torn meniscus a sports injury

8/8/2019 Torn meniscus a sports injury

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MENISCUS TEAR

Presented by

Pradeep Gowriraju


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WHAT IS THE MENISCUS ?

It usually refers to either of two specific

parts of cartilage of the knee:

The Lateral andMedial Meniscus.

Both are Cartilaginous tissues that

provide structural integrity to the knee

when it undergoes tension and torsion .


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ITS FUNCTION ?

The menisci act to disperse

the weight of the body and

reduce friction during

movement.

These two menisci act like

shock absorbers in the knee.

Forming a gasket between the

shinbone and the thighbone


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ITS IMPORTANCE ?

Walking puts up to two times

your body weight on the joint.

Running puts about eight

times your body weight on

the knee.

As the knee bends, the back

part of the menisci takes

most of the pressure


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CAN WE MANAGE WITHOUT MENISCUS ?

Yes we can BUT ?

with..


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The menisci add stability to the knee joint. They

convert the surface of the shinbone into a shallow

socket, which is more stable than its otherwise flatsurface.

Without the menisci, the round femur would slide on

top of the flat surface of the tibia.


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HOW DO MENISCAL PROBLEMS DEVELOP?

Meniscal injuries can occur at any age, butthe causes are somewhat different for eachage group.

In younger people, the meniscus is a fairlytough and rubbery structure. Tears in themeniscus in patients under 30 years oldusually occur as a result of a fairly forceful

twisting injury.

In the younger age group, meniscal tears aremore likely to be caused by a sport activity.

Young Age


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The tissue that forms the menisciweakens with age, making the menisciprone to degeneration and tearing.

People of older ages often end up with atear as result of a minor injury, such asfrom the up-and-down motion ofsquatting.

Most often, there isn't one specific injuryto the knee that leads to the degenerativetype of meniscal tear.

These tears of the menisci are commonlyseen as a part of the overall condition ofosteoarthritis of the knee in aging adults

. Degenerative tears cause the menisci tofray and become torn in many directions

OLD AGE


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PEOPLE WHO GENERALLY FACE?

Dancers

Sports Persons

Aged


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TYPES OF MENISCUS TEAR


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TYPES OF MENISCUS TEAR


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SYMPTOMS

The most common problem caused by a torn meniscus is pain.The pain may be felt along the edge of the knee joint closest towhere the meniscus is located. Or the pain may be more vagueand involve the whole knee.

The knee may swell, causing it to feel stiff and tight. This isusually because fluid accumulates inside the knee joint. Thisis sometimes called water on the knee. This is not unique tomeniscal tears, since it can also occur when the knee becomesinflamed.

The knee joint can also lock up if the tear is large enough.Lockingrefers to the inability to completely straighten out theknee. This can happen when a fragment of the meniscus tears

free and gets caught in the hinge mechanism of the knee, likea pencil stuck in the hinge of a door.

A torn meniscus can cause long-term problems. The constantrubbing of the torn meniscus on the articular cartilage maycause the joint surface to become worn, leading to kneeosteoarthritis.


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DIAGNOSIS

How do doctors identify this problem?

Diagnosis begins with a history and physical exam.

Your doctor will try to determine where the pain islocated, whether you've had any locking, and if youhave any clicks or pops with knee movement.

X-rays will not show the torn meniscus. X-rays aremainly useful to determine if other injuries arepresent.

If there is uncertainty in the diagnosis following thehistory and physical examination, or if other injuriesin addition to the meniscal tear are suspected, the

MRI scan may be suggested


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MAGNETIC RESONANCE IMAGING (MRI)

Magnetic resonance imaging(MRI) is very good at showingthe meniscus.

The MRI machine uses magnetic waves rather than X-rays

to show the soft tissues of the body.

This machine creates pictures that look like slices of thearea.

Usually, this test is done to look for injuries, such as tearsin the menisci or ligaments of the knee.

If the history and physical examination indicate a tornmeniscus,Arthroscopy may be suggested to confirm thediagnosis and treat the problem at the same time.


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MRI OF ATORN MENISCUS


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TREATMENT

What can be done for this injury?

Nonsurgical Treatment

Surgical Treatment


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NONSURGICAL TREATMENT

Initial treatment for a torn meniscus focuses ondecreasing pain and swelling in the knee. Restand anti-inflammatory medications, such asaspirin, can help decrease these symptoms. You

may need to use crutches until you can walkwithout a limp.

Some patients may receive physical therapytreatments for meniscal problems.

Therapists treat swelling and pain with the useof ice, electrical stimulation, and rest periodswith your leg supported in elevation.

Exercises are used to help you regain normalmovement of joints and muscles


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SURGERY

If the knee keeps locking up and can't bestraightened out, surgery may be recommendedas soon as reasonably possible to remove the tornpart that is getting caught in the knee joint.

But even a less severely torn meniscus may notheal on its own. If symptoms continue afternonsurgical treatment, surgery will probably besuggested to either remove or repair the tornportion of the meniscus.

Surgeons use an arthroscope (mentioned earlier)during surgery for an injured meniscus. Smallincisions are made in the knee to allow theinsertion of the camera into the joint.


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ARTHROSCOPY


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WHAT ISARTHROSCOPY?

Arthroscopy is an operation that involves

inserting a miniature fibre-optic TV camera into

the knee joint, allowing the orthopaedic surgeon

to look at the structures inside the joint directly.

The arthroscopy lets the surgeon see the

condition of the articular cartilage, the ligaments,

and the menisci.


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MENISCAL REPAIR

Using the arthroscope and a probe, the surgeon

locates the tear. The probe is used to push the

torn edges of the meniscus together. A small rasp

or shaver is used to roughen the edges of the

tear. Then a hollow tube called a cannula is

inserted through one of the portal.

The surgeon threads a suture through the

cannula and into the knee joint. The suture issewn into the two edges of the tear. The surgeon

tugs on the thread to bring the torn edges close

together


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PARTIAL MENISCECTOMY

The procedure to carefully remove a damaged

portion of the meniscus is calledpartial

meniscectomy.


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FULL MENISCECTOMY

Removing an entire meniscus, either the medial

or lateral, is called a complete meniscectomy. If

the tear is too large, or if it cuts across the entire

meniscus, there may be no

alternative. Fortunately only a very small

percentage of patients undergo a complete

meniscectomy compared to the number who get a

partial meniscectomy.

Once the meniscus is removed it is likely theknee joint will further degenerate and the patient

may develop osteoarthritis or other conditions

that require subsequent surgery.


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CONSEQUENCES


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GRADES OF OSTEOARTHRITIS


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OSTEOARTHRITIS

Osteoarthritis (OA) is a common problem for

many people after middle age. OA is sometimes

referred to as degenerative, or wear and tear,

arthritis.

OA commonly affects the knee joint. In fact, knee

OA is the most common cause of disability in the

United States.

In the past, people were led to believe that

nothing could be done for their problem. Nowdoctors have many ways to treat knee OA so

patients have less pain, better movement, and

enhanced quality of life


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REHABILITATION

physical therapy

For the first six weeks after a meniscal repair, you shouldavoid bending the knee more than 90 degrees. Then it is

safe to gradually bend the knee fully. However, you shouldavoid squatting for at least three to four months while therepair fully heals.

It is not advisable to run, jump, or twist the knee for atleast four to six months. Patients sometimes resume sportactivities within four to six months after surgery to repair

the meniscus. Range-of-motion exercises start right away after a

transplant. The goal is to get the knee to bend to 90degrees within four weeks after surgery. As time goes on,more challenging exercises are chosen to safely advance theknee's range of motion, strength, and function.


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Ideally, patients will be able to resume their

previous activities. Some patients may be

encouraged to modify their activity choices,

especially if an allograft was used.

The physical therapist's goal is to help you keep

your pain under control and improve your knee's

range of motion and strength. When you are well

under way, regular visits to your therapist's

office will end. The therapist will continue to be aresource, but you will be in charge of doing your

exercises as part of an ongoing home program.


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Q & A


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THANK YOU

torn meniscus a sports injury

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