Because there is no supply, there is little capacity for these tears to heal on their own. Because other knee injuries can cause similar symptoms, your doctor may order imaging tests to help confirm the diagnosis. Printed from Australian Family Physician - https://www.racgp.org.au/afp/2012/april/meniscal-tear The Australian College of General Practitioners www.racgp.org.au, AJGP: Australian Journal of General Practice, https://www.racgp.org.au/afp/2012/april/meniscal-tear, shock absorption and distributing load throughout the joint, providing nutrition for articular cartilage. Absence of the medial meniscus (entire medial meniscal root tear) places large stresses on the ACL, the primary ligament that prevents anterior translation of the knee. Reactive synovitis and edema (arrowheads) are readily apparent deep to the tibial collateral ligament on the coronal view. Meniscus tears can happen during physical activities, but they can also occur from: Sometimes, a torn meniscus can occur due to degenerative changes in the knee, even if there is little to no trauma. Unfortunately, general practitioners cannot currently order Medicare funded MRI, although this may change with The Royal Australian College of General Practitioners recent submission to the Australian Government Department of Health and Ageing. Coronal MRI sequences are generally considered the best images for visualization of medial meniscal root tears (Figure 1). Your meniscus acts like a cushion between your thigh bone (femur) and shin bone (tibia). Lateral meniscus is intact. I could not really walk on it. It absorbs about 50% of the shock of the medial compartment. Meniscus tears simply do not heal on their own, regardless of conservative treatment. 2013. Am J Sports Med 2008;36:12839. In other words, when the majority of the meniscus forms the handle, that requires tear formation near the meniscal periphery, resulting in a vascular site for operative repair. Non-anatomic placement of a PCL reconstruction tibial tunnel is a reported cause of iatrogenic medial meniscal posterior root tears. The described meniscal tears will lead to possible necessary total knee replacement. Figure 1. X-rays provide images of dense structures, such as bone. Medial meniscal root tears are radial tears within 1 cm of the meniscal root insertion or an avulsion of the insertion of the meniscus. A meniscus tear is an injury to one of the bands of rubbery cartilage that act as shock absorbers for the knee. Inferiorly displaced flap tears of the medial meniscus: MR appearance and clinical significance. The procedure can reduce pain, improve mobility and stability, and get you back to life's activities. Tears that are stable, < 1 cm in length, and that do not cause significant . Horizontal cleavage, oblique, and complex meniscal tear patterns have traditionally been poor candidates for meniscal repair. The best known displaced tear that is amenable to repair is the bucket-handle tear. Arthroscopy. In many areas, nonessential orthopaedic procedures that were postponed due to COVID-19 have resumed. Considered a feature of knee osteoarthritis. A horizontal meniscus tear runs along the circumference of the fibers of the meniscus. Longitudinal tears do not disrupt the circumferential architecture of the meniscus, and thus repair of longitudinal tears leads to a meniscus with relatively normal biomechanical function. Clin J Sport Med 2009;19:912. Your doctor might move your knee and leg into different positions, watch you walk, and ask you to squat to help pinpoint the cause of your signs and symptoms. Bull NYU Hosp Jt Dis 2010;68:8490. w/severe pain? 5 Horizontal tears, the most common meniscal tear pattern, lie parallel to the tibial plateau and separate the meniscus into upper and lower parts (4a,4b). Bernstein J. They act as shock absorbers and stabilize the knee. As orthopaedic surgeons increasingly consider meniscal repair, accurate pre-operative assessment with MR becomes more important, allowing proper planning on the part of both the surgeon and the patient. It is therefore quite important in treatment planning for the pre-operative MR to provide information that can be used to determine whether meniscal repair rather than partial meniscectomy is to be performed. The vertical flap tear is a displaced type of radial tear that often occurs in the posterior medial meniscus. With the foot as close to the hip as possible, the clinician holds the knee joint (with fingers along the joint line) with one hand, and the other hand rotates the tibia internally and externally while extending and flexing the knee. https://www.verywellhealth.com/types-of-meniscus-tears-3862073 As the risk of osteoarthritis is increased if meniscal structures are not optimally functional,7 it may also be appropriate to refer all young patients for opinion if symptoms do not rapidly improve. This technique allows for anatomic reduction and fixation of the meniscal root by restoring the joint contact pressure and area similar to the intact state. Krych AJ, McIntosh AL, Voll AE, Stuart MJ, Dahm DL. Rehabilitation time for a meniscus repair is about 3 to 6 months. It has the shape of two C's. The medial meniscus is the C shape on the knee's inner side, and the lateral meniscus is the C shape on the outer side of the knee. Medial Meniscus: oblique tear of the posterior portion with a separated and unstable fragment. If you have unusual pain and discomfort in your knee, let us help you get back to doing the things you love. Symptomatic treatment with rest, ice, NSAIDs and/or an unloader brace may help alleviate symptoms in some cases. Meniscal injury is common, and the medial meniscus is more frequently injured. The ghost sign or absence of an identifiable meniscus anterior to the posterior cruciate ligament is also indicative of a root tear (Figure 2). He/she will probably recommend surgery. 1 Sutton JB. In this case, a portion may break off, leaving frayed edges. No meniscal tears were observed. Missouri: Mosby, 1998. Meniscal injury and repair: clinical status. 17 Old Kings Road N., Suite K Palm Coast, FL 32137, East Coast Surgery Center Meniscus Repair. Thessaly test: The clinician holds the patient's outstretched hands for support, while the patient stands flat-footed with their knee flexed to 20 degrees and rotates their body and knee three times, internally and externally. Arthroscopy 1998;14:8249. 2010. Non-operative treatment of degenerative posterior root tear of the medial meniscus. Clin Sports Med 2010;29:81106. Orthopedics 2009;32:8. If your meniscus tear is not severe, your doctor will likely recommend the following treatment: If you have a meniscus tear, physical therapy can help to strengthen the muscles around the knee as well the muscles in your legs which in turn will stabilize and support the knee. Patients with ACL tears are also thought to be better candidates for meniscal repair because of the presence of serum-derived growth factors within the hemarthrosis that accompanies ACL tears.15. If you've torn your meniscus, it might take 24 hours or more for pain and swelling to begin, especially if the tear is small. However, it may also occur in older athletes through gradual degeneration. Surgery is most likely needed to resolve your problem. An MRI scan assesses the soft tissues in your knee joint, including the menisci, cartilage, tendons, and ligaments. Mui LW, Engelsohn E, Umans H. Comparison of CT and MRI in patients with tibial plateau fracture: can CT findings predict ligament tear or meniscal injury? However, whether they will respond well to surgery depends on the type of tear, the location, and blood flow in the area where the tear occurred. I have been diagnosed with a subtle oblique tear involving the posterior horn of the medial meniscus and extends to the inferior articular surface of the meniscus. The most common symptom of a torn meniscus is localized pain in the knee that worsens when rotating the leg. Imaging tests X-rays. As people age, they are more likely to have degenerative meniscus tears. J Bone Joint Surg Am 2005;87:71524. The anatomic landmark for repair is anterior to the PCL footprint on the tibia. Primary repair of medial meniscal avulsions: 2 case studies. Many meniscus tears will not need immediate surgery. The meniscus root attachment aids meniscal function by securing the meniscus in place and allowing for optimal shock-absorbi New advances in musculoskeletal pain. Radial Tear B. Horizontal Tear C. Vertical Tear D. Longitudinal Tear E. Oblique Tear. swelling . Adjunctive measures to promote vascularity and healing at the repair sites are also recommended. A tear in this "red" zone may heal on its own, or can often be repaired with surgery. Treatment of meniscal tears includes simple observation, meniscectomy, and meniscal repair. Horizontal tear posterior horn medial meniscus, Tear of posterior horn of medial meniscus treatment, Horizontal tear posterior horn and body medial meniscus, Body and posterior horn of the medial meniscus, Homeopathy treatment posterior horn medial meniscus. Meniscus Surgery. In many cases, rehabilitation can be carried out at home, although your doctor may recommend working with a physical therapist. J Bone Joint Surg Am 1988;70:120917. Sometimes conservative treatment doesnt work. Nicholas Colyvas, MDClinical ProfessorDepartment of Orthopaedic Surgeryorthosurg.ucsf.edu . Jul 2000;31(3):419-36. Fat suppressed proton density-weighted (15a) coronal and (15b) sagittal images reveal a tibial sided flap tear of the body of the medial meniscus, with displacement of the undersurface component (arrows) into the inferior gutter. Seldom are they the sign of a problem. Arthroscopic treatment is typically required for adequate symptom relief in patients with displaced meniscal flap tears. Any tears appear as white lines. he is 44 y o tennis player. The ideal candidate for a medial meniscal root repair is an individual younger than 40 years who presents after an acute, traumatic event with a BMI less than 30 and a MRI that shows a medial meniscal root tear without secondary signs of osteoarthrosis or varus malalignment. Identification of a meniscal root tear on MRI may be challenging due to the relatively small size of the root. As such, it is critical to repair medial meniscal root tears during ACL reconstruction to help stabilize the knee, as well as to decrease stresses that the graft experiences. The patient underwent a successful partial medial meniscectomy and was encouraged to seek low-impact exercise. One of the most common knee injuries is a torn meniscus. A magnetic resonance imaging (MRI) scan is often used to diagnose meniscal injuries. With a bucket handle tear, a tear forms in the center of your meniscus. This pattern of tear requires resection to prevent propagation of the tear as the flap gets caught within the joint during flexion. There are numerous treatments for meniscus tears, but treatment generally begins conservatively depending on the location, type, and size of the tear. Have swelling, stiffness or tightness in your knee. A 501(c)(3) non-profit organization. The surgeon then inserts surgical instruments through two or three other small portals to trim or repair the tear. You might feel a pop when you tear the meniscus. The anterior horn of the medial meniscus demonstrates half of the normal anatomic 'bow-tie configuration'. Always follow your healthcare professional's instructions. Oblique tears combine features of radial and longitudinal tears in that they lie perpendicular to the free edge of the meniscus but then curve such that a portion of it lies parallel to the c-shaped fibers of the meniscus. Gillquist J, Hamberg P, Lysholm J. Endoscopic partial and total meniscectomy. A meniscectomy requires less time for healing approximately 3 to 6 weeks. Meniscal pain occurs during torsional, weight bearing knee movements (classically pivoting on the knee while walking) as a sharp stab lasting several seconds, often followed by a dull ache for several hours. Meniscal repairs are more likely to be successful when performed near the time of injury. Sometimes these tears require surgical repair. Requests for permission to reprint articles must be sent to permissions@racgp.org.au. what is the treatment? 2. The parrot beak shape of an oblique tear (arrow) is readily apparent on (7a) a proton density-weighted axial image of the menisci. Most oblique meniscus tears are happen in the posterior third of the medial meniscus. The role of preoperative MRI in knee arthroscopy: a retrospective analysis of 2,000 patients. Because a torn meniscus is made of cartilage, it won't show up on X-rays. If mechanical symptoms are present in this subset of patients, a partial or subtotal meniscectomy may improve symptoms; although, these tears are not usually associated with traditional meniscal-based mechanical symptoms. Weakness, grinding, instability or giving way rarely result from meniscal pathology. J Bone J Surg Am 2006;88:6607. Before your visit, write down questions you want answered. These tears occur within the avascular zone of the meniscus where there is no blood supply. 10 DeHaven KE. 1890 LPGA Blvd., Suite 240 Daytona Beach, FL 32117, Port Orange North & South Because these two tear patterns differ greatly in prognosis and treatment approach, vertical is therefore not the preferred descriptor for such meniscal tears, unless paired with the proper category, such as vertical longitudinal. The joint is fairly flexible only the last 10-15 degrees is painful, but the pain on walking constant and vulnerable to . Solomon L, Warwick D, Nayagam S. Apley's Concise System of Orthopaedics and Fractures. The menisci are "wedge-shaped" pieces of cartilage that rest between the thigh bone ("femur") and lower leg bone ("tibia") in the knee joint. In older patients, referral is appropriate if conservative management fails to improve symptoms. The most common symptoms of a meniscus tear are: After discussing your symptoms and medical history, your doctor will examine your knee. https://www.verywellhealth.com/types-of-meniscus-tears-3862073, https://www.webmd.com/pain-management/knee-pain/meniscus-tear-injury, https://orthop.washington.edu/patient-care/articles/sports/torn-meniscus.html, A sensation that the knee is locked in place. 2023 Cedars-Sinai. Now, 49 I have had intense pain 2 days after a 3 hour steep mountain walk- the first in 6 months. Psterior horn of medial meniscus Poterior oblique ligament . Chronic tears may be scarred to the capsule and require release of the meniscocapsular junction to allow anatomic repair. Not all meniscal tear types, however, are amenable to repair, and thus an accurate description of meniscal tears on MR can have a dramatic impact on preoperative planning. This part of the tibia is also known as the tibial plateau. Coronal proton weighted MRI of horizontal tear of lateral meniscus (white arrow) with complicating ganglion (black arrow) at the lateral margin of the meniscus, Australian Family Physician was the peer-reviewed, scholarly journal of The Royal Australian College of General Practitioners (RACGP) from 1971 to 2017. I read on a medical site that it is difficult to get to the posterior horn of the meniscus and sometimes there is a need to make an incision or the knee becomes dislocated. Currently, routine MR images do not reveal signal intensity differences between the red and white zones of the menisci. Know the reason for your visit and what you want to happen. Damaged avascular meniscus must be removed.27 However, meniscectomy causes long term osteoarthritis,28 so is only performed when the patient suffers joint locking or mensical pain that is refractory to conservative management. The most commonly encountered signs are posterior knee pain with deep flexion and joint line tenderness. The menisci of the knee have several important roles: The medial meniscus is 'C' shaped whereas the lateral is a shorter incomplete circle with closer spaced 'horns'. Types of meniscus tears:(Left) Bucket handle tear. w/severe pain? In sports, a meniscus tear usually happens suddenly. It has been reported that the force experienced by the medial meniscus in the ACL-deficient knee increased by 52% in full extension and by 197% at 60 of flexion under a 134-N load. oblique ligament, and the . Typically, complex tears are not treated with meniscus repair due to their complex nature. I have an oblique tear of the posterior horn of my medial meniscus that extends to the undersurface of the cartilage. 12 Sources By Jonathan Cluett, MD We use cookies to ensure that we give you the best experience on our website. what is the treatment for that? You will start with exercises to improve your range of motion. The meniscus is a thick cartilage structure that sits between the bones of the knee. If a repair is attempted within meniscal tissue that is questionably vascular or non-vascular, healing enhancement techniques such as the use of fibrin clot and the creation of channels that communicate with the vascular zone may be utilized.10. Vertical flap (oblique, flap, parrot's beak) tears are unstable tears and occur in younger patients. Recovery and rehabilitation take a few weeks. Medial and lateral menisci are crescent-shaped fibrocartilage structures that provide joint congruity, stabilization and lubrication and act as shock absorbers for joint preservation. Crawford R, Walley G, Bridgman S, Maffulli N. Magnetic resonance imaging versus arthroscopy in the diagnosis of knee pathology, concentrating on meniscal lesions and ACL tears: a systematic review. Biomaterials 2011;32:741131. a feeling that your knee is catching or locking, usually when it's bent - you may notice it clicking. Reciprocally, an increased force is also placed on an ACL graft with a deficient medial meniscus. All rights reserved. Tell your doctor of any recurrent swelling or of your knee repeatedly giving way. Those with a meniscus tear are also more likely to develop osteoarthritis in the injured knee. An experimental study in dogs. Aged, worn tissue is more prone to tears. Ligaments: their nature and morphology. Meniscus tears, indicated by MRI, are classified in three grades. Afterward, you may experience: pain, especially when the area is touched. 6 Vande Berg BC, Poilvache P, Duchateau F. Lesions of the menisci of the knee: value of MR imaging criteria for recognition of unstable lesions. 2nd edn. Disclosures: LaPrade reports he is a consultant for and receives royalties from Arthrex, Ossur and Smith & Nephew. The absent bow tie sign in bucket-handle tears of the menisci in the knee. Fat-suppressed proton density-weighted (4a) sagittal and (4b) coronal images reveal a horizontal tear of the posterior horn of the medial meniscus (arrows), extending to the tibial surface. what is the treatment? Rosemont, Ill. American Academy of Orthopaedic Surgeons. The knee: a comprehensive review. Medial meniscal root tears: Fix it or leave it alone Orthopedics Today | Medial and lateral menisci are crescent-shaped fibrocartilage structures that provide joint congruity, stabilization and. Parrot Beak Tear: MRI 3rd Edition. The medial meniscus is on the innermost side of your knee (the C-shaped curve faces in toward your body, the opposite knee). (Right) Degenerative tear. In circumstances where the flap causes catching in the knee, the flap can simply be removed. Meniscal tears may be categorized into five common configurations, including horizontal, longitudinal, radial, oblique (parrot-beak), and complex. Even better would be to describe a peripheral longitudinal tear extending to the tibial surface within the posterior horn of the medial meniscus! During the exam, your doctor will look for signs of tenderness along the joint line. The amount of pain and first appearance of swelling can give important clues about where and how bad the injury is. Liodakis E, Hankemeier S, Jagodzinski M, Meller R, Krettek C, Brand J. Arthroscopic partial meniscectomy The goal of this surgery is to remove a small piece of the torn meniscus in order to get the knee functioning normally. Clin Orthop Related Res 2010;468:11902. Severe pain and swelling may occur up to 24 hours afterward. In comparison , however, meniscal root tears (MRTs) often go unnoticed and represent a unique injury pattern with unique biomechanical consequences. Patients are often aware of movements that aggravate mensical pain, but should also be educated to avoid twisting on a weight bearing, flexed knee. RICE stands for Rest, Ice, Compression, and Elevation. The typical meniscal pain profile comprises well localised joint-line pain (with medial pain generally being indicative of a medial tear and vice-versa). The absolute indication for specialist referral is the locked knee loss of joint function necessitates surgical intervention. AJSM 2003; 31:216-220. American Board of Orthopaedic Surgery Practice of the Orthopaedic Surgeon: Part-II, certification examination case mix. 1993;9(1):33-51. No bone marrow edema. A torn meniscus often can be identified during a physical exam. The operative equipment needs and post-operative rehabilitation process markedly differ between meniscal repair and partial meniscectomy. Two bones meet to form your knee joint: the femur and the tibia. Your doctor will bend your knee, then straighten and rotate it. This is one of the first muscles to atrophy post knee immobilization Question options: is lis oblique is lis medius In rehabilitating an ACL, . Meniscus tears are either degenerative or acute. Symptoms. Meniscal tears are the most common lesions followed by the meniscal cyst. Depending on the cut thickness, axial MRI images may display the root tear (Figure 3). Performing activities that involve aggressive pivoting and twisting of the knee puts you at a significantly higher risk of tearing your meniscus. Perhaps the best know of these is the bucket-handle tear. https://orthop.washington.edu/patient-care/articles/sports/torn-meniscus.html, Phone (10a) A GRE T2*-weighted sagittal image reveals a complex tear of the posterior horn of the medial meniscus, having horizontal (arrows) and longitudinal (arrowhead) components. (8a) The curvilinear course of oblique tears often results in abnormal vertical signal (arrows) that progresses towards or away from the free edge of the meniscus on consecutive images, as seen in these sequential images of an oblique tear (arrows) of the posterior horn of the medial meniscus. Sounds like it will not get better without arthroscopic surgery. 9 Lecase LK, Helms CA, Kosarek FJ, Garret WE. Making a medial meniscal root tear diagnosis is difficult because the typical history of locking, catching or giving way is less likely to be present. The lateral meniscus is on the outermost side of your knee, so the tear location is outside-front. What to Do If Your Orthopaedic Surgery Is Postponed. Survivorship analysis and clinical outcome of one hundred cases. Repair of locked bucket-handle meniscal tears in knees with chronic anterior cruciate ligament deficiency. This often signals a tear. By using our website, you consent to our use of cookies. Know why a test or procedure is recommended and what the results could mean. The oblique meniscomeniscal ligament is but one of several known structures that can mimic meniscal pathology. Diagnosis can be suspected clinically with joint line tenderness and a positive Mcmurray's test, and can be confirmed with MRI studies. (6a) A radial tear of the body of the lateral meniscus also appears vertical on sagittal MR images (arrow), though in the case of radial tears, the lesion is oriented perpendicular to the c-shaped fibers of the meniscus. The second patient reviewed in this video is an 11-year-old girl who fell while playing tag and hit the front of her left lower leg. A meniscus tear can lead to knee instability, an inability to move the knee normally, and chronic knee pain. Meniscal root tears, less common than meniscal body tears and frequently unrecognized, are a subset of meniscal injuries that often result in significant knee joint disorders. (3a) A fat-suppressed proton density-weighted axial image through the knee joint demonstrates the C-shaped menisci. Lim HC, Bae JH, Wang JH, Seok CW, Kim MK. Your doctor will hold your heel while you lie on your back and, with your leg bent, straighten your leg with his or her other hand on the outside of your knee as he or she rotates your foot inward. If an ACL tear is also present, meniscal repairs are more successful if the ACL is also repaired, likely due to the protection afforded by knee stability. New surgical advances allow surgeons to repair these tears. Similarly, tears that are not associated with locking of the knee will typically become less painful over time. Walking can become difficult. Anti-inflammatory drugs such as aspirin, ibuprofen, and naproxen help reduce pain and swelling. For information:Questions and Answers for Patients Regarding Elective Surgery and COVID-19. Results: Medial meniscus posterior horn longitudinal tears in ACL-deficient knees resulted in a significant increase in anterior-posterior tibial translation at all flexion angles except 90 (P < .05). How is Oblique Fracture Treated? Radial tears, because they are oriented perpendicular to the c-shaped fibers of the meniscus, have a devastating effect upon meniscal function. These imaging pearls improve recognition of meniscal root tears (Figure 2). Steroid injection. The menisci are two rubbery disks that help cushion the knee joint. You may be asked about your physical and athletic goals to help your doctor decide on the best treatment for you. Helms CA, Laorr A, Cannon WD, Jr. With advances in surgical techniques and instrumentation, meniscal root repair is a viable option that can restore the biomechanics and kinematics of the knee (Figure 4). Knee pain: Depending on your duration of symptoms you can at least start off with physical therapy, a knee sleeve, and if there is arthritis present consider a c Read More oblique tear of the posterior horn and body of the medial meniscus involving inferior articular surface and peripheral meniscal margin. Physical therapy should start immediately after surgery and include early passive range of motion from 0 to 90 for the initial 2 weeks and progress to full range of motion thereafter. Note: the cartilage deficit more anteriorly on the medial femoral condyle and altered subchondral cortical bone interface, Figure 5. Acta Orthop Scand 1982;53:9759. Scuderi G, Tria A. Meniscal tears are categorised as traumatic or non-traumatic (degenerative) on the basis . This type of tear has an unusual pattern. HealthTap uses cookies to enhance your site experience and for analytics and advertising purposes. If the knee is still painful, or if it locks, your doctor may recommend surgery. These tendons have poor blood supply and will not heal themselves. Sekiya JK, West RV, Groff YJ, Irrgang JJ, Fu FH, Harner CD. Meniscus tears are extremely common knee injuries. McMurray (Figure 1) and Apley tests (Figure 2) are often positive, although these are specific but not sensitive specificity being 5798% and 8099%, and sensitivity being 1066% and 1658% respectively.2,9 The most useful clinical test for meniscal injury is the Thessaly test, which is demonstrated in Figure 3. Knowing where and how a meniscus was torn helps the doctor determine the best treatment.. MRI scans show (left) a normal meniscus and (right) a torn meniscus. Arthroscopic total meniscectomy Occasionally, a large tear of the outer meniscus can best be treated by arthroscopic total meniscectomy, a procedure in which the entire meniscus is removed. Regular exercise to restore your knee mobility and strength is necessary. For patients requiring meniscectomy, meniscal autograft has been utilised with good outcomes,2931 but is only performed in specialist centres. A flap tear is a descriptive term that refers to a situation where the meniscus tears within its midsubstance, usually in a predominantly horizontal pattern, and then the upper or lower component of the torn meniscus becomes displaced from its site of origin (14a).8 These tears are most common at the medial meniscal body, and when displaced, the flap component may migrate into the superior or inferior meniscal gutter (15a,15b). (14a) A 3D depiction of a flap tear of the posterior body of the medial meniscus illustrates displacement of the upper component of the flap (arrow) from its site of origin. Every care is taken to reproduce articles accurately, but the publisher accepts no responsibility for errors, omissions or inaccuracies contained therein or for the consequences of any action taken by any person as a result of anything contained in this publication. Intrasubstance/incomplete tear (top left) This type of tear is often a sign of degenerative changes in the meniscus tissue. MR imaging: effectiveness and costs at triage of patients with nonacute knee symptoms. The double posterior cruciate ligament (PCL) sign appears on sagittal MRI images of the knee when a bucket-handle meniscal tear (medial meniscus in 80% of cases) flips towards the center of the joint so that it comes to lie anteroinferior to the posterior cruciate ligament (PCL) mimicking a second smaller ligament.. A double posterior cruciate ligament sign from a torn medial meniscus can . In the present case, a full-thickness radial tear of the medial meniscus is visualized (Fig 1).An arthroscopic torpedo shaver (Arthrex, Naples, FL, U.S.A.) is used to debride the meniscus tear edges back to a healthy, stable rim (Fig 2).For improved access to the medial meniscus, an 18-gauge spinal . Meniscal tears often occur in young patients who have suffered a twisting injury to the knee. Your doctor may inject a corticosteroid medication into your knee joint to help eliminate pain and swelling. However, anyone at any age can tear the meniscus.
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