Meniscus Tears 

When people talk about torn cartilage in the knee, they are usually referring to a torn meniscus.
Meniscus tears are among the most common knee injuries.
Any activity that causes you to forcefully twist or rotate your knee, especially when putting your full weight on it, can lead to a torn meniscus.
Playing contact sports also increases your risk of a meniscus tear.
Getting hit or tackled can make you twist your knee, tearing the cartilage.
In older adults, degenerative changes of the knee can contribute to a torn meniscus with little or no trauma.
With a meniscus tear as a result of a sports accident, one must give attention to the high frequency of associated anterior-cruciate ligament tears.
The tear can be vertical, horizontal or radial:
A vertical tear crosses the meniscus from top to bottom and runs parallel to the shape of the meniscus.
If this tear extends it may result in a bucket-handle tear.
The ‘handle’ or ‘bucket-handle’ tears run across nearly the entire length of the meniscus.
The horizontal tear divides the meniscus into an upper and a lower part.
It is also known as a “cleavage” or “fishmouth” tear.
If the tear stretches from the thin inner edge to the thicker outer edge of the meniscus, it’s known as a radial tear.
Radial tears are the most common type of meniscus tear.
Parrot beak meniscal tear is a type of radial meniscal tear with a more oblique course,
occasionally causing catching in the joint.
a combination of tear patterns is classified as a complex tear.
Posterior horn tears are much more common and located in the back of the meniscus.
Anterior horn tears are less common and located in the front of the meniscus.
Central tears are on the inner side of the meniscus.
This part of the meniscus does not have a blood supply and is therefore not responsive to repair.
Peripheral tears are located on the outside of the meniscus.
These are the types of tears that surgeons can sometimes repair.
Symptoms.
Severe pain and swelling may occur up to 24 hours afterward especially when flexing or twisting the knee.
Walking can become difficult.
You might feel a ‘pop’ if you tear your meniscus.
Locking of the knee can occur temporarily when some portion of a torn meniscus interposes between the femur and the tibia preventing motion and full extension of the leg.
Some patients with a torn, interposed meniscus may not have a mechanical impediment to movement
but may be apprehensive about moving the knee or having it manipulated.
diagnosis:
he will check for tenderness along the joint line where the meniscus sits.
This often signals a tear.
he will perform effusion tests.
Joint aspiration may be helpful.
Thessaly test.
Apley Test.
McMurray Test.
An MRI scan is the best imaging study to detect a torn meniscus.
If your doctor is still unsure whether you have a meniscal tear, he or she might recommend surgery called "arthroscopy."
Treatment.
Happily, not all meniscal tears require surgery.
Degenerative tears often improve over time with treatment of the arthritis,
so surgery usually isn't indicated.
Many traumatic meniscus tears will not need immediate surgery.
If your symptoms do not persist and you have no locking or swelling of the knee, your doctor may recommend nonsurgical treatment.
Avoid activities that aggravate your knee pain.
using crutches.
Use cold packs.
Oral nonsteroidal anti-inflammatory medications (Nsaids.
wear an elastic compression bandage.
A physical therapy treatment.
The outer one-third of the meniscus has a rich blood supply.
A tear in this zone may heal on its own,
or can often be repaired with surgery.
In contrast, the inner two-thirds of the meniscus lacks a significant blood supply.
tears in this zone with limited blood flow cannot heal.
symptomatic tears in this zone that do not respond to conservative treatment are usually trimmed surgically.
we try to exhaust conservative management options before referring the patient for surgery.
if the knee is locked or motion is severely restricted,
if the tear associated anterior cruciate ligament tear,
or if there is little improvement in symptoms after three to six weeks despite proper conservative treatment,
the surgery is indicated.
These instruments allow careful trimming of the torn meniscal fragments or, for some cases, a repair of the meniscal tear with sutures.
Partial meniscectomy.
Meniscus repair.