MENISCAL NTUAY
DEFINT1ON
Meniscall ugury ave he mos E
Common 9ohE issue injury HneejoinE
Meni 9eal uinjury s a Common nj ury un
twhich ovelul hwisting Causes covtaun
Ei96ue wn heHnee bo tea.
ANATOM y
Theve ae two meni9ci un the
he medial meniscuS
end the
nee DinE
Jatera menigcus.These ibroeanlilaginouS
a
elisks dlcopen e Dinb, therebpemitEing
Oore dtabe as ticudaion betuueor the emuuy
ard ibia
hey als0 acl ad a hock
abeos bers weight tansmitters) and hel
he Eibia
mooth bhe glidinq oclion
n the kermuy
The medial menigcus Jies on he
ofnes
medial Eibial
medial ibial plaleau, which w Qon Cave
Hhe Jateoal bbial plateau, which us n
The meni9ci move with he Bbia during
e i o n eund extension and with Be Remur
euuing otabon. The blocd duply b be
nmeni eci w via pernpheval vessols hom be
umovial and eapsular tissues,ard u
Hat bo he
Bolaivelu poor, especially
Censal sdocion e he meni9Cus. Masl o
the mubibional neos ave hevetove met by
He diffugion adunovial ud
medial meniSc us Joleralren
pephexg
CenteY oidid
MENISC1
The menisci avs hieker at theur
periphery thet tharn un ther fenterS
9/40/9 And
Ccuar un hapl
IMEDIAL MENI9CU9
The medial menigcus u
Coed
ad Consisls a n antenor poion, or body
ead a posLeior dament, oY hom, Theve u
uumpovtanE ettachment to he doep apsulay
pov hon oh Be mdial eapsula ligomont
N
p e p h @ral ole tach ment e the meniscud
ean TeS ule thi3 medial capsular diç@ment
9 u torn.
xhe emimembrano9us mudce u
ettoched to he posterior dpec e the medial
ad
meni9cs via he poslevomediall eapsule)
ends to pull the meni9cus nck out e
the
way oluing lexionm. Howevey, mobility eN
toedia meniscus us imited, whieh Jeaves
he posberioY hon vulnevalde to tearing
LTERAL MENISCuS
The Jaleral meniscus u more O
mobil e than the3 medial
haped and u more
meniscuG becauGe ut does not awe any
Gltachment to bhe eleep posberalakerol e
m which t us deparated by the
the
pophtealterdon oheath. The aCuale
oavon
fmly allbched. bo the lateval
meni9eus
and. d He popiteus mud cle us abtoached to
both the 6xcuate ligamenE and He Laterad
meni9euS, He poslenor dcoment he
meniseus ean be puledl bac Loard dunng
1edialTotabonn e the bbia uun flexion
Mo FeabesMedial meni9cuS laleral meni9Cus
Shope Semiciveular cireulay
Alochod o ibial Jo
Anterior
uintoreondula
hovn inborcordyav eminence bbia
Jobsme Ominence un Jaleral w Acl
ont e Ael.
9 oslerioY nbevcondyas aveao be unteicanuJ
hoYY uin front d Pel Ominence.
uGnd ehind. posleio
horn Jatevd
meni sc uS
M
Ouor Aoched o Sepaxated rom
Galpect Copgule
pslenabes
TeLU
FcL b
Gund popliLe u
5 Mobiliby ess mobile Moe mobile
palelax
end onu
Medio
MeniscuS
Lalera
meniSCS
Aeteror
evuciahe
Jigomont
Media Postenorexuciate
eOpeulox
oaid uigomontotor Joikbsm
hqOamen
o
EMENI9C o
odqfuncbhong e he menigei oc
Shoe the Jlood un weig hE beaing
and inerease he joinE eonlact area.
axbeorb hocK therel potec Eing
he viloy arbilage.
Help stabilize Hejon y
datpening He asHcular duafares he
ibia plateau.
Help acihtake onlrol eome
rota onal movemenLS (dluch ad he
Narew home" movemen t).
d un jin nubitiun and
Jubricabion.
rmiliels elassidication
Media menigeuS unwr un over
1 the eases. n 5 e Coses, unj uy
omedial meniseus us bilaleral. Laleral
meni 9cud us de99 Commonly unjund
Han tha medial meniseuS becase it w
Gmaller un diameler, hicKe un
pen phe
Luide move moble, athached o boh
Cauciate ligaments ano talbilized
po posteosly o he emore tandyles
by popli eua
) lomgitudhineol teass( 35)-
these peipheval
these attachments tear 1D
Comple te tea 93. ( bucho hande
bear), and. deqmenbal ea 2f (antfps)
i Hon2onbal ears 48) Coud be
postenor, middle. D antenor
i) Cysbe degeneva Lion 12)
iv) Comoribal eboomalities (5)
) Hecenexative Jesions
cnori
Longituolineal
9o 98 Rodial
Honnontal
Bcket hordle Poumot beak Seprmen al
teD
Smillie ho tavbeol tat aCturabely
olescmbed ck a large Weomenb of
emll Cirela. uohereas, by eomparnson he
medial u a rall ment ea
large eirele.
Mechanigm huy
Mechani Sm dunjuy a
otahonal fovre whon a leyed Rn exla
younq w ean occwr Only wohen
weight being aken, Hnea l e r e d
ti
ard heo a buisbrg ehain. you
Gchve athle tes ure more prone
dle lle ibois hoa
decveasel he moblity e menigeul dr
hente tear Dctr Loi th Jess korce
This pivo ng w COmmo) wn
povS uch ast doccor, bosketball o ooth
an uneverl
pid edtepping ov dauatbng on
durface. Can Caudes dispropor ionate ore
en the KneeS, leading bo teaxs b e meniS
elinicall eabures
ympbomns
Paun nserdag)a
ain ouwelling
poin 4eing wOu
x
Lockinq and unlo Kinq
Vasbud medicel alophy
bSAusion
Joire ine. terdemess (uportant
xoin on orceexion ov exlensionu
«Block bo eonplete lesion OY
Posibive MeMurrays tesb
Locking posibive 990sr
nveg tiqati ons
Moclicaph u udually momal, the
Mews netonmended ane anteroposterior,Jaera
inboscordylar noteh arol dunise views o
Bhe abello
Anhvoscapy hols o udnbf be
o m moni9cus.
hthogephy ma oeol he 1or
Doule Contrest anthrpgrapy wo 5 . ue
MR) s pensive But
oelul. I
He goldstardarsl n maRing didgnoss
menig9cal uteorg.
Special leste for diaqnosis moniseal
w u
i MeMuYays lest
ocrsk9
The pahent Jies un he oupine
DoSi bun with he Knee eompetely leyed
he exami nor bhon med ialy r
untemally rotaled bhe ihia nd aerdb
the Knee. .avicn
46 Hore us a loe Teqement
e be akral meniscuel , hus echon udid
adap x cick that ohtn attmpaing
poin to
The leb malii edb Jatereally
by emally obeules the bbia. arol evlend5
he Knee ard the proress L
epeated
epeated
est the medial meniseus.
x Posibive dign -
he pain oCtLLY, Bhe
medial menigcu w tenY,
A s Compressi on eSE
the paient Nes in the prone
wi th the Hnae fleyedq0, hing
at
posibion
Bhe thigh qaing he ebe.
ascinoo
The
the laminey presses he faot
And leg downuorsl twhile votahivng he bia
«Positive dinpain noed. duoig
Er CompreSsion ump'ie a meniga esion.
oniocr
Hdeys distracko es
Jaibeo
The technigue u e
dame ad
Jovsjol
above bu hore he eoomi ner puulld by
Hoo
oo ard lo upuoivdl to diotrete he
,
oint ohile egaih ola bo the bibia
xbia
Pbsi e aian poin mobRd. duir
bhis distaecbion coint umplies a
lig amentotl Jockion
Duck wodolle test
The pahent ossumes a dauabi
psbon Loith heols ouching he buttock
a ddutK Lwalk
and us asHed bo pertonm
Jhe pahent will be unable b
aldume ul dquatting po bon
un
medial
menisCue
2oupo
9
Jhis us entledl od ohildred h
and. uw a diamostic les Bor posteio
hovn benr o medial
moni9Cus
N)3toimmanns Sign o or
x Menisca pacthology may be
ouspected u madial pain w olicite on
dateral o taion Cmedial meniscus
unjwry ad
lakeval pain on medlial Hbial otaon
CJaleca menis cal uuy
id fong
v)Helfe9 an idt
eoile Jn nomalnoo wn giuhoq
posi bon bialuhercle Jial in line wi Lwiby
mid ine he patella. when olenoladl
dakevel ióial bovde pobella.
Positiue dign ocur when the
otati a w boc Het by a tom menisCu
Cnd the duhovele mainS Cenlreo DveY
he palella tun extension.
>Jeq
AEATM ENT dromanonn Ja0ipru
PT Managomentgecopiih
Rest with Knee flexion
le packs
Appimbion o
-) Compression bandaae
-levaion
Buck's dkin bachon
uadiceps evoeies
beouring
Abstinenc ceom weight beoinq
Joint aspiva Eion
dympbom pesists, a cylindicol
eosk my he eonsideved
Manipula hon undes anesheSi, :
Joint JocHol due. to e tom
meni9c, manpula tion urder ancs hesia
e Conmondeol.
Medical Maroqomenb
NGAID9
Analges bic
jwai call Maaqement
rthaoSt opid memisC Depaur This
the teament oehoice dh
Jake Repain
tear l o mm or
undiakel the u
unbhale on probnq hepain dutessi
e
un he bulor (vel-el 2oro) edge
ohile 2ore ard even un
Vac culor m ved
(wohi le whi le zonu
ew avoeltuulor
-
2one
Via
Closec partial Menis eeetomy
eur
n hvo 9cop w betton Bon total
emoval e menisei by open
toib
Menisal transplant n ase
verspbrt
botal meniectpmies, codaver menise1
us dtill
may he Considerel, Housover, hi
un the ovolvig dtoge.
Cornplele emoval o t h e
meni9eCi un@apacitales the Kneo hence
duree ry
he emphoalis us on Conservohue
than he edial emoval
Phuoio thevapy meodured aler urgorY
Preopovabve phusiothespy
aumed to makohe
Jhis s
progeun moe otecie
pobtopova he ehabilitaHon
dothat the pmient ean have a tostey
dome e he
Detoveyy Theollouwing @re
menS uesS
umpos tant preoprabve physiohevepu
Jov uodi cop exeveises oeupe
he duoelling
nee duoinginq o7 Carlu eku
ounchon
Raiseol 3LA bo drorgbhon
he Knee
Jo umproe the poseri Dy
tabihb the Hnee eistive ore3ec
o hanaltingg ond Cal mudelol
rogkesevabve physiothovapy.
Pirst 5 doys
Croic
Meaduwred to Tedlull poun-
0
them otherapg
Measured toeoute euio-
poedu Guadnceps eveicej, veshve
anhle ard hjoot movemenES,3LA
etc,
o o ceeMeosured to prevent elX
unhibition - dlueytained Quodi Caps exoreised
with S-10 detondshold.vvo
Mecelueres uprove Bhee
eunge he movement 5-elayed hnee
Guwngng9
9-15 day9
The above meoolterel are mode
ore Vi9ooo,
Hnee rakcheb ard. ped- 0 -Cyte
oegime.
Ambulaion twib odupon tel or
ul weght beaing
xkien is taught weghe tunstes
On this t e , pakent houd
able to acieveQ0 nee movemen b 3
12-3 wee KS noernd
S nea movemenks Jhould e
Oround 120.
Pahent dhould. e abe to etlend
Slarcd alone on the unoleckedlJa
RE be 9uodliceps
Pahents is alowed. oov,
6quathg. Cvcss loq dlitting ordprore
irCumdu.chon Otereises o Bhe
OnKle oint. Accisled SLR w ndiake
tosdu
1Somotme eveveses to the 9uod
and hamskinq9 Godual weigh becur
Hne
Nctive pleion elension
eyeveides ae, bequn,
oumstim helehin ereises
moulahon with minimuum o
mo luppot.
3-9 weeKs
Soonice Knee eyereises are
ommenc ec.
RT o the Quadnops Are
ConEinued
balandng echvih e bo wmprvt
gf
propn o epion.
hail breiing.
Pohent may be pomi tted 6o
vedume Loor ,
APter b wee Ks
xahen allowed pot
Tunnin9, dtraight g,
hoppin ebe, pahent Can be alla
toebum to active porbS.
NOTE
Diagram not cleaun this l
please a or dioqwaumrom 1) lloven 7o
Pge ournbe297, 2) Jhn obne2Or qe
umbex 238, ) B.D. chaur a5ias
P g num bo 155.
