This document discusses meniscus injuries of the knee. It describes the anatomy and functions of the medial and lateral meniscus. Common types of meniscal tears are described based on location and pattern. Physical exam maneuvers for diagnosing meniscal tears include Thessaly test, McMurray's test, and Apley's grinding test. MRI is the most sensitive imaging method. Treatment involves initial rest, ice, and NSAIDs for minor tears. Surgery options include partial meniscectomy, meniscal repair, or meniscal transplantation for more severe tears. The goal of treatment is to relieve symptoms and prevent further joint damage.

1. Meniscus Injury
Presented By Siti Nur Rifhan Kamarudin

2. ANATOMY
• Meniscus is a cushion structure made of
cartilage which fits within the knee joint
between tibia and femur.
• Each Menisci has
- Two ends
- Two borders
- Two surfaces

4. MEDIAL MENISCUS
• C- Shaped structure and
lateral meniscus is more
circular.
• Anterior horn : Attached to
the tibia anterior to the
intercondylar eminence to
the ACL.
• Posterior horn : Anchored
immediately in front of the
attachment of PCL posterior
to the intercondylar
eminence.

5. Medial Meniscus
• Peripheral border
attached to the
medial capsule
through the coronary
ligament to the upper
border of tibia.
• Most of the weight
borne on the
posterior portion of
meniscus

6. LATERAL MENISCUS
• Circular shaped
• The anterior and posterior
horns are closer to each
other & near insertion of ACL
• Anterior Horn : Attached to
the tibia in front of the
intercondylar eminence.
• Posterior Horn : Attached to
the posterior aspect of the
intercondylar eminence in
front of posterior attachment
of medial meniscus.

7. Lateral Meniscus
• The lateral meniscus is mobile and medical
meniscus is more fixed -> causing more tears to
occurs in medical meniscus
• Lateral meniscus is associated with discoid
meniscus and meniscal cysts
• Lateral meniscus is also assoc. with acute injury
to ACL
Medial Meniscus
• Tears of medical meniscus occurs more with
degenerative tears
• Associated with a baker’s cyst.

8. BLOOD SUPPLY
• The blood supply of meniscus
decides the healing potential of the
meniscus
• The outer one-third of meniscus is
vascular. It will heal if repaired
• The inner one-third is not vascular
and is nourished by synovial fluid.
• The middle third is red/white and it
is avascular.
• The blood supply of meniscus
originates from medial and lateral
genicular arteries

9. FUNCTIONS OF MENISCUS
• Shock Absorber: Provides load
sharing across knee by increasing
the contact area and decreasing
the contact stress.
• Act as joint filler : Compensates
for the gross incongruity
between tibial and femoral
articulating surfaces.
• Joint Lubrication: help to
distribute Synovial fluid through
the joint and aiding the nutrition
of articular cartilage.

10. OVERVIEW of MENISCAL INJURY
• Epidemiology:
- Most common indication for knee surgery
• Location:
 Medial Tears
- More common
- Degenerative tears in older patients usually
occur in posterior horn of medial meniscus.
 Lateral Tears
- More common in acute ACL tears

11. CLINICAL FEATURES
• Pt is usually a young person who sustain
twisting injury to the knee
• Knee pain (often severe)
• Swelling of the knee within 48hours
• “Locking” : Sudden inability to extend the knee
fully – suggest a ‘bucket-handle tear’.
• Popping or clicking within the knee.
• Limited motion of knee joint.
• Tenderness when pressing on the meniscus
(Knee joint line)

12. CLASSIFICATION OF MENISCAL TEAR
• Based on Location
 Red Zone: Outer third, vascularized
 Red-White Zone : Middle Third
 White Zone : Inner third, Vascularized

13. Based On Pattern
• Vertical/Longitudinal
- Common, esp. with
ACL tears
• Bucket Handle
- Vertical tear which
may displace into
notch
• Horizontal
- More common in
older population
- May be associated
with meniscal cysts

14. PHYSICAL EXAMINATION
• The joint may be held slightly flexed and there
is often an effusion.
• In late presentations, the quadriceps will be
wasted.
• Tenderness is localized to the joint line,
particularly the medial line.
• Flexion is usually full but extension is often
limited.

15. SPECIAL TESTS
1) Thessaly Test
• Standing at 20 degrees of knee flexion on
affected limb
• Patient twists with knee external and internal
rotation.
• Positive Test: Clicking, pain or discomfort on
joint line.

17. 2) McMurrays Test
• Principle: To trap the meniscus
between the tibia and femur.
• Pt needs to be relaxed.
• One hand on knee joint line.
Other hand holds the foot &
ankle.
• Flex the knee as far as possible
(Hyperflexion)
• Externally rotate(Medial Me.) or
internally rotate (Lateral Me.) the
tibia and then extend the knee.
• Positive McMurray’s : Clicking or
popping felt associated with
pain.

19. 2) Apley’s Grinding test
• Patient is in prone
position
• Knee flexed to 90 degrees
• The leg is rotated from
side to side
• Compression force
applied
• A painful response
signifies a torn or
degenerate meniscus.

21. IMAGING
Radiographs
• Should be normal in young patient with acute
meniscal injury
MRI
• Most sensitive diagnostic test
• Findings
- MRI Grade III signal is indicative of a tear
- Parameniscal cyst indicates presence of meniscal
tear
- May see ‘Double PCL” sign that indicates bucket-
handle meniscal tear.

23. MANAGEMENT
NON-OPERATIVE TREATMENT
Indication: First line of treatment for degenerative
tears
: Acute episode without locking but with
acute synovitis
• Immediate abstinence from weight bearing
• Rest
• Ice pack application
• Compression dressing
• NSAIDS
• Rehabilitation exercises

24. SURGICAL MANAGEMENT
1)Meniscectomy
2)Meniscal Repair
3)Meniscal Transplantation

25. OPERATIVE TREATMENT
1) Partial Meniscectomy
• Indication: Tears not amenable to repair (complex,
degenerative, radial tear patterns)
: Repair failure > 2 times
• Objective: Remove the torn meniscal fragment and
contour the peripheral rim, leaving a balanced, stable rim
of meniscal tissue.
• Outcomes
- >80% satisfactory function
• Partial is preferred over total meniscectomy
- Shorter operating time, Faster recovery, better
post-op function.

26. Anthroscopic Meniscal Repair
3 important steps:
- Appropriate patient selection : should have
documented tear that is able to heal
- Tear debridement and local synovial, meniscal
and capsular ablation to stimulate a
proliferative fibroblastic response
- Suture placement to reduce and stabilize the
meniscus

27. Meniscal Repair
Risks:
– Saphenous Nerve and Vein damage
– Peroneal Nerve
– Popliteal Vessels

28. 3) Meniscal Transplantation
• Attempts at meniscal replacement with
- Allograft meniscus
- Autograft fascial material
- Synthetic meniscus

29. REFERENCES
• Apley and Solomon’s Concise System of
Orthopedic and Trauma, 4th Edition