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Meniscal Injuries of the Knee

©

Edward P. Mulligan, MS, PT, SCS, ATC

VP, National Director of Clinical Education

HealthSouth Corporation

Grapevine, TX

Clinical Instructor

University of Texas Southwestern PT Dept

Dallas, TX

The contents of this presentation are copyrighted © 2004 by continuing ED . They may not be utilized, reproduced,

stored, or transmitted in any form or by any means, electronic or mechanical, or by any information storage or

retrieval system, without permission in writing from Edward P. Mulligan.

continuing ED

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Learning Objectives

Following the completion of the inservice the participant will be able to:

1. identify meniscal anatomy and vascular penetration

2. describe meniscal biomechanics, pathomechanics,

and mechanisms of injury

3. explain common meniscal mechanisms and

resultant classification of injury

4. describe relevant orthopedic examination

procedures relevant to the meniscus

5. define indications for surgical excision, repair,

and allograft replacement

6. design and effective post-operative rehab program

continuing ED

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Meniscal Anatomy

Semilunar wedges

of fibrocartilage

interposed between

the femoral condyles

and tibial plateau

continuing ED

General Overview of Left Knee anatomy from a cross-sectional perspective.

The menisci are semilunar wedges of fibrocartilage interposed between the femoral

condyles above and the tibial plateau below.

On the lateral meniscus note the anterior and posterior horns; posterior

meniscofemoral ligament (Ligament of Wrisberg); and popliteal muscle’s (not the

tendon’s ) attachment

The medial Meniscus also has anterior and posterior horns

The origins of the anterior and posterior cruciate ligament are evident. The anterior

cruciate ligament courses in a superior, posterior, and lateral direction to insert on

the medial wall of the lateral femoral condyle. The much larger PCL moves in a

superior and anterior direction towards its insertion on the femur.

continuing ED

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Medial Meniscus

z "C" shaped

z Broader posteriorly than anteriorly

z Peripheral Attachments:

• entire peripheral border is firmly

attached to the medial capsule

• semimembranosus tendon slip

attaches to posterior horn

• fibers of ACL attach to anterior horn

• meniscopatellar fibers attach to

medial border of meniscus

continuing ED

The medical meniscus is shaped like a "C" and is broader posteriorly than

anteriorly. It is firmly attached to the tibial plateua by a number of structures.

Peripheral Attachments:

•The entire peripheral border is firmly attached to the medial capsule via the

coronary ligaments

•A slip of the semimembranosus tendon attaches to posterior horn

•The fibers of ACL blend into the anterior horn of the medial meniscus

•The meniscopatellar fibers attach to medial border of meniscus

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Lateral Meniscus

z "O" shaped covering 2/3 of tibial plateau

z Smaller in diameter, thicker in periphery, and

wider in body than the medial meniscus

z More mobile than medial meniscus

z Peripheral Attachments:

• popliteus muscle (not tendon) sends

fibrous slip to posterior border

• ligament of Wrisberg (meniscofemoral ligament)

attaches to posterior horn

• anterior horn to ACL

continuing ED

The peripheral attachments on the lateral side are not a seucre or significant as on

the medial side. Peripheral attachments include:

•The popliteus muscle (not tendon) sends a fibrous slip to posterior border

•The ligament of Wrisberg (posterior meniscofemoral ligament) attaches to posterior

horn and is intimate with the posterior cruciate ligament

•The ligament of Humphry (anteior meniscofemoral ligament) also courses obliquely

form the lateral aspect of the medial femoral condyle to attach to the central portion

of the posterior horn of the lateral meniscus.

•The anterior horn tof the lateral mensicus terminates in in the area of the origin of

the anterior cruciate lgiament.

•The small, anterior, transverse intermeniscal ligament connects the anterior horns

of the medial and lateral menisci

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