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58 KNEE MENISCAL INJURIES
John P Goldblatt, MD
John C Richmond, MDINTRODUCTION
- The meniscus plays an important role in weight dis-
tribution, reduction in joint contact stresses, joint sta-
bilization, and energy absorption (Greis et al, 2002(a);
Fairbank, 1948; Arnoczky and McDevitt, 2000; Rath
and Richmond, 2000; Lo et al, 2003). Injury to the
meniscus can result in marked physical impairment. - Once thought to be a vestigial organ, it is now recog-
nized that meniscectomy often leads to a recognizable
pattern of joint deterioration including, joint space
narrowing, osteophyte formation, and squaring of the
femoral condyles (Fairbank, 1948).
•Meniscal preservation is the goal of new surgical pro-
cedures.- Arthroscopy facilitates optimal treatment of meniscal
tears with minimally invasive techniques.
ANATOMY AND BASIC SCIENCE- Each of the medial and lateral compartments of a knee
has an intervening meniscus located between the
femur and tibia. - The menisci are peripherally thick and convex, and
centrally taper to a thin free margin (Arnoczky and
McDevitt, 2000). - The meniscal surfaces conform to the femoral and
tibial contours. - Each meniscus has anterior and posterior bony attach-
ment sites.
MEDIAL MENISCUS- The medial meniscus is semicircular, crescent shaped,
and measures approximately 3.5 cm in length. - The medial meniscus covers 50–60% of the medial
tibial plateau. The posterior horn is wider than the
anterior horn in the anteroposterior(AP) dimension
(Rath and Richmond, 2000; Lo et al, 2003). - The attachment site for the anterior horn is variable, in
the area of the intercondylar fossa in front of the ante-
rior cruciate ligament(ACL), often to the anterior
surface of the tibial plateau. - The posterior fibers of the anterior horn merge with
the transverse fibers of the intermeniscal ligament,
which connects the anterior horns of the medial and
lateral menisci. The intermenicscal ligament is
located approximately 8 mm anterior to the ACL
(Arnoczky and McDevitt, 2000). - The posterior horn is firmly attached to the posterior
intercondylar fossa of the tibia, anterior and medial to
the PCL attachment site (Arnoczky and McDevitt,
2000). - The periphery is attached to the capsule throughout its
length, and the tibial portion of this attachment is
called the coronary ligament. In addition, at its mid-
point, the medial meniscus is firmly attached to the
femur and tibia through a condensation of the joint
capsule known as the deep medial collateral ligament
(Rath and Richmond, 2000).
LATERAL MENISCUS- The lateral meniscus is almost circular in gross mor-
phology, and covers 70–80% of the lateral tibial
342 SECTION 4 • MUSCULOSKELETAL PROBLEMS IN THE ATHLETE