Horizontal tear medial meniscus

Case
This 41-year-old male recreational football player presents two weeks following a minor twisting injury. He described developing localised medial knee pain and swelling the morning after the injury. On examination he was found to have a moderate effusion, localised medial joint line tenderness and pain with tibial rotation (McMurray’s test).

Findings
X-ray imaging was completely normal. MRI sequences showed linear increased signal within the posterior horn of the medial meniscus suggestive of a cleavage type tear. The articular cartilage is normal. There is a large bakers cyst.

Discussion
An initial attempt was made to manage this injury non-operatively. A period of activity modification (avoiding running, squatting and pivoting) combined with regular Physiotherapy was trialled. Unfortunately, his pain persisted, and he eventually underwent an arthroscopy with partial medial meniscectomy three months after his initial injury. Over the next six weeks his symptoms improved, and he was able to return to football. He remains asymptomatic nine months after the surgery.

Partial meniscectomy is not a benign procedure and is clearly linked to post-traumatic osteoarthritis. It is important to clearly council patients that the operation will not make their knee ‘normal’. This may mean that they have ongoing symptoms and that they may be at an increased risk of osteoarthritis. There is also a chance the procedure may make their symptoms worse. In addition to this there is increasing evidence that surgery may be no better than time and/or physiotherapy. While this procedure has its limitations, it can be useful on a case by case basis (as this patient illustrates). In general, a trial of non-surgical treatment is advised for up to three months. In cases where this treatment fails, and the articular cartilage is preserved, a partial meniscectomy (with informed consent) could be considered.

Important notice
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Les menisquessont avant tout constitue de tissus confonctif.il ont une forme de disque et sont situés entre les surfaces articulaires.leur fonction est de repartir les charges de freiner d amortir et de stabiliser l articulation du genou. Une lésion du ménisque est une blessure du tissus meniscal pouvant prendre la forme d une fissure d une dégénérescence ou d une combinaison des deux. Le ménisque interne ou medial peux parfois se déchirer et se retourner dans l articulation .le principal problème d une fissure du ménisque est qu’ elle ne cicatrise jamais contrairement à la peau qui se régénère grâce… Read more »