Meniscus Tears

What are the menisci?
The menisci are pieces of cartilage in the knee athletes who participate in life. These are two C-shaped structures that are located between the femur and tibia on the inside ("medial") and outside (lateral) aspect of the knee. Consisting mainly of water and collagen fibers. Historically, the role of the meniscus is clear, and some regard them as remnants of remnants of embryonic tissue, such as the appendix. For this reason, the complete removal of the meniscus (total meniscectomy) was not uncommon in the creation of a symptom of a meniscus tear.

tranmission • Load – menisci are responsible transmission from 50% to 70% of the loads through the knee joint. In his absence, these charges are passed directly to the articular cartilage at the ends bones.
• Joint stability – the meniscus of the knee secondary stabilizers at various levels, and become the main front to rear stabilizer (Anteroposterior) movement of the knee when the anterior cruciate ligament (ACL) is broken.
• Shock absorption
• joint lube and nutrition

What is the anatomy of the meniscus?
The menisci are "wedge" pieces of cartilage maintained between the thigh bone (femur) and shin bone (tibia) in the knee joint. There are two menisci, one inside inside "the knee and lateral on the "outside" of the knee. The medial meniscus is C-shaped, while the lateral meniscus is semicircular in shape. Both on the basis of the surface of the tibia and anchored to the bone in the front and rear of the tray ("roots of the meniscus).

Each meniscus can be divided into parties on the basis of (i) the location in the knee, or (ii) the supply of blood. In some places, the meniscus can be divided into (i) the dorsal horn, (ii) the body, and (iii) anterior horn. These are useful to describe the location of meniscal tear. The tears in the posterior horn are the most common.

The blood supply comes from the meniscus periphery where it attaches to the lining of the knee joint (capsule). For this reason, the peripheral one third of the meniscus are usually well perfused, while the internal aspects are more limited blood supply and thus limited potential for healing. These sites differ from peripheral to central have been called the "red-red," red-white and white-white "areas. This classification is important in the evaluation of meniscal tears and given its ability to heal after surgical repair.

Unfortunately, young patients Total meniscectomy has been shown to significantly accelerate degenerative knee wear. In addition, several essential functions of the knee meniscus health maintenance have been well established. These include:

What are the meniscus tears in athletes?
A meniscus tear is one of the most common orthopedic injuries and was known familiarly "Torn Cartilage" knee. They have played almost every sport athletes. Even if it is seen more frequently in the dorsal horn may occur anywhere and affect the medial, lateral, or both.

In athletes, a meniscus tear usually a traumatic origin. Forces are the result of abnormally high or that the substance of the meniscus. Although these often are the result of a twisting force or pivoting movements can also occur with a seemingly harmless activity, such as squatting or jog. Professional Baseball sensors defensive lineman, almost all sports and the player's position has been affected by this injury. Some names that are recognized Umeniyora Osi Johan Santana, Sedrick Ellis, and Shawne Merriman – all fought against the tears of the meniscus in his career.

In elderly patients, a torn meniscus can not be traumatic, but rather part of the degenerative changes in the knee. These tears are often accompanied by changes in knee arthritis and are known as "degenerative" tears.

How falling meniscus tear?
Meniscus tears can be classified several ways – by the anatomical location, the proximity of blood, etc. Various models and configurations have been described tear. These include:

• radial tears
• parrot beak tears or flap
• peripheral longitudinal tears
• bucket handle tears
• horizontal division of tears
• Complex tears, degenerative

These tears are classified by their local blood supply in the meniscus, whether they are in the "red-red," red-white "or" white-white "areas.

Functional classifications of such importance, however, ultimately determine whether a meniscus is repaired. Given the vital functions of the meniscus in athletes, should be maintained and repaired as possible. The repairability of a meniscus is dependent on a number of factors. These include:

• Age
• Activity Level
• Laceration Model
• The chronicity of the tear
• Associated injuries (old ligament injury)
• Possibility of Healing

What injuries can accompany a torn meniscus in athletes?
If a meniscus tear can only occur in isolation, often accompanied by other injuries to the knee as well. In the context of a high-energy trauma, fractures of proximal tibia (tibial plateau) may occur. tearing of the menisci have been reported to be as common as 50% of these fractures.

Torn meniscus tears often accompany ACL and / or the collateral ligaments too. The posterior horn of medial meniscus is a secondary stabilizer anteroposterior translation of the joint and makes it particularly vulnerable to injury with loss anterior cruciate ligament (the main stabilizer of the common anteroposterior).

How does a torn meniscus in athletes of this?
A meniscal tear can occur in several ways. Sometimes an explosion "feel the athlete experiences during a traumatic event. In general, significant pain along the common line on the side of the tear (internal or external). Sometimes athletes can keep walking in the knee, while other large tears may too much pain to body weight. Sometimes, the tear model may cause a portion of the meniscus to be trapped between the articular surfaces or in the notch of the knee. In these cases, the knee is often blocked and the athlete can flex or extend the knee. The classic signs of a torn meniscus Search by:

• Pain often along the line of the knee joint
• Swelling (effusion in the joint) often develops due to inflammation and bleeding from the wound O
• Inability to extend or flex the knee without pain
• Locking or catching of the knee
• The weakness of the leg especially the quadriceps. This may be obvious when you try to perform a straight leg raise or up and down stairs.

In addition to analyzing signs and symptoms above, a doctor can assess the athlete's ability to squat without discomfort in the knee. They doctor may also McMurray perform a test when the knee is bent, folded, and became an attempt to trap a torn meniscus in the joint. If you have a meniscus broken, this movement can play click and pain.

What imaging studies help confirm the presence of a tear meniscus?
Plain X-rays (radiographs) the knee can be helpful in evaluating the presence of associated injuries such as fractures of the tibial plateau and avulsion of ligament. They will not, however, confirm or exclude the presence of a torn meniscus.

Magnetic resonance imaging (MRI) of the knee has become the gold standard imaging studies for a torn meniscus. These high-resolution images from multiple perspectives for greater sensitivity of 95% to detect a tear meniscus. They also provide valuable information on model and configuration tear to assist preoperative planning and evaluation of repairability of the tear.

Knee MRI allows not only to define the tear but allows an assessment of other important anatomical structures of the knee. The warranty status and the cruciate ligaments and cartilage surfaces of the joint be carefully evaluated to help design the best treatment plan.

What does a torn meniscus in athletes Treaties?
With this greater appreciation of the role of the meniscus, surgical techniques have focused on the preservation and where possible repair in athletes. Arthroscopy has different strategies for minimally invasive repair and excellent display. However, the model should be repairable tear tissues and are capable of curing a repair to be successful. Moreover, the age of the athlete, expectations and associated injuries must be considered together. For this reason, no definitive set of guidelines can be provided to determine no tears should be treated, which must be repaired or must be partially removed (partial meniscectomy). However, some principles of general interest may be:

• Width of the rim is the most important prognostic factor for healing after meniscus repair. Therefore, peripheral longitudinal tears within 3 mm (red-red "vascular zone) of the union meniscocapsular must be repaired. longitudinal tears in the 3-6 mm wide (red and white area) are less predictable success, but should always be considered for repair in young patients.
• The tears more than 6 mm from the peripheral blood are generally avascular and is not suitable for repair.
• Acute traumatic tears have improved the prognosis for recovery from chronic degenerative diseases.
• Longitudinal tears are more willing to make the flap, the horizontal division or degenerative intricate.
• The management of radial tears is controversial. Large radial tears extending to the periphery are technically easier to repair and should be considered for repair in young patients to restore function to reduce the size and transmission load meniscus.
• The age should not be used as an absolute criterion to determine the feasibility of repair. Although younger patients have a more favorable prognosis, success has been healing in elderly patients.
• Higher rates failure have been identified in unstable knees secondary to excessive shear forces that impede healing. Therefore, the failure anterior cruciate ligament (ACL) be reconstituted at the time of meniscus repair. The anterior cruciate ligament reconstruction at the time of meniscus repair was associated with a higher rate favorable healing of the meniscus.
• partial failures are shallow and stable (<3 mm deep and <1 cm in length) usually heal spontaneously. Unstable partial-thickness tears, however, must be repaired.

What is the surgery of the meniscus in athletes?
If a meniscus tear is symptomatic and limiting the ability of an athlete back in the game, usually is sent to surgery. The vast majority of surgery in the meniscus arthroscopy can be accomplished through small incisions in the skin. The camera is used to visualize and define carefully tear model.

By irreparable tears, the broken fragments are generally eliminated and the remaining meniscus smooth contours. Care must be taken to preserve the fabric stable as possible to preserve important function of the load transfer of the meniscus. To repair the tears, the instruments are introduced to refresh the torn edges, align ("reduce" tear), and suture the tear. Different techniques of suturing the edges of the torn meniscus have been described. They fall into two broad categories to repair the tear particularly in the joint ("all in") from inside the city ("inside out" of the repair), or out of town ("the outside-in "). Each technique has its strengths and limitations. I used, however, the ultimate goal is reduced and the repair of the meniscus safely through the torn edges.

If the blood supply to the tear olocation is dim, increasing substances to promote recovery can be considered. fibrin clot has been used with some effectiveness in this regard. increase in platelet-rich plasma on the site of the tear can be beneficial, and studies in underway to evaluate its effects on the healing of the meniscus.

In What is the recovery of athletes after surgery meniscus, and when I can play again?
Recovery Program knee after surgery depends largely on the specific procedure performed and specific nature of your tears. Their expectations and sport must be considered as well.

In general, a partial meniscectomy irreparable tears to load faster than the meniscus surgery. Because the time interval to allow tissue healing is not necessary. After meniscectomy partial body weight is gradually accepted that exercise tolerance and quickly introduce full range of motion of the knee. Strengthening exercises later was launched. Although the time to return to sports is variable, a target of 3-4 months is usually possible.

Surgical repair meniscus, a period of wide circulation and is not limited in body weight is usually applied after the operation to optimize the environment for healing tissue. A range of motion and strengthening program takes place later. In general, an objective of return to the game six months is typical, but can be much longer depending the severity of the tear and functional goals.

Some useful principles of rehabilitation meniscus repair include:

• The breaking effect of configuration and extent of knee motion in the rehabilitation of guide meniscus healing.
• compression loads peripheral longitudinal tears in the knee in extension usually reduces Tear the edges.
• The compressive loads in longitudinal bending peripheral tears around the rear edges of Gaff tear.
• The meniscus subsequently translated knee flexion, but at least 00-60 degrees. The next example of the translation the medial meniscus.
• Some protocols typical for the repair of the meniscus are:

or devices, longitudinal tears: postoperative hinged knee brace locked in extension for 3-4 weeks. body weight for 4 weeks with the fixed position of extension brace. advance of movement and final body weight 3-6 weeks. Sport-specific training and strengthening at 6-8 weeks. No running for four months.
No Radial tears / tears Complex hinged knee brace locked in extension after surgery for 3-4 weeks. Toe foot touches the body weight for 4 weeks with reinforcement of key extension. Range of motion and body weight are advanced in the media at 4-6 weeks.

For injuries related to sports and more questions, please visit www.sportsmd.com . SportsMD is the most reliable resource Sport and fitness health information for those interested in sport everywhere. We have brought together leading doctors in the sports industry and health experts – Each exchange Useful tips to keep playing without injury.

References:

1. C Rangger, WT Gloetzer Klestil, Kemmler G, Benedetto KP. Osteoarthritis after arthroscopic partial meniscectomy. I J Sports Med 1995, 23:240-244.
2. Hede A, Larsen E, Sandberg H. The long- term partial or total open meniscectomy related to the amount and location of the meniscus removed. Int Orthop 1992, 16:122-125.
3. Diduch DR, Poelstra KA. Evolution meniscus repair all inside. Operating techniques of Sports Medicine 2003; 11:83-90.
4. King DJ, and MJ Matav. All devices in repair meniscus. Operative Techniques in Sports Medicine 2004 12:161-169.
5. Medvecky MJ and FR Noyes. Surgical approaches for posterior and posterolateral knee. J Am Acad Orthop Surg 2005, 13:121-128.
6. DB Cohen, and TL Wickiewicz. The outside-in technique for arthroscopic repair of the meniscus. Operative Techniques in Medicine Sports 2003, 11:91-103.

About the Author

Dr. Asheesh Bedi is an Assistant Professor of Sports Medicine and Shoulder Surgery at the University of Michigan and MedSport Program. He is a team physician for the University of Michigan Athletic Department and specializes in both arthroscopic and open surgery for athletic injuries of the shoulder, elbow, hip, and knee.

Dr. Bedi completed his undergraduate training at Northwestern University where he graduated Summa Cum Laude. He graduated from the University of Michigan Medical School with AOA recognition, and remained in Ann Arbor to pursue residency training in Orthopaedic Surgery at the University of Michigan. After completing his training, Dr. Bedi completed a two-year fellowship in sports medicine and shoulder surgery at the Hospital for Special Surgery and Weill Cornell Medical College in New York. He has also pursued additional dedicated training with Dr. Bryan Kelly in arthroscopic hip surgery for young athletes. While in New York, he was an assistant team physician for the New Jersey Nets professional basketball and New York Mets professional baseball organizations with Dr. Riley Williams, Struan Coleman, and David Altchek. He was also an orthopaedic consultant for the U.S. Open Tennis Tournament in 2007 and 2008 with Dr. David Dines and an assistant team physician for Iona College Athletic Programs.