The document discusses the anatomy, function, types of tears, clinical assessment, and treatment options for meniscal injuries. It provides details on the anatomy of the medial and lateral menisci, the different types of tears that can occur, clinical tests to diagnose tears, and surgical and non-surgical treatment methods including meniscal repair, partial meniscectomy, and meniscal transplantation.

1. Dr . SAYF ALDEEN HUSSAMDr . SAYF ALDEEN HUSSAM
ALAL-WASITY TEACHING HOSPITAL-WASITY TEACHING HOSPITAL

2. ●Menisci is a crescentric
shaped fibrocartilagenous
structures between the
condyles of femur & tibia
●Peripheral edges are thick,
convex& fixed to inner
surface of capsule.

3. ●Triangular in cross section
●Covers peripheral 2/3 rd of
articular surface.
●Each menisci has
2ends---- anterior and posterior
horns
2borders----outer and inner
border
2Surfaces ---upper and lower

4. C shaped, larger in radius than lateral meniscus
Anterior horn: Attached anterior to intercondylar
eminence and to the ACL  Posterior horn:
Attached in front of attachment of PCL, posterior
to the intercondylar eminence 
Entire peripheral border firmly
attached to the medial capsule and through coronary
ligament to the upper border of tibia

5. Smaller, More circular, thicker in
periphery, wider in body and more
mobile than medial meniscus 
ANTERIOR HORN: attached medially in
front of the intercondylar eminence
 POSTERIOR HORN: inserts into
the posterior aspect of the
intercondylar eminence Attached
posteriorly to the medial femoral
condyle by either the ligament of
Humphry or the ligament of
wrisberg

6. ●outer one-third: supply
from the peripheral
meniscal plexus, in
turn formed from the
medial, lateral and
middle genicular
arteries
●inner two-thirds: no
vascular supply;
diffusion dependent

7. VASCULAR ZONES
●Red-red zone: fully vascular
●Red-white :minimal blood
supply
●White-white: fully avascular

8. ●outer one-third innervated by posterior
articular branch of the tibial nerve and
terminal obturator and femoral nerve
branches
●posterior horns have highest concentration
of mechanoreceptors
●The inner two-thirds has no nerve fibers.

9. 1-Joint lubrication
2-Joint stability- ( rotary(
3-Shock absorbers-reduce the stress on articular
cartilage
4-Load bearing function
5-Deepening the cavity
6-Prevents impingement during joint motion.
7-Medial meniscus – provides stability to Anterior
Cruciate Ligament deficient knees.(ACL(

10. ●occur with rotational force ,on a partially flexed knee
like Foot ball players
●Most common site- posterior horn
●Most common type- longitudinal tear
●Length ,depth, position of tear depend on the position
of the meniscus in relation to condyles at the time of
injury.

11. 1-Trauma
2-Meniscal cyst
3-Decreased mobility of the meniscus
4-Discoid meniscus
5-Aging- degeneration
6-Abnormal mechanical axis- ligamentous laxity.
7-Congenitally relaxed joints
8-Inadequate tone and musculature.

12. 1-Longitudinal tears
2-Horizontal tears
3-Oblique tears
4-Radial tears
5-complex tears

13. ●Most common type
●affect young pt.
●Post trauma
●2types:
-Vertical incomplete tear
-Vertical complete: Displaced
tear (bucket handle(

14. ●Extend from inner margin to
capsule horizontally
●Common in posterior horn of
medial meniscus & lateral
meniscus

15. ●Full thickness tear extending obliquely
from the inner margin into the body
●Types:
-Anterior oblique
-posterior oblique
●Commonly seen at the junction of
middle & posterior 1/3 of medial
meniscus

16. ●Extend radially from inner margin into
the body
●Common in middle 1/3 of lateral
Meniscus
:●types
-complete
-incomplete
-parrot beak tear-(Radial tear with
longitudinal or oblique extension(

17. ●Combination of all the above
●Common in chronic meniscal lesions & degenerative
menisci
●Predisposing conditions:
*Discoid lateral meniscus
*Meniscal cyst
*Calcium pyrophosphate deposition

18. ●History:
*May be asymptomatic
*Pain
*Sports injuries
*Trauma
*Giving way
*Locking

19. ●Physical signs:
*Effusion
*Quadriceps wasting
*Joint line tenderness
*Limitation of movements.

20. ●Mc Murray test.
●Apley’s grinding test

21. ●For medial meniscus tear
Fully flex the knee
Externally rotate the leg
Keep the fingers on the medial joint line.
Then Slowly abduct and external rotate the
knee.
Click and pain is indicative

22. ●For lateral meniscus tear:
Fully flex knee ,internally rotate and extend the leg.
If a click or pain is indicative
●confirms this after examining the other normal knee for clicks of other
origins like tendon and soft tissues snapping etc.

23. *Prone position
*Bend examiner knee and press the
patients thigh.
*Hold the ankle and the foot by both
hands
*Compress the leg downwards and
rotate internaly and externally.
*If patient elicit pain it indicated
meniscal tear

24. *X-Ray-Antero posterior ,lateral view of knee &
intercondylar notch view
*MRI
*Arthroscopy
*Arthrography

25. Grade I –increase in signal,not extending to articular surface
Grade II- linear increased density, not extending to articular surface
GradeIII- signal extending to articular surface

26. *Gold standard for diagnosis and treatment
*Thorough inspection of menisci, ligaments &cartilage
is possible
*Anteromedial or anterolateral portals
*Full extent ,type, site of tears & degenerative changes
can be seen

27. NON- SURGICAL
SURGICAL

28. Indications:
1-Incomplete meniscal tear
2-A small stable peripheral tear (5mm) without any
other injuries.

29. *Grion-ankle cylindrical cast 4 - 6 weeks
*Toe-touch partial weight bearing
*Rehabilitative exercise program for 6 weeks to
strengthen quadriceps, hamstrings, gastro-soleus
&hip.

30. Meniscal repair
Meniscectomy
Meniscal transplant

31. *Depend on the location of the tear, its morphology and
patients factors
*indications:
1-Peripheral tear(Red on Red region Also on red on
white region(
2-Size <1-2 cm
3-Vertical longitudinal tears are ideal
*young patient shows better outcome
*Can be done Open or Arthroscopicaly

32. 1-Tear>3 cm
2-Transverse tear even in periphery
3-Flap tear, radial tear, vertical tear with secondary
lesions.
4-Ligament instability

34. 1-inside out technique
-considered gold standard
-medial approach to capsule
-lateral approach to capsule
2-all inside technique (suture devices with plastic or bioabsorbable anchors(
-most common
-many complications (device breakage, iatrogenic chondral injury(
3-outside in repair
–useful for anterior horn tears
-open repair

35. *Limit knee flexion to 90 degree
*Low impact activity for 3months
*Full activity after 6months

36. 3types:
1-Partial
2-Subtotal
3-Total
Methods:
Open
Arthroscopic

37. *Excision of only torn portion of meniscus.
:*Indications
1-Tears >5mm from menisco-synovial junction.
2-Flap tears
3-Complex and horizontal tears.
*Treatment of choice in young adults who require
vigorous activities.
:Advantage
Short operating time.

38. * requires excision of portion of peripheral rim of meniscus
- Most of the anterior horn and a portion of middle 3 rd of
the meniscus are not resected
*used in complex tears of posterior horn

39. Indications:
1-if Meniscus is detached from its periphery.
2-extensive meniscal tears and degenerative

40. Early:
1-Haemarthrosis
2-Chronic Synovitis
3-Synovial fistulae
4-Painful neuromas
5-Thrombophlebitis
6-Infection
7-Reflex sympathetic dystrophy
Retained meniscal fragment 8-

41. Late changes:
Degenerative changes within the
joint. Fairbank described three
changes:
1-Narrowing of joint space
2-Flattening and squaring of femoral
condyle
3-Antero-posterior ridge formation

42. By using either meniscal allografts
or autograft fascial material
or synthetic menisci scaffolds

43. Aim:
To prevent degenerative changes, in the post
meniscectomy patient
Indications:
Patient less than 45 yrs age, with pain and
discomfort associated with early OA, without
ACL deficiency or significant malalignment

44. Contraindications:
1-Age more than 60 yrs.
2-Bony architectural changes.
3-Prior infection.
4-Significant malalignment.
5-Instability.