External meniscus lesion

Definition of external meniscus tear

Of the External meniscus (Meniscus lateralis) is located on the outer edge of the joint space and serves together with the Medial meniscus the stabilization and enlargement of the articular surface of the Knee joint. Since the external mensicus has greater mobility, injuries are rare here.

Frequency / occurrence

There Mensic lesions often in the context of Sports accidents occur, men are twice as likely to occur Meniscus lesions affected than women. Overall the number of Medial meniscus lesions much more common than that of the External meniscus lesion.

Cause of the external meniscus lesion

Basically be two different causes differentiated for a meniscus lesion:

1. the degenerative causes (wear and tear)
   and
2. the accidental lesion.

Degenerative changes in the area of ​​the menisci begin around the age of 40.
This depends on the strain on the knee.
So are especially athletes with very knee-stressing sports such as:

• Soccer
• Handball
  or
• Discus throwing

affected. But jobs such as tiling put a lot of strain on the knees and can lead to spontaneous tears. Traumatic (accident-related) external meniscus lesions mostly affect young people. A clumsy movement in combination with an incorrect load is often the trigger for a meniscus lesion. The outer meniscus is affected when the knee is rotated inwards and an axial load (force from above) is applied at the same time, which would be typical, for example, in a football foul. Due to its significantly higher mobility, the outer meniscus is generally less affected by injuries than the inner meniscus.

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The knee joint is one of the joints with the greatest stress.

Therefore, the treatment of the knee joint (e.g. meniscus tear, cartilage damage, cruciate ligament damage, runner's knee, etc.) requires a lot of experience.
I treat a wide variety of knee diseases in a conservative way.
The aim of any treatment is treatment without surgery.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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to form

In the Meniscus lesion different forms are distinguished.
Coarse can be between one simple bruise (Contusion) and one real meniscus tear can be distinguished.
The meniscus tears are subdivided again depending on their course. Of the Radial crack pulls outward from the inner edge of the meniscus along the meniscus radius.
If the crack line runs parallel to the inner edge after a bend, this crack is also called Flap tear designated.
At a Basket handle tear the tear line runs longitudinally through the meniscus and thus parallel to the main direction of the individual fibers. There is no connection to the inner edge and the anterior and posterior ends of the fibers connect to the rest of the meniscus.
If the free margin is shifted into the joint space (dislocated) this can lead to discomfort. Of the Horizontal crack denotes a crack course horizontal to the meniscus.

Symptoms

Kick one External meniscus lesion acutely, the patient experiences sudden severe pain in the area of ​​the external joint space. These mainly occur when walking. Partly is also a Snapping over the joint space possible.
Will the meniscus trapped in the joint space, the joint is blocked. This means that it is no longer possible to flex or stretch the knee joint. Smaller, spontaneous cracks can often be asymptomatic.

Diagnosis

As a rule they are Symptoms and the Medical history (anamnesis) of the course of the accident already indicative of a External meniscus lesion.
In addition, the clinical examination reveals significant tenderness over the affected external joint space.
In the case of an incurred Joint effusion this is also to be felt. There are different clinical tests, so-called meniscus tests, which are Meniscal tear are positive and should therefore be tested.

• The Steinmann -I- symbol describes a passive rotation of the patient by the examiner. Severe pain occurs during internal rotation.
• The Steinmann II sign is positive if pressure pain that occurs in the joint space moves backwards when the knee joint is flexed.
• Another test is the Apley grinding test. Here the patient lies on his stomach, the knee joint is bent by 90 °.

At a External meniscus lesion pain occurs with internal rotation in this position. In addition, external stress on the external meniscus leads to pain if there is a lesion here.
Since bony involvement cannot be ruled out, a X-ray of the affected knee joint in two planes.
The most valuable diagnosis, however, is that Magnetic resonancenanztomographie (MRI for a meniscus tear). This can rule out or confirm an external meniscus lesion with 95% certainty.
The MRI is a radiation-free examination method with which soft tissues, especially the meniscus and a meniscus tear, can be shown.

Therapy of an external meniscus lesion

Usually after a External meniscus lesion a Arthroscopy (Mirroring the knee).
Arthroscopy offers the opportunity to examine the injury closely and provide direct therapy.
However, this is often difficult and does not always produce satisfactory results.
On the one hand, in the context of arthroscopy, a Removing part of the meniscus (menisectomy). However, this depends on the extent of the injury, as only small portions can be removed. Attempts are made to sew the meniscus, especially in young patients (Meniscus suture).
Due to the good blood supply in the peripheral (outer) third, this often works well in this area. After the treatment, a long period of rest and very careful reloading is often necessary. Overall, sporting activities often have to be reduced.

forecast

The quality of the operation and the extent of the Partial meniscus removal usually determine the prognosis of an external meniscus lesion. If the Meniscus suture holds sufficiently and the meniscus does not tear at the seam, the prognosis is relatively good. On the other hand, if a large part of the meniscus has been removed, one develops very quickly Osteoarthritis of the knee.

Summary

Of the External meniscus is affected by an injury much less often than the Medial meniscus, Therapy and prognosis do not differ essentially.
The outer meniscus can mainly be injured by strong internal rotation with axial load. With an external rotation, the external meniscus is rather relieved.
Depending on the shape and direction of the meniscus tear, different shapes are distinguished. In principle, the overall extent of the meniscus tear determines the therapy and prognosis of the external meniscus lesion. Smooth tears in the area of ​​the peripheral meniscus can be sutured relatively well because the blood supply is very good here.
However, it is part of the meniscus almost completely torn off, often only a partial removal of the affected part remains. The risk of a resulting Osteoarthritis of the knee is then very high.