The greater a patients age and longer time from initial acl injury are predictive factors of the severity of chondral lesions, and time from initial acl injury is significantly associated with the number of chondral lesions. Insideout repair of meniscal ramp lesions sciencedirect. Differential diagnosis of lesions at the knee disorder diagnosis treatment anterior knee pain patellar bursitis inspection and palpation aspirationinfiltration or surgery subsynovial haematoma history of local blow aspiration marked limitation of flexion normal extension suprapatellar tendinitis painful resisted extension deep friction or. Resultsoverall agreement with arthroscopy was respectively 78% and 82% on first and second mri readings. Lesions were classified according to trillats descriptive anatomic classification, initially used for traumatic medial meniscus lesion in adults and later extended to lateral meniscus lesions. A fullthickness sagittal plane groove of grade iv chondromalacia caused by a bioabsorbable meniscal repair device is demonstrated. Background the meniscus is known to play an important role in the complex biomechanisms of the knee. Meniscal cysts are a rare disease constantly combined with a horizontal meniscal lesion. As lesions of the posterior root of the meniscus are the most frequently reported in. Any information contained in this pdf file is automatically generated from digital.
Options for surgical treatment include arthroscopic repair using an allinside or insideout. Ramp lesions of the medial meniscus mm are associated with 9 to 17% of acl tears and are seldom recognized on preoperative magnetic resonance imaging mri scans. Because of this, it is less prone to tears than the medial meniscus just because it is more mobile. Classification and surgical repair of ramp lesions of the. Diagnosis and treatment of ligamentous and meniscal. Biomechanical analysis of the effect of medial meniscus. The main role of the meniscus is to act as a cushion and protect the bones from grinding together. Any information contained in this pdf file is automatically generated from. In the current case, absence of such communication confirmed a grade 2 lesion. The extrinsic pathway, which usually takes place in lesions of the vascular area where there is a net of capillaries, which supplied undifferentiated mesenchymal cells with nutrients to induce healing figs 1,2. The concordance of mri and arthroscopy in traumatic. Patients with evidence of acute disruption of the meniscocapsular junction with. This technical note describes the suture hook technique using an accessory. Some authors suggest that this entity results from disruption of the meniscotibial ligaments of the posterior horn of the medial meniscus, whereas others support the idea that it is created by a tear of the peripheral attachment of the posterior horn of the medial.
The adult meniscus is relatively avascular, except for the peripheral 1025% the red zone 3. Disruption of the posterior horn of the medial meniscus could lead to excessive forces within the knee joint and surrounding structures. The lateral meniscus is on the outer side of the knee and is attached to the tibia but not to the corresponding lateral collateral ligament. The mechanisms of meniscal repair follow two patterns 1,2. Meniscocapsular separation key imaging features and common. Each meniscus is thicker where it attaches to the joint lining and thinner as it gets nearer. The lateral meniscus is more mobile than the medial meniscus and bears approximately 70% of the load in the lateral compartment under normal conditions. Data from anterior cruciate ligament acl registries show that 47% to 61% of acl tears are associated with meniscal lesions. Development of the menisci of the human knee joint. However, despite advances in imaging, mr imaging continues to have inherent limitations, particularly for detection of small posterior horn tears and tears that. After cartilage, meniscus, and ligament assessment, an arthroscopic hook probe is passed above, below, and on the free edge of the meniscus to confirm communication with the meniscal lesion. Meniscal and articular cartilage lesions revision 2018 clinical practice guidelines linked to the international classification of functioning, disability and health from the orthopaedic section of the american physical therapy association. Rehabilitation guidelines for meniscal repair there are two types of cartilage in the knee, articular cartilage and meniscus cartilage.
The first stage involves fashioning standard high anterolateral and anteromedial arthroscopic portals. Technology commercialization office at meniscal rootradial tears present in a variety of forms, ranging from partial to complete avulsion. Current concepts on posterior meniscal root lesion. Lateral meniscus lesions result in loss of meniscus hoop stresses and can lead to lateral compartment overload and early degenerative changes. The primary function of the articular cartilage is to provide. This is because the articular surface of the round humeral head is approximately four times greater than that of the relatively flat shoulder blade face glenoid fossa1 figure 1. Any information contained in this pdf file is automatically generated from digital material submitted to. Our knowledge and understanding of the anatomy and function of the meniscus.
When the knee is symptomatic, arthroscopic partial meniscectomy has been practised for a long time with many case series reporting improved patient outcomes. Patients andmethods a prospective study was undertaken at the university hospital kuala lumpur, from january 1983 to june 1984. Rehabilitation guidelines for slap lesion repair the anatomic configuration of the shoulder joint glenohumeral joint is often compared to a golf ball on a tee. Peripheral disinsertion is a longitudinal lesion extending beyond the meniscal wall. To describe the varied morphology of meniscal tears, its grading system and associated findings, emphasizing the features that influence management. Insideout repair of meniscal ramp lesions arthroscopy. Anatomy and biomechanics there are four meniscal root anchors that firmly attach the medial and lateral menisci to the anterior and posterior tibial intercondylar region. Lateral meniscus repair using posterolateral portal. The state of the literature in the nonoperative management of meniscus and articular cartilage lesions is rapidly evolving and will be explored and presented in. Each meniscus is cshaped in the transverse plane and consists of the following connected parts. A meniscus is a small piece of tissue that acts like a shock absorber.
Pdf kissing cartilage lesions of the knee caused by a. Arthroscopic repair of ramp lesion of medial meniscus vumedi. Such menis cus lesions are frequent in the general population and are often incidental findings on knee mri fig. Pdf meniscal ramp lesion repair using an allinside. Arthroscopic suture repair provides good longterm results. Meniscal lesions are one of the commonest indications for mri of the knee. Meniscal ramp lesions have been reported to be present in 9% to 17% of patients undergoing anterior cruciate ligament reconstruction. Since 2002, several randomised clinical trials demonstrated no additional benefit of. Surgical management of degenerative meniscus lesions. Knee surgery, sports traumatology, arthroscopy, apr 2016 romain seil, roland becker. Articular cartilage is made up of collagen, proteoglycans and water and lines the end of the bones that meet to form a joint. A degenerative meniscus lesion is a slowly developing process typically involving a horizontal cleavage in a middleaged or older person. Mr imagingbased diagnosis and classification of meniscal.
This disparity in motion contributes to the frequency in which each meniscus is injured. Arthroscopic allinside repair of medial meniscus grade 2. There are 2 meniscus located in the knee joint between the femur thigh bone and tibia shin bone. The medial meniscus is injured much more often than the lateral menis cus, with the posterior horn being the most afflicted component. The intrinsic pathway is based on the selfrepair capacity of the meniscal fibrocartilage and the. Arthroscopic appearance of the articular cartilage of the medial compartment of the patients right knee. This video describes an arthroscopic approach to repair a ramp lesion of the medial meniscus. Meniscal ramp lesions are more frequently associated with anterior cruciate ligament acl injuries than previously recognized. A treatment algorithm will also be recommended based on the currently available evidence. A degenerative meniscus lesion is a slowly developing lesion, typically involving a. The state of the literature in the nonoperative management of meniscus and articular cartilage lesions is rapidly evolving and will be explored and presented in the next iteration of this cpg. Beaufils p1, becker r2, kopf s3, matthieu o4, pujol n1. They also often remain undiagnosed when viewing from the standard anterior compartment arthroscopic portals. On the other hand, the medial meniscus has been estimated to carry 50% of the medial load and play a vital role in restraining the anterior drawer of the medial femoral condyle 4,5.
All patients underwent repair of the posterior horn ramp lesion of the medial meniscus, using a suture hook device with pds no. The meniscus of the child is better vascularized than that of the adult. A degenerative meniscus lesion is a slowly developing lesion, typically involving a horizontal cleavage of the meniscus in a middleaged or older person. Meniscal ramp lesions occur concomitantly with 9% to 19% of all acl tears. Ramp lesions, which are commonly associated with acl injuries and are often misdiagnosed, 1 disrupt the meniscotibial ligament and the posteromedial meniscus in the meniscocapsular zone. Pdf medial and lateral knee joint menisci serve to transfer load and absorb. If you do not see its contents the file may be temporarily. Lesions of the meniscus are commonly encountered in the practice of knee surgery. Detection at the time of arthroscopy can be accomplished based upon clinical suspicion and careful evaluation without the use of an accessory posteromedial portal.
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