Meniscus Tear Cont

Fig. 118 A peripheral tear to the medial meniscus can be resutured

Fig. 117 Bucket handle tear of the meniscus, locking the knee from bending or extending

Fig. 118 A peripheral tear to the medial meniscus can be resutured

Fig. 120 A posterior horn tear can be refixated with meniscal arrows

Fig. 119 Missed meniscoscapular lesion, healed with laxity, causing persistent knee instability significant meniscus injuries but is more important for evaluating associated injuries. TREATMENT An athlete with effusion and suspected meniscus injuries should be seen by an orthopaedic surgeon to consider arthroscopy. This procedure can verify the diagnosis and deal with associated injuries. Meniscus injuries are trimmed

Fig. 120 A posterior horn tear can be refixated with meniscal arrows or vaporised and partially excised. Loose bodies are excised. Meniscus injuries in the periphery can sometimes be sutured, which results in longer morbidity before a return to sport but better future protection for the knee. Meniscus re-implantation is experimental surgery and the long-term outcomes are not clear. Note: a meniscus tear should be treated for its symptoms. A non-symptomatic tear, seen on MRI, does not require surgery.

REFERRALS Refer to orthopaedic surgeon for further investigations to verify the extent of the injury. Physiotherapists will be involved in close collaboration with the surgeon. EXERCISE PRESCRIPTION Cycling and swimming (not breast stroke) are good alternatives to keep up general fitness. Rehabilitation back to full sport usually takes a long time if micro-fracture is performed.

EVALUATION OF TREATMENT OUTCOMES

Monitor clinical symptoms and signs. Different functional knee scores for different sports are available to measure when the knee allows a return to full sport.

DIFFERENTIAL DIAGNOSES Cartilage injury, loose bodies, medial plica syndrome; all differentiated by arthroscopy.

PROGNOSIS Surgery (partial excision, timing or meniscus suture) will allow a return to professional sports in two weeks to several months. The knee will be more vulnerable to stress at the site of meniscus excision and in the long term, 10 to 20 years, the risk of developing local osteoarthritis is significant compared to a non-injured knee.

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