From the Guidelines
The treatment for a displaced medial posterior horn meniscus tear with extrusion typically involves arthroscopic partial meniscectomy, as this procedure has been shown to be effective in relieving mechanical symptoms and improving function in patients with knee osteoarthritis 1.
Treatment Options
- Arthroscopic partial meniscectomy: This procedure involves removing the damaged portion of the meniscus while preserving as much healthy tissue as possible.
- Meniscal repair: This may be attempted in younger patients with tears in the vascular "red zone" of the meniscus to preserve the meniscus and its load-bearing function.
Post-Operative Rehabilitation
- Progressive weight-bearing and range of motion exercises
- Strengthening exercises, including quadriceps strengthening and hamstring stretching
- Proprioceptive training for 6-12 weeks
- Use of crutches with partial weight-bearing for the first 1-2 weeks, progressing to full weight-bearing as tolerated
Rationale for Treatment
The meniscus has limited healing capacity in its avascular regions, and displaced tears with extrusion often cause mechanical symptoms like catching, locking, and pain that don't respond well to conservative management alone 1. Additionally, a study by Magee and Williams 1 reported high sensitivity and specificity of 3T MRI in the detection of meniscal tears, which can aid in diagnosis and treatment planning.
Important Considerations
- Patient factors, such as age and overall health, should be taken into account when determining the best course of treatment.
- The location and pattern of the tear should also be considered when deciding between arthroscopic partial meniscectomy and meniscal repair.
From the Research
Treatment Options for Displaced Medial Posterior Horn Meniscus Tear with Extrusion
- Non-operative management: According to 2, non-operative treatment of medial meniscus posterior horn root tears is associated with poor clinical outcome, worsening arthritis, and a relatively high rate of arthroplasty at 5-year follow-up.
- Partial meniscectomy: A study by 3 found that patients who underwent partial meniscectomy had higher rates of progression to arthroplasty and arthritic progression compared to those who underwent meniscus root repair.
- Meniscus root repair: The same study by 3 found that meniscus root repair leads to significantly less arthritis progression and subsequent knee arthroplasty compared to non-operative management and partial meniscectomy.
- Transtibial pull-out repair: A study by 4 found that adjustable transtibial pull-out repair using a knotless adjustable suture anchor-based fixation technique resulted in higher initial repair strength and less displacement with cyclic loading compared to fixed repair techniques.
Biomechanical Performance of Repair Techniques
- A study by 4 found that adjustable transtibial pull-out repair using a knotless adjustable suture anchor-based fixation technique resulted in higher initial repair strength and less displacement with cyclic loading compared to fixed repair techniques.
- The study by 5 found that the degree of degeneration of the posterior horn of the medial meniscus on MRI showed a significant correlation with the pullout failure strength.
Diagnostic Significance of Medial Extrusion
- A study by 6 found that medial extrusion of the posterior segment of the medial meniscus is a sensitive sign for posterior horn tears, especially in the early stages of osteoarthritis.