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Knee Case Review: Adult Female Chronic Meniscus Tear

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Okay, this is an older woman,

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not going to say what's older

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to be politically correct in the current environment,

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but she has a meniscus tear that is

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not unique to anybody over the age of 50.

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In fact,

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the overwhelming majority of people over 50,

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you're going to have something like this

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that's maybe a little less severe.

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And what does she have?

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She has the typical chronic body cleavage tear

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in a pseudo extruded lax meniscus

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whose attachments have grown progressively

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more lax over time due to the altered

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hoop stresses and tension from the femur,

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pressing down on the tibia.

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Part of this exacerbation of hoop stresses

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comes in the form of bony remodeling.

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The femoral condyle is not a

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nice half circle anymore.

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Kind of has a little bit of a dippity-do right here.

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It's also shifted.

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You can see the femur is shifted

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relative to the tibia,

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and that doesn't do the lateral meniscus any good.

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In fact,

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it's a very unfriendly phenomenon

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to either meniscus.

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It's also a very unfriendly phenomenon to the knee notch.

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Because now, you've got these spines

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that are pressing against,

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or in some cases,

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tugging on the cruciates aberrantly or abnormally

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because you're no longer aligned straight up and down,

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so you end up with some notch synovitis.

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So notch synovitis,

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remodeling shift and meniscal pseudo extrusion,

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or meniscus displacement from meniscal capsular laxity,

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they all go hand in hand.

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These are not surgical menisci.

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You can't fix this.

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Person's lying on their back,

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the meniscus is not even sitting

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between the femur and the tibia.

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It's doing the patient no good supine.

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So imagine how little good it does

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than when they are standing up.

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Never should you see signal in the

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inner third of the meniscus,

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at least not in a normal person.

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You're going to see it in just about everybody.

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As we said, over the age of 50,

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certainly over the age of 60,

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these are a source of pain.

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They are not resected.

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They are usually either injected

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or they're treated with lubricant

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injected into the joint,

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steroid injected into the joint,

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or some unloader brace

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until finally the patient requires a total knee replacement.

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Now, one of the reasons why these tears

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are so often underdiagnosed,

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and maybe it's a good thing

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that you're under diagnosing them

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because then they won't have an unnecessary resection.

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But if you're going to diagnose them,

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call them incidental,

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trizonal, horizontal, cleavage tears

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in a degenerated knee.

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If you really want to slam the door shut

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on a surgery,

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call the tear degenerative,

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although some surgeons may object

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to that descriptor.

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Now, again,

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one of the reasons why this tear is so often undercalled

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is because it's hard to see in the sagittal projection.

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It's coming straight at you,

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right?

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It's kind of like a line.

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Here it is.

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There is the tear.

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It doesn't often articulate with an articular surface

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because it's coming into the screen.

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It's going from medial to lateral.

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So, you're cutting it like you're cutting through

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a turkey sandwich.

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So, here's the turkey.

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The dark is a piece of bread,

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and the other dark is the other piece of bread.

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So, that is the same tear as this,

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just coming straight at you into the sagittal projection.

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So just for emphasis,

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tears that are shaped like this in degenerated knees

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that begin in the inner third

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and kind of go straight out

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and get a little irregular

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and somewhat mushy looking,

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they're non-surgical tears.

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They're common,

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they're chronic,

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they're often degenerative.

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They're even more common in women,

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and they're especially common in people

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who are overweight.

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Let's do another one, shall.

Report

Description

Faculty

Stephen J Pomeranz, MD

Chief Medical Officer, ProScan Imaging. Founder, MRI Online

ProScan Imaging

Tags

Non-infectious Inflammatory

Musculoskeletal (MSK)

MRI

Knee

Idiopathic

Acquired/Developmental

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