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John C. Pearce, M.D.
Financial Disclosure
Dr. John Pearce has no relevant financial relationships with commercial interestesto disclose.
Team Physician, UT Women’s Athletic Department
Team Physician, Men’s and Women’s Athletic Department St. Edward’s University
This presentation is the intellectual property of the author. Contact them at [email protected] for permission to reprint and/or distribute.
Meniscal Injuries:
Diagnosis and Treatment
Meniscal Tears
Anatomy
– Medial Meniscus
– Lateral Meniscus
Meniscal Tears
Anatomy– Biphasic
Solid phaseFluid phase
– Protects the articular cartilage
Decreases loadIncreases contact area
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Meniscal Tears
Role
– Protects the articular cartilage
– Joint stability
– Proprioception
Meniscal Tears
Meniscal Tears
Diagnosis
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Meniscal Tears
Mechanism of Injury
– Acute trauma
Meniscal Tears
Mechanism of Injury
– Cumulative trauma
Meniscal Tears
Clinical Symptoms
– Pain
– locking/catching
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Meniscal Tears
Meniscal Tears
Clinical Signs
– Effusion
– Joint line tenderness
– Meniscal “tests”
Meniscal Tears
Joint Line Tenderness - Medial
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Meniscal Tears
Joint Line Tenderness - Lateral
Meniscal Tears
Diagnostic Studies
– Radiographs
– MRI
Confirm diagnosisAssociated Pathology
– Ligament tear– Arthritis
Meniscal Tears - Diagnosis
Accuracy of an experienced examiner in diagnosis of meniscal tears approachs that of an MRI.
Always correlate clinical symptoms and signs with MRI to make correct diagnosis.
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Meniscal Tears
Treatment
Meniscal Tears
Classification– Location– Type– Orientation
Associated Pathology– Ligament tears– Arthritis
Age/Activity Level
Meniscal Tears
Treatment Options
– Nonsurigcal
– Surgical
RepairExcisionReplacement (allograft)
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Meniscal Tears
Nonoperative
– “Older” , less active
– YES degenerative arthritis
– NO mechanical symptoms
Meniscal Tears
Nonoperative
– Initial
RICE
NSAID
Activity modification
Meniscal Tears
Nonoperative
– Subsequent
Knee injection
Physical therapy
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Meniscal Tears
Operative
– “young”, active
– YES mechanical symptoms
Meniscal Tears
Operative
– “old”, less active
– Fail to respond to nonoperative treatment
Meniscal Tears
Operative
Goal: preserve functional meniscal tissue
Options : repair, excision or replace (allograft)
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Meniscal Tears
Operative Repair
Meniscal Tears
Treatment – Operative Repair
Healing capacity dependent on tear …
– Location
– Type
– Patient age
– ACL tear?
Meniscal Tears
Treatment – Operative Repair
Technique
– Tear recognition– Assessment of vascularity– Preparation of tissue– Suture/implant placement– Healing factors?
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Meniscal Tears
Rehabilitation – Operative Repair
– First 4 to 6 weeks
Brace
ROM to 90 degrees
protected weight bearing
Meniscal Tears
Rehabilitation – Operative Repair
– Next 6 weeks
Discontinue Brace
No ROM limit
Full weight bearing
Meniscal Tears
Rehabilitation – Operative Repair
– Return to Run @ 4 months
– Return to “Sports” @ 6 months
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Meniscal Tears
Treatment – Operative Results
– Most studies report a healing rate of 70 to 90% after meniscus repair of appropriate tears.
Meniscal Tears
Treatment – Operative Excision
Meniscal Tears
Treatment – Operative Excision
– Indentify tear
– Resect to stable base
– Sculpt remaining tissue
– Avoid over resection
This presentation is the intellectual property of the author. Contact them at [email protected] for permission to reprint and/or distribute.
Meniscal Tears
Meniscal Tears
Meniscal Tears
This presentation is the intellectual property of the author. Contact them at [email protected] for permission to reprint and/or distribute.
Meniscal Tears
Meniscal Tears
Rehabilitation – Operative Excision
– Initial
No brace
Immediate ROM
Full weight bearing
Meniscal Tears
Rehabilitation – Operative Excision
– Return to run @ 4 weeks
– Return to “Sports” @ 6 weeks
This presentation is the intellectual property of the author. Contact them at [email protected] for permission to reprint and/or distribute.
Meniscal Tears
Treatment – Operative Results
– Most studies report good long-term clinical and functional results following arthroscopic partial menisectomy.
– Increase Radiographic signs of arthritis
Meniscal Tears
Meniscal Allograft
– Indications
– Outcome
Meniscal Tears - Conclusion
The meniscus protects the Articular Cartilage.
Diagnosis is based primarily on History and Physical Exam.
Individualize both treatment and rehabilitation and preserve meniscal tissue
This presentation is the intellectual property of the author. Contact them at [email protected] for permission to reprint and/or distribute.
Thank You!
