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Meniscus tear and knee pain

Meniscus tear, knee pain. Join this channel to support the channel.    / @nabilebraheim   The meniscus is a fibrocartilage structure located between the femur and tibia, essential for knee joint health and function. Composed predominantly of type I collagen, the meniscus has a triangular shape in cross-section and exists as two distinct structures: the lateral meniscus and the medial meniscus. The lateral meniscus, which is circular and more mobile than the medial meniscus, covers approximately 70% of the lateral tibial plateau. In contrast, the medial meniscus is C-shaped, covers about 50% of the medial tibial plateau, and is more prone to tearing. The primary functions of the meniscus include shock absorption, load distribution, and providing joint stability, all of which help protect the knee from excessive wear and tear. Meniscal tears can arise from sudden twisting, jumping, or directional changes during sports activities like skiing or football. Degenerative tears, especially of the medial meniscus, are common in older individuals and are often linked to arthritis. Common symptoms of a meniscal tear include pain on either the medial or lateral side of the knee, as well as mechanical issues such as locking, clicking, and swelling. Diagnosis often involves a clinical examination where joint line tenderness serves as a highly sensitive indicator of meniscal tears. Knee joint effusion, or swelling, may appear hours after the injury, which can make immediate detection challenging. ACL tears generally cause more rapid swelling and bleeding. To assist in diagnosis, McMurray’s Test is often employed. This test involves moving the knee from flexion to extension with either internal or external rotation; a painful pop or click suggests a meniscal tear. Testing the medial meniscus involves flexing the knee, placing a hand on the medial aspect, and then extending the knee. If a pop or click occurs during extension, along with pain, this indicates a positive test for a medial meniscal tear. Similarly, internal knee rotation is used to diagnose a lateral meniscal tear. In some cases, such as a bucket-handle tear, the knee may lock and lose full extension capability. The accuracy of clinically diagnosing meniscal tears is about 70%, with MRI often used to confirm the diagnosis and identify other potential issues in the knee. Differential diagnoses include intra-articular problems like synovial plica irritation, osteochondritis dissecans, patellofemoral pain, and loose bodies, as well as extra-articular issues, including collateral ligament injury, pes anserine bursitis, lumbar disc herniation, stress fractures, iliotibial band syndrome, and slipped capital femoral epiphysis (SCFE). The meniscus receives its blood supply from the genicular vessels and capsular attachment, with the outer one-third being the most vascularized area, which allows for better healing potential in this region. The specific location of the tear significantly influences treatment choices. Treatment options for meniscal tears include nonoperative and surgical approaches. Nonoperative treatment is typically recommended for small, nondisplaced, or degenerative tears and may involve physiotherapy, NSAIDs, and possibly cortisone injections if symptoms persist. Surgery is considered when conservative treatment fails. Surgical options include partial meniscectomy, where complex, degenerative, or irreparable radial tears are excised, and meniscal repair, typically reserved for peripheral tears with adequate blood supply. Meniscal transplant is an option primarily for younger patients who have had a total meniscectomy, often for the lateral meniscus, as the graft takes approximately one year to heal. In cases where a total meniscectomy is performed, future knee arthritis is likely. Special situations affecting meniscal injury patterns include a higher frequency of medial meniscal tears compared to lateral ones, especially in older adults who often experience posterior horn involvement. Acute ACL tears frequently coincide with lateral meniscal tears, while chronic ACL injuries are more associated with medial meniscal tears. In children, tibial eminence fractures may trap the medial meniscus, while tibial plateau fractures can lead to meniscal injuries based on the side of the fracture. Displacement or depression of more than 5 mm further increases the likelihood of meniscal damage. A unique condition, known as a discoid meniscus, occurs when the meniscus is larger than normal, most commonly affecting the lateral meniscus. Symptomatic discoid menisci are generally treated with saucerization, sometimes with additional repair if necessary.