eMedicine Specialties > Sports Medicine > Knee

Meniscus Injuries: Follow-up

Author: Bradley S Baker, MD, Clinical Professor, Department of Orthopedic Surgery and Orthopedic Sports Medicine, Sanford School of Medicine, University of South Dakota; Orthopedic Consultant/Team Physician, Sanford Sports Medicine
Coauthor(s): James Lubowitz, MD, Director, Taos Orthopedic Institute, Holy Cross Hospital of Taos; Clinical Professor, Department of Orthopedic Surgery, University of New Mexico
Contributor Information and Disclosures

Updated: Dec 16, 2009

Follow-up

Return to Play

Return to play after a meniscus injury is expected. The timing varies and depends on the injury, treatment, and rehabilitation protocol. In many cases, athletes can return to their sport as soon as 2-3 weeks status post arthroscopic partial meniscectomy or 6-8 weeks status post meniscal repair.

Complications

Complications are discussed under Recovery Phase, Medical Issues/Complications. In the long term, meniscal repairs fail to heal in 5-10% of patients. Failure rates are lower when the tears are repaired in patients with concomitant ACL reconstruction.

In patients with untreated tears, enlargement of the tear and arthrosis are common. In patients who are status post partial meniscectomy, arthrosis is also a concern. However, arthroscopists are hopeful that long-term outcome studies will demonstrate that a partial meniscectomy can delay or prevent the degenerative changes noted by Fairbanks in patients who had open total meniscectomy.2

Prevention

Prevention of recurrent problems is accomplished best by reestablishing and maintaining knee fitness with strength, flexibility, and proprioception.

Miscellaneous

Medicolegal Pitfalls

  • Patient expectations: Patients must understand the pathology of their own knees so they have appropriate expectations regarding outcome. Outcomes of treatment and prognosis are individualized depending on the type of injury and the associated joint pathology, such as articular cartilage damage and instability. Appropriate expectations are key to achieving subjectively successful outcomes.

Special Concerns

  • Discoid meniscus
    • Approximately 5% of the white persons have a disc-shaped lateral meniscus.
    • Discoid meniscus often manifests as snapping of the knee in a patient younger than 10 years.22
    • Radiographic signs include a widened joint space, squaring of the lateral femoral condyle, cupping of the tibial plateau, and hypoplasia of the tibial spine. MRI is the imaging technique of choice.
    • Three types of discoid meniscus have been described.
      • Type I – Complete, covers the entire plateau
      • Type II – Incomplete
      • Type III (Wrisberg ligament type) – Deficiency of the posterior meniscotibial ligaments, resulting in instability of the posterior horn
    • No treatment is required for the asymptomatic discoid meniscus.
    • Symptomatic type I and II discoid menisci warrant arthroscopic partial meniscectomy with saucerization to a normal meniscus shape. Likewise, a torn discoid meniscus requires partial meniscectomy; saucerization, with removal of the tear, often allows preservation of a meniscus of normal morphology. A symptomatic type III discoid meniscus requires stabilization of the posterior horn.
 


More on Meniscus Injuries

Overview: Meniscus Injuries
Differential Diagnoses & Workup: Meniscus Injuries
Treatment & Medication: Meniscus Injuries
Follow-up: Meniscus Injuries
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Bland-Sutton J. Ligaments: Their Nature and Morphology. 2nd ed. London, UK: HK Lewis; 1887.

  2. Fairbanks TJ. Knee joint changes after meniscectomy. J Bone Joint Surg Br. 1948;30:664-70. [Full Text].

  3. Arendt EA, ed. Orthopaedic Knowledge Update: Sports Medicine 2. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1999.

  4. Insall JN, Scott WN, eds. Surgery of the Knee. 3rd ed. Philadelphia, Pa: WB Saunders Co; 2001.

  5. Rodkey WG. Basic biology of the meniscus and response to injury. Instr Course Lect. 2000;49:189-93. [Medline].

  6. Fu FH, Harner CD, Vince KG, eds. Knee Surgery. Philadelphia, Pa: Lippincott Williams & Wilkins; 1994.

  7. Arnoczky SP, Warren RF. The microvasculature of the meniscus and its response to injury. An experimental study in the dog. Am J Sports Med. May-Jun 1983;11(3):131-41. [Medline].

  8. Arnoczky SP, Warren RF. Microvasculature of the human meniscus. Am J Sports Med. Mar-Apr 1982;10(2):90-5. [Medline].

  9. Vaziri A, Nayeb-Hashemi H, Singh A, Tafti BA. Influence of meniscectomy and meniscus replacement on the stress distribution in human knee joint. Ann Biomed Eng. May 22 2008;epub ahead of print. [Medline].

  10. Eren OT. The accuracy of joint line tenderness by physical examination in the diagnosis of meniscal tears. Arthroscopy. Oct 2003;19(8):850-4. [Medline].

  11. Behairy NH, Dorgham MA, Khaled SA. Accuracy of routine magnetic resonance imaging in meniscal and ligamentous injuries of the knee: comparison with arthroscopy. Int Orthop. May 28 2008;epub ahead of print. [Medline].

  12. Nikolaou VS, Chronopoulos E, Savvidou C, et al. MRI efficacy in diagnosing internal lesions of the knee: a retrospective analysis. J Trauma Manag Outcomes. Jun 2 2008;2(1):4. [Medline].

  13. Spindler KP, McCarty EC, Warren TA, Devin C, Connor JT. Prospective comparison of arthroscopic medial meniscal repair technique: inside-out suture versus entirely arthroscopic arrows. Am J Sports Med. Nov-Dec 2003;31(6):929-34. [Medline].

  14. Bin SI, Kim JM, Shin SJ. Radial tears of the posterior horn of the medial meniscus. Arthroscopy. Apr 2004;20(4):373-8. [Medline].

  15. Shelbourne KD, Heinrich J. The long-term evaluation of lateral meniscus tears left in situ at the time of anterior cruciate ligament reconstruction. Arthroscopy. Apr 2004;20(4):346-51. [Medline].

  16. Nicholas SJ, Golant A, Schachter AK, Lee SJ. A new surgical technique for arthroscopic repair of the meniscus root tear. Knee Surg Sports Traumatol Arthrosc. Dec 2009;17(12):1433-6. [Medline].

  17. Logan M, Watts M, Owen J, Myers P. Meniscal repair in the elite athlete: results of 45 repairs with a minimum 5-year follow-up. Am J Sports Med. Jun 2009;37(6):1131-4. [Medline].

  18. Adachi N, Ochi M, Uchio Y, Kuriwaka M, Shinomiya R. Torn discoid lateral meniscus treated using partial central meniscectomy and suture of the peripheral tear. Arthroscopy. May 2004;20(5):536-42. [Medline].

  19. Kelly JD 4th, Ebrahimpour P. Chondral injury and synovitis after arthroscopic meniscal repair using an outside-in mulberry knot suture technique. Arthroscopy. May 2004;20(5):e49-52. [Medline].

  20. Barber FA, Harding NR. Meniscal repair rehabilitation. Instr Course Lect. 2000;49:207-10. [Medline].

  21. Choi NH, Kim TH, Victoroff BN. Comparison of arthroscopic medial meniscal suture repair techniques: inside-out versus all-inside repair. Am J Sports Med. Nov 2009;37(11):2144-50. [Medline].

  22. Hart ES, Kalra KP, Grottkau BE, Albright M, Shannon EG. Discoid lateral meniscus in children. Orthop Nurs. May/June 2008;27(3):174-9. [Medline].

  23. Cox CL, Deangelis JP, Magnussen RA, Fitch RW, Spindler KP. Meniscal tears in athletes. J Surg Orthop Adv. Spring 2009;18(1):2-8. [Medline].

  24. Ding J, Zhao J, He Y, Huangfu X, Zeng B. Risk factors for articular cartilage lesions in symptomatic discoid lateral meniscus. Arthroscopy. Dec 2009;25(12):1423-6. [Medline].

  25. Freedman KB, Nho SJ, Cole BJ. Marrow stimulating technique to augment meniscus repair. Arthroscopy. Sep 2003;19(7):794-8. [Medline].

  26. Iwamoto J, Takeda T, Sato Y, Matsumoto H. Retrospective case evaluation of gender differences in sports injuries in a Japanese sports medicine clinic. Gend Med. Dec 2008;5(4):405-14. [Medline].

  27. Jerosch J, Riemer S. [How good are clinical investigative procedures for diagnosing meniscus lesions?] [German]. Sportverletz Sportschaden. Jun 2004;18(2):59-67. [Medline].

  28. Kisiday JD, Vanderploeg EJ, McIlwraith CW, Grodzinsky AJ, Frisbie DD. Mechanical injury of explants from the articulating surface of the inner meniscus. Arch Biochem Biophys. Nov 24 2009;epub ahead of print. [Medline].

  29. Metcalf MH, Barrett GR. Prospective evaluation of 1485 meniscal tear patterns in patients with stable knees. Am J Sports Med. Apr-May 2004;32(3):675-80. [Medline].

  30. Oei EH, Koster IM, Hensen JH, et al. MRI follow-up of conservatively treated meniscal knee lesions in general practice. Eur Radiol. Nov 17 2009;epub ahead of print. [Medline].

  31. Pearse EO, Craig DM. Partial meniscectomy in the presence of severe osteoarthritis does not hasten the symptomatic progression of osteoarthritis. Arthroscopy. Nov 2003;19(9):963-8. [Medline].

  32. Uysal M, Akpinar S, Bolat F, et al. Apoptosis in the traumatic and degenerative tears of human meniscus. Knee Surg Sports Traumatol Arthrosc. Apr 30 2008;epub ahead of print. [Medline].

[ CLOSE WINDOW ]

Further Reading

Related eMedicine Topics

Clinical Trials

Clinical Guidelines

[ CLOSE WINDOW ]

Keywords

meniscus injuries, acute meniscal tears, meniscal tear, medial meniscus, lateral meniscus, meniscus tear, meniscal injury, knee injury, meniscectomy, discoid meniscus, McMurray test, Steinmann test, Apley test, Bragard sign, Böhler sign, Payr sign, Merke sign, Childress sign, Finochietto sign

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Bradley S Baker, MD, Clinical Professor, Department of Orthopedic Surgery and Orthopedic Sports Medicine, Sanford School of Medicine, University of South Dakota; Orthopedic Consultant/Team Physician, Sanford Sports Medicine
Bradley S Baker, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Sports Medicine, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and Mid-America Orthopaedic Association
Disclosure: Nothing to disclose.

Coauthor(s)

James Lubowitz, MD, Director, Taos Orthopedic Institute, Holy Cross Hospital of Taos; Clinical Professor, Department of Orthopedic Surgery, University of New Mexico
James Lubowitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and Arthroscopy Association of North America
Disclosure: Arthrex Consulting fee Consulting; Smith and Nephew Consulting fee Consulting; Breg Grant/research funds Other

Medical Editor

Leslie Milne, MD, Assistant Clinical Instructor, Department of Emergency Medicine, Harvard University School of Medicine
Leslie Milne, MD is a member of the following medical societies: American College of Sports Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Henry T Goitz, MD, Fellowship Director, Sports Medicine, Department of Orthopedic Surgery, Henry Ford Hospital
Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Society for Sports Medicine
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD, Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, Medical College of Wisconsin
Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, and Phi Beta Kappa
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.