Meniscus injuries

Mechanism of injury
Rotational force impacts the flexed loaded knee, usually during sports or after a fall. Most meniscus injuries are of a degenerative nature.

Clinical presentation
With a peripheral tear, ie, acute pain in the knee, rapid swelling of the joint, and the knee cannot take a load in extension. Pain in the medial or lateral aspect. A displaced meniscus can lead to a locked knee, meaning the knee cannot be extended but it can be flexed.

Diagnostics 

Physical examination: For a peripheral tear: hemarthrosis, pain over the lateral or medial joint line, pain on flexion, extension, and rotation. With nonperipheral longitudinal tears, acute hemarthrosis does not necessarily occur. A “bucket handle” injury can lead to a locked knee.
X-ray examination: X-rays of the knee in two planes to exclude bone injuries.
Other examinations: When meniscus injury is strongly suspected perform an MRI or arthroscopy which can include a curative intervention. If problems persist, atrophy of the thigh musculature occurs. Arthrography may be useful if MRI is limited by metallic artifact from nearby implants.

Classification

• Injury of the medial or the lateral meniscus 
• Peripheral longitudinal tear
• Horizontal tear
• Bucket handle tear
• Degenerative tear

The accurate traumatic meniscus injury is a peripheral tear, often in combination with tendon or cruciate ligament injuries. Most longitudinal tears of the meniscus are the result of existing degenerative abnormalities.

Treatment
Conservative treatment: For partial tears of the outer margin of the meniscus, often occurring in combination with minimal ligamentous injury, and in degenerative tears causing few symptoms. 

Surgical treatment: An isolated meniscus injury seldom requires acute surgery, unless associated with restrictions in extension. A large peripheral tear, in the vascularized peripheral 1/3, can best be repaired within 14 days. Because this sort of tear is often associated with injuries to the collateral ligament and/or cruciate ligament, insertion of the meniscus to the ligament and/or tendon attachment itself, respectively, should be performed at the same time. Follow-up treatment: After repairing the meniscus use a cast or brace for 6 weeks, restricting the extremes of flexion/extension. Muscle exercises supervised by a physiotherapist.

Duration
After suturing of the meniscus the injury takes 8 weeks to heal; after partial meniscectomy, 3−4 weeks.
Duration of disability is 6−8 weeks after suturing of the meniscus; after partial meniscectomy, 3−4 weeks.

Prognosis
Prognosis of isolated meniscus injury in patients with a normal leg axis is good with regard to the function of the leg. When related to other abnormalities, the prognosis depends more on other structures than on the meniscus itself. After total meniscectomy, the risk of arthrosis is high. Since the introduction of arthroscopy, total meniscectomy is rarely if ever indicated.

Meniscus injuries 2017-05-03T04:29:00-07:00 Rating: 4.5 Diposkan Oleh: Unknown