Degenerative Meniscus

  • Degenerative meniscal lesions are tricky to diagnose and treat, in particular difficult to differentiate from Osteoarthritis (OA).
  • Degenerative tears can be found in as much as 60% of the population over age 65
  • Generally speaking vertical tears are traumatic and horizontal tears are degenerative.
  • Horizontal Tear:  are ‘degenerative’ tears. They are often described as “lesions of middle age” occurring in abnormal fibrocartilage. 
  • They are most commonly found in the posterior horn of the medial meniscus. 

     

    Degenerative Meniscus

    Development of a degenerative lesion on follow-upMRI in a patient who sustained a distortion of his right knee. a/ on the initial MRI examination, a normal anterior horn of the lateral meniscus was seen. b/ Follow-up MRI after 1 year demonstrated a linear band of increased signal intensity that did not extend to the articular surface, which was scored as a grade 2 degenerative lesion

     

    Subjective Hx:

    • Onset: may be sudden, but will be atraumatic or minimal trauma in the older age groups.
    • Normal age group 40-60.
    • Pain localised to Tibiofemoral joint line.
    • May complain of clicking and locking (important to establish if ‘true’, degenerative meniscal tears are normally horizontal and therefore locking is rare in this group).

    Objective Hx:

    • Not normally a loss of motion, unless true locking, but often pain on overpressure end range flexion or extension, depending on site of lesion (e.g. Anterior or Posterior horn)
    • Palpation: concordant pain over Tibiofemoral joint line palpated with the knee flexed 45-90 degrees

    Indication for onward orthopaedic referral would be if the knee is truly locking the patient relative or another person has to manual unlock (not just a knee which is stiff after sitting)

    Treatment:

    Refer to Physiotherapy:

    • Initial management should involve protection, rest, ice, compression and elevation (PRICE).
    • Painful activities should be avoided 
    • Avoid deep squatting as this is likely to cause pain.

    0-48 hrs:

    • PRICE
    • Active pain-free exercises (gentle range of movement)

    After the first 48 hrs:

    • Gradually increase strength:
    • Quads strengthening
    • Initially straight leg raise as this can activate quads without causing pain in the knee
    • progress to weight bearing and stability exercises (pain free)

    Functional Strengthening:

    • Bike
    • Pool running
    • Swimming not breast stroke legs

    If not improving after 6 months of conservative measure consider referral on to the orthopaedic team.

     

    References

    • Image from OpenI – Licensed by CC

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