lateral compartment load)
⚬ increased BMI
⚬ > 40 years old
⚬ lower preoperative activity level
STUDY
● SUMMARY
factors at time of partial lateral meniscectomy associated with increased risk of developing
symptomatic osteoarthritis at 20-year follow-up include age > 38 years, obesity, valgus
malalignment, and cartilage and degenerative meniscal lesions
COHORT STUDY: Knee Surg Sports Traumatol Arthrosc 2015 Jan;23(1):225

Details
STUDY
● SUMMARY
arthroscopic partial meniscectomy may increase risk of radiographic signs of osteoarthritis at 8- to
16-year follow-up, but may not increase risk of clinical symptoms
SYSTEMATIC REVIEW: Arthroscopy 2011 Mar;27(3):419

Details
Meniscal transplant
STUDY
● SUMMARY
knee-related military discharge reported in 22% of 227 military personnel after meniscal allograft
transplantation
COHORT STUDY: Am J Sports Med 2016 May;44(5):1237

Details
STUDY
● SUMMARY
survivorship probability estimates of meniscus transplants reported to be 77% at 5 years, 45% at 10
years, and 19% at 15 years

Details
STUDY
● SUMMARY
mean survival time of arthroscopic meniscal allograft transplantation without bone plugs reported
to range from 8 to 9.7 years depending on failure criteria
COHORT STUDY: Knee Surg Sports Traumatol Arthrosc 2016 May;24(5):1432

Details
Prevention and Screening
Prevention
STUDY
● SUMMARY
physical exercise program combined with education about injury risk may prevent soccer-related
knee injuries in teenage girls DynaMed Level 2
RANDOMIZED TRIAL: Arch Intern Med 2010 Jan 11;170(1):43

Details
STUDY
● SUMMARY
exercise programs consisting of landing skills training or progressive resistance training may help
in preventing injuries in pre-elite athletes DynaMed Level 2
SYSTEMATIC REVIEW: J Sci Med Sport 2019 Mar 12 early online

Details
STUDY
● SUMMARY
reduction in training duration or frequency might reduce lower limb soft tissue injuries in runners
DynaMed Level 2
COCHRANE REVIEW: Cochrane Database Syst Rev 2011 Jul 6;(7):CD001256

Details
STUDY
● SUMMARY
selection of running shoes based on plantar shape may not reduce lower limb injury
DynaMed Level 2
RANDOMIZED TRIAL: Am J Sports Med 2010 Sep;38(9):1759

Details
STUDY
● SUMMARY
conflicting evidence for multi-intervention training programs to reduce incidence of lower limb
injuries DynaMed Level 2
SYSTEMATIC REVIEW: Med Sci Sports Exerc 2010 Mar;42(3):413

Details
● neuromuscular warm-up regimens to prevent lower limb injuries
STUDY
⚬ SUMMARY
Fédération Internationale de Football Association (FIFA) 11+ program of warm-up exercises may
reduce injuries in elite male basketball players DynaMed Level 2
RANDOMIZED TRIAL: Am J Sports Med 2012 May;40(5):996
Details
STUDY
⚬ SUMMARY
FIFA 11+ program may reduce injuries in soccer players DynaMed Level 2
SYSTEMATIC REVIEW: Int J Environ Res Public Health 2014 Nov 19;11(11):11986 | Full Text
RANDOMIZED TRIAL: Am J Sports Med 2015 Nov;43(11):2628 | Full Text
RANDOMIZED TRIAL: J Sports Sci Med 2014 May;13(2):321 | Full Text
Details
STUDY
⚬ SUMMARY
inconsistent evidence for neuromuscular warm-up regimens to prevent lower limb injuries
SYSTEMATIC REVIEW: BMC Med 2012 Jul 19;10:75 | Full Text

Details
● con icting evidence for use of foot orthoses to reduce lower limb injuries in military recruits
STUDY
⚬ SUMMARY
use of shoe insoles does not appear to reduce lower limb soft tissue injuries in runners
DynaMed Level 2
COCHRANE REVIEW: Cochrane Database Syst Rev 2011 Jul 6;(7):CD001256

Details
STUDY
⚬ SUMMARY
custom foot orthoses associated with decreased risk of overuse lower limb injury in military
trainees DynaMed Level 2
RANDOMIZED TRIAL: Am J Sports Med 2011 Jan;39(1):30

Details
STUDY
⚬ SUMMARY
orthotic insoles may not reduce lower limb overuse injuries DynaMed Level 2
RANDOMIZED TRIAL: Scand J Med Sci Sports 2011 Dec;21(6):804

Details
Screening
● not applicable
Quality Improvement
Choosing Wisely Canada
● Canadian Academy of Sport and Exercise Medicine recommends against ordering magnetic resonance
imaging for suspected degenerative meniscal tears or osteoarthritis (Choosing Wisely Canada 2017 Jan
26)
Guidelines and Resources
Guidelines
United States guidelines
● American College of Radiology (ACR) Appropriateness Criteria for chronic knee pain can be found at ACR
2018 PDF
● American College of Radiology/Society of Pediatric Radiology/Society of Skeletal Radiology (ACR/SPR/SSR)

practice parameter on performance and interpretation of magnetic resonance imaging (MRI) of knee can
be found at ACR 2015 Oct PDF
● Orthopedic section of American Physical Therapy Association (APTA) guideline on knee pain and mobility
impairments: meniscal and articular cartilage lesions
⚬ original guideline can be found in J Orthop Sports Phys Ther 2010 Jun;40(6):A1 full-text
⚬ revised guideline can be found in J Orthop Sports Phys Ther 2018 Feb;48(2):A1 full-text
● Colorado Division of Workers' Compensation guideline on lower extremity injury medical treatment can
be found at 2016 Jan 19 PDF
● United States expert recommendations on acute and nonacute lower extremity pain in pediatric
population
⚬ part II can be found in J Pediatr Health Care 2012 May-Jun;26(3):216
⚬ part III can be found in J Pediatr Health Care 2012 Sep-Oct;26(5):380
United Kingdom guidelines
● BMJ Rapid Recommendations clinical practice guideline on arthroscopic surgery for degenerative knee
arthritis and meniscal tears can be found in BMJ 2017 May 10;357:j1982 full-text
Canadian guidelines
● Université du Québec à Trois-Rivières (UQTR) practice guideline on diagnostic imaging for

musculoskeletal complaints in adults: lower extremity disorders can be found in J Manipulative Physiol
Ther 2007 Nov-Dec;30(9):684
European guidelines
● Haute Autorité de Santé conseils pour prise en charge thérapeutique des lésions méniscales et des
lésions isolées du ligament croisé antérieur du genou chez l’adulte se trouvent sur le site Haute Autorité
de Santé 2008 Jun [French]
Review articles
● review of evaluating acutely injured patients for internal derangement of knee can be found in Am Fam
Physician 2012 Feb 1;85(3):247 EBSCOhost Full Text full-text , editorial can be found in Am Fam
Physician 2012 Feb 1;85(3):221
● review of evaluation of acute traumatic knee injury can be found in J Fam Pract 2008 Feb;57(2):116
EBSCOhost Full Text
● case report of deceptive magnetic resonance imaging appearance of medial meniscus in 14-year-old boy
can be found in Cases J 2009 Jan 6;2(1):16 full-text
MEDLINE search
● to search MEDLINE for (Meniscus tears) with targeted search (Clinical Queries), click therapy , diagnosis
or prognosis
Patient Information
● handouts from
⚬ American Academy of Orthopaedic Surgeons or in Spanish

⚬ TeensHealth
⚬ Patient UK PDF
● handout on knee injuries from TeensHealth
● handout on arthroscopy and arthroscopic surgery from Patient UK PDF
ICD Codes
ICD-10 codes
● S83.2 tear of meniscus, current
● S83.3 tear of articular cartilage of knee, current
● M23 internal derangement of knee
⚬ M23.2 derangement of meniscus due to old tear or injury

⚬ M23.3 other meniscus derangements
⚬ M23.4 loose body in knee
⚬ M23.9 internal derangement of knee, unspeci ed
⚬ optional subclassi cation to indicate site of involvement for M23
– 0 multiple sites
– 1 anterior cruciate ligament or anterior horn of medial meniscus
– 2 posterior cruciate ligament or posterior horn of medial meniscus
– 3 medial collateral ligament or other and unspeci ed medial meniscus
– 4 lateral collateral ligament or anterior horn of lateral meniscus
– 5 posterior horn of lateral meniscus
– 6 other and unspeci ed lateral meniscus
– 7 capsular ligament
– 9 unspeci ed ligament or unspeci ed meniscus
References
General references used
1. Logerstedt DS, Snyder-Mackler L, Ritter RC, Axe MJ, Orthopedic Section of the American Physical Therapy
Association. Knee pain and mobility impairments: meniscal and articular cartilage lesions. J Orthop Sports
Phys Ther. 2010 Jun;40(6):A1-A35 full-text , correction can be found in J Orthop Sports Phys Ther 2010
Sep;40(9):597
2. Mordecai SC, Al-Hadithy N, Ware HE, Gupte CM. Treatment of meniscal tears: An evidence based
approach. World J Orthop. 2014 Jul 18;5(3):233-41 full-text
3. Ma ulli N, Longo UG, Campi S, Denaro V. Meniscal tears. Open Access J Sports Med. 2010 Apr 26;1:45-54
full-text
4. Bhatia S, LaPrade CM, Ellman MB, LaPrade RF. Meniscal root tears: signi cance, diagnosis, and treatment.
Am J Sports Med. 2014 Dec;42(12):3016-30
5. Cavanaugh JT. Rehabilitation of meniscal injury and surgery. J Knee Surg. 2014 Dec;27(6):459-78
6. Frank RM, Cole BJ. Meniscus transplantation. Curr Rev Musculoskelet Med. 2015 Dec;8(4):443-50 full-
text
7. Howell R, Kumar NS, Patel N, Tom J. Degenerative meniscus: Pathogenesis, diagnosis, and treatment
options. World J Orthop. 2014 Nov 18;5(5):597-602 full-text
Recommendation grading systems used
● European League Against Rheumatism (EULAR) grading system for recommendations
⚬ levels of evidence
– Level Ia - meta-analysis of cohort studies

– Level Ib - meta-analysis of case-control or cross-sectional studies
– Level IIa - cohort studies
– Level IIb - case-control or cross-sectional studies
– Level III - noncomparative descriptive studies
– Level IV - expert opinion
⚬ Reference - EULAR evidence-based recommendations on diagnosis of knee osteoarthritis (Ann Rheum

Dis 2010 Mar;69(3):483 )
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7/5/2020 Meniscus Tears

● Desgarro parcial o completo de 1 o ambos meniscos (estructuras brocartilaginosas semicirculares,

● La patomecánica más común detrás de las lágrimas meniscales:

⚬ para desgarros meniscales agudos -

● La presentación clínica de desgarros meniscales agudos típicamente incluye:

Desgarros degenerativos del cuerpo meniscal

⚬ historial de inicio insidioso de síntomas y la incapacidad de recordar un momento preciso de lesión

Desgarros de raíz meniscales agudos o degenerativos

● La resonancia magnética generalmente se requiere para con rmar el diagnóstico.

● El tratamiento conservador es generalmente el enfoque inicial en la mayoría de los pacientes, si no hay

● Las indicaciones para el manejo conservador inicial pueden incluir:

⚬ lágrimas meniscales degenerativas

● Indications for surgical management may include:

⚬ failure of conservative management up to 6 weeks

● See Management of meniscus tears for additional information.

● Management of meniscus tears

● Decision rules for x-ray use in knee injuries

● Anterior cruciate ligament (ACL) injury

● Osteoarthritis (OA) of the knee

Normal anatomy and function

● normal anatomy and function of medial and lateral menisci

– located between femoral condyles and tibial plateau

● Reference - J Athl Train 2001 Apr;36(2):160 full-text

– vascular region, located in periphery of meniscus

– avascular region, located in central portion of meniscus

– region of meniscus with attributes from red-red and white-white zone

● innervation of menisci is intrinsic 7

● meniscal horns and outer two-thirds of meniscal body have 5

⚬ free nerve endings

● innervation of menisci is thought to play an important role in proprioception during knee

– distribute load/stress during weight bearing

optimal shock absorption during weight-bearing activities 4

● classi cation systems for meniscus tears can be used to

● meniscus tears may be classi ed as stable or unstable 2

● meniscus tears may be classi ed by orientation 2 , 3

⚬ vertical longitudinal tears

– occur parallel to long axis of meniscus, between circumferential collagen bers

⚬ vertical radial tears

– occur perpendicular to long axis of meniscus, sectioning circumferential collagen bers

– ≥ 2 tear patterns exist

● proposed classi cation system of meniscal root tears by morphology

⚬ type 1 - partial stable root tears

– type 2A - located 0 to < 3 mm from root attachment

⚬ type 3 - bucket-handle tears with complete root detachment

⚬ Reference - Am J Sports Med 2015 Feb;43(2):363

Who is most affected

● persons most commonly a ected according to type of meniscus tear 3

⚬ for acute meniscus tears

– younger persons (< 40 years old) involved in acute traumatic event

⚬ for degenerative meniscus tears, persons > 40 years old

COHORT STUDY: N Engl J Med 2008 Sep 11;359(11):1108 | Full Text

● meniscus root tears

SYSTEMATIC REVIEW: J Orthop Sports Phys Ther 2013 Jun;43(6):352

SYSTEMATIC REVIEW: J Orthop Sports Phys Ther 2013 Jun;43(6):352

SYSTEMATIC REVIEW: J Orthop Sports Phys Ther 2013 Jun;43(6):352

CASE-CONTROL STUDY: Am J Prev Med 2005 May;28(4):364

● for acute meniscal root tears 4

Etiology and Pathogenesis

● meniscal injuries result from either mechanical or biochemical (degenerative) causes 5

adjustment in speed coupled with a directional change 5

⚬ acute meniscal tears

● contact injuries, with varus or valgus forces acting on knee 5

ligament, leading to undue stress on meniscus 5

⚬ degenerative meniscal tears 5 , 7