Medial meniscus

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Medial meniscus
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Head of right tibia seen from above, showing menisci and attachments of ligaments. (Medial meniscus visible at left.)
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Left knee joint from behind, showing interior ligaments.
Details
Identifiers
Latin meniscus medialis
TA98 A03.6.08.005
TA2 1888
FMA 44620
Anatomical terminology

The medial meniscus is a fibrocartilage semicircular band that spans the knee joint medially, located between the medial condyle of the femur and the medial condyle of the tibia. [1] It is also referred to as the internal semilunar fibrocartilage. The medial meniscus has more of a crescent shape while the lateral meniscus is more circular. The anterior aspects of both menisci are connected by the transverse ligament. It is a common site of injury, especially if the knee is twisted.

Contents

Structure

The meniscus attaches to the tibia via coronary ligaments.

Its anterior end, thin and pointed, is attached to the anterior intercondyloid fossa of the tibia, in front of the anterior cruciate ligament;

Its posterior end is fixed to the posterior intercondyloid fossa of the tibia, between the attachments of the lateral meniscus and the posterior cruciate ligament.

It is fused with the tibial collateral ligament which makes it far less mobile than the lateral meniscus. The points of attachment are relatively widely separated and, because the meniscus is wider posteriorly than anteriorly, the anterior crus is considerably thinner than the posterior crus. The greatest displacement of the meniscus is caused by external rotation, while internal rotation relaxes it. [1]

During rotational movements of the tibia (with the knee flexed 90 degrees), the medial meniscus remains relatively fixed while the lateral part of the lateral meniscus is displaced across the tibial condyle below. [2]

Function

The medial meniscus separates the tibia and femur to decrease the contact area between the bones, and serves as a shock absorber reducing the peak contact force experienced. It also reduces friction between the two bones to allow smooth movement in the knee and distribute load during movement.

Clinical significance

Injury

Medial meniscus injury Medial Meniscus Injury.png
Medial meniscus injury

Acute injury to the medial meniscus frequently accompanies an injury to the ACL (anterior cruciate ligament) or MCL (medial collateral ligament). A person occasionally injures the medial meniscus without harming the ligaments. Healing of the medial meniscus is generally not possible unless the patient is very young, usually <15 years old. Damage to the outer third of the meniscus has the best healing potential because of the blood supply, but the inner two thirds of the medial meniscus has a limited blood supply and thus limited healing ability. Large tears to the meniscus may require surgical repair or removal. In terms of a meniscus tear, the doctor can categorize the injury in a plethora of ways. For example, a tear on the outer edge of the meniscus has great chance of healing. Doctors call this site the “red zone” because this outer portion of the meniscus is highly vascularized; therefore, it receives the amount of nutrients and support needed for a successful recovery. Conversely, the inner two-thirds of the meniscus are called the “white zone.” This portion of the meniscus is not highly vascularized; it receives its nourishment from only the synovial fluid via diffusion. Considering these facts, doctors consider different treatments to different kinds of tears: [3]

If the meniscus has to be removed (menisectomy) because of injury (either because it cannot heal or because the damage is too severe), the patient has an increased risk of developing osteoarthritis in the knee later in life. [4] [5] [6] If the meniscus is removed and there is no arthritis, there are now meniscus transplant options if the patient is young and has normal alignment. [7] [ unreliable source? ]

More chronic injury occurs with osteoarthritis, made worse by obesity and high-impact activity. The medial meniscus and the medial compartment are more commonly affected than the lateral compartment.

Often, moderate to severe injury or injury past early middle age to the meniscus will indicate a total knee replacement.

See also

Additional images

Related Research Articles

<span class="mw-page-title-main">Human leg</span> Lower extremity or limb of the human body (foot, lower leg, thigh and hip)

The leg is the entire lower limb of the human body, including the foot, thigh or sometimes even the hip or buttock region. The major bones of the leg are the femur, tibia, and adjacent fibula. The thigh is between the hip and knee, while the calf (rear) and shin (front) are between the knee and foot.

<span class="mw-page-title-main">Knee</span> Leg joint in primates

In humans and other primates, the knee joins the thigh with the leg and consists of two joints: one between the femur and tibia, and one between the femur and patella. It is the largest joint in the human body. The knee is a modified hinge joint, which permits flexion and extension as well as slight internal and external rotation. The knee is vulnerable to injury and to the development of osteoarthritis.

<span class="mw-page-title-main">Tibia</span> Leg bone in vertebrates

The tibia, also known as the shinbone or shankbone, is the larger, stronger, and anterior (frontal) of the two bones in the leg below the knee in vertebrates ; it connects the knee with the ankle. The tibia is found on the medial side of the leg next to the fibula and closer to the median plane. The tibia is connected to the fibula by the interosseous membrane of leg, forming a type of fibrous joint called a syndesmosis with very little movement. The tibia is named for the flute tibia. It is the second largest bone in the human body, after the femur. The leg bones are the strongest long bones as they support the rest of the body.

<span class="mw-page-title-main">Posterior cruciate ligament</span> One of four major ligaments of the knee

The posterior cruciate ligament (PCL) is a ligament in each knee of humans and various other animals. It works as a counterpart to the anterior cruciate ligament (ACL). It connects the posterior intercondylar area of the tibia to the medial condyle of the femur. This configuration allows the PCL to resist forces pushing the tibia posteriorly relative to the femur.

<span class="mw-page-title-main">Anterior cruciate ligament</span> Type of cruciate ligament in the human knee

The anterior cruciate ligament (ACL) is one of a pair of cruciate ligaments in the human knee. The two ligaments are also called "cruciform" ligaments, as they are arranged in a crossed formation. In the quadruped stifle joint, based on its anatomical position, it is also referred to as the cranial cruciate ligament. The term cruciate translates to cross. This name is fitting because the ACL crosses the posterior cruciate ligament to form an "X". It is composed of strong, fibrous material and assists in controlling excessive motion. This is done by limiting mobility of the joint. The anterior cruciate ligament is one of the four main ligaments of the knee, providing 85% of the restraining force to anterior tibial displacement at 30 and 90° of knee flexion. The ACL is the most injured ligament of the four located in the knee.

<span class="mw-page-title-main">Segond fracture</span> Avulsion fracture of the lateral tibial condyle of the knee

The Segond fracture is a type of avulsion fracture from the lateral tibial plateau of the knee, immediately below the articular surface of the tibia.

<span class="mw-page-title-main">Medial collateral ligament</span> Ligament on the inner side of the knee joint

The medial collateral ligament (MCL), also called the superficial medial collateral ligament (sMCL) or tibial collateral ligament (TCL), is one of the major ligaments of the knee. It is on the medial (inner) side of the knee joint and occurs in humans and other primates. Its primary function is to resist valgus forces on the knee.

<span class="mw-page-title-main">Meniscus (anatomy)</span> Fibrocartilaginous part of a bone joint

A meniscus is a crescent-shaped fibrocartilaginous anatomical structure that, in contrast to an articular disc, only partly divides a joint cavity. In humans, they are present in the knee, wrist, acromioclavicular, sternoclavicular, and temporomandibular joints; in other animals they may be present in other joints.

<span class="mw-page-title-main">Lateral meniscus</span>

The lateral meniscus is a fibrocartilaginous band that spans the lateral side of the interior of the knee joint. It is one of two menisci of the knee, the other being the medial meniscus. It is nearly circular and covers a larger portion of the articular surface than the medial. It can occasionally be injured or torn by twisting the knee or applying direct force, as seen in contact sports.

The knee examination, in medicine and physiotherapy, is performed as part of a physical examination, or when a patient presents with knee pain or a history that suggests a pathology of the knee joint.

<span class="mw-page-title-main">Lower extremity of femur</span>

The lower extremity of femur is the lower end of the femur in human and other animals, closer to the knee. It is larger than the upper extremity of femur, is somewhat cuboid in form, but its transverse diameter is greater than its antero-posterior; it consists of two oblong eminences known as the lateral condyle and medial condyle.

<span class="mw-page-title-main">Fibular collateral ligament</span> Collateral fibular ligament

The lateral collateral ligament is an extrinsic ligament of the knee located on the lateral side of the knee. Its superior attachment is at the lateral epicondyle of the femur ; its inferior attachment is at the lateral aspect of the head of fibula. The LCL is not fused with the joint capsule. Inferiorly, the LCL splits the tendon of insertion of the biceps femoris muscle.

<span class="mw-page-title-main">Unhappy triad</span> Medical condition of the knee

The unhappy triad, also known as a blown knee among other names, is an injury to the anterior cruciate ligament, medial collateral ligament, and meniscus. Analysis during the 1990s indicated that this 'classic' O'Donoghue triad is actually an unusual clinical entity among athletes with knee injuries. Some authors mistakenly believe that in this type of injury, "combined anterior cruciate and medial collateral ligament disruptions that were incurred during athletic endeavors" always present with concomitant medial meniscus injury. However, the 1990 analysis showed that lateral meniscus tears are more common than medial meniscus tears in conjunction with sprains of the ACL.

<span class="mw-page-title-main">Articular capsule of the knee joint</span>

The articular capsule of the knee joint is the wide and lax joint capsule of the knee. It is thin in front and at the side, and contains the patella, ligaments, menisci, and bursae of the knee. The capsule consists of an inner synovial membrane, and an outer fibrous membrane separated by fatty deposits anteriorly and posteriorly.

<span class="mw-page-title-main">Posterior meniscofemoral ligament</span>

The Posterior meniscofemoral ligament is a small fibrous band of the knee joint. It attaches to the posterior area of the lateral meniscus and crosses superiorly and medially behind the posterior cruciate ligament to attach to the medial condyle of the femur.

<span class="mw-page-title-main">Meniscus tear</span> Rupturing of the fibrocartilage strips in the knee called menisci

A tear of a meniscus is a rupturing of one or more of the fibrocartilage strips in the knee called menisci. When doctors and patients refer to "torn cartilage" in the knee, they actually may be referring to an injury to a meniscus at the top of one of the tibiae. Menisci can be torn during innocuous activities such as walking or squatting. They can also be torn by traumatic force encountered in sports or other forms of physical exertion. The traumatic action is most often a twisting movement at the knee while the leg is bent. In older adults, the meniscus can be damaged following prolonged 'wear and tear'. Especially acute injuries can lead to displaced tears which can cause mechanical symptoms such as clicking, catching, or locking during motion of the joint. The joint will be in pain when in use, but when there is no load, the pain goes away.

<span class="mw-page-title-main">Transverse ligament of knee</span>

The transverse or [anterior] meniscomeniscal ligament is a ligament in the knee joint that connects the anterior convex margin of the lateral meniscus to the anterior end of the medial meniscus.

<span class="mw-page-title-main">Discoid meniscus</span>

Discoid meniscus is a rare human anatomic variant that usually affects the lateral meniscus of the knee. Usually a person with this anomaly has no complaints; however, it may present as pain, swelling, or a snapping sound heard from the affected knee. Strong suggestive findings on magnetic resonance imaging includes a thickened meniscal body seen on more than two contiguous sagittal slices.

<span class="mw-page-title-main">Tibial plateau fracture</span> Medical condition

A tibial plateau fracture is a break of the upper part of the tibia (shinbone) that involves the knee joint. This could involve the medial, lateral, central, or bicondylar. Symptoms include pain, swelling, and a decreased ability to move the knee. People are generally unable to walk. Complication may include injury to the artery or nerve, arthritis, and compartment syndrome.

The anterolateral ligament (ALL) is a ligament on the lateral aspect of the human knee, anterior to the fibular collateral ligament.

References

PD-icon.svgThis article incorporates text in the public domain from page 343 of the 20th edition of Gray's Anatomy (1918)

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