In this episode of PodMD, Australian trained Orthopaedic Surgeon Dr Terry Stephens will be discussing meniscal tears in the over 40 age group, including what meniscal tears are, management of the condition, treatment, when a GP should refer and more.
- Transcript
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*As always, all in this PODMD podcast is intended for health professionals and the comments are of a general nature. Information given is not intended as specific medical advice pertaining to any given patient. If you have a clinical issue with one of your patients please seek appropriate advice from a colleague with expertise in the area.
Today I’d like to welcome to the PodMd studio Dr Terry Stephens
Dr Stephens is an Australian trained Orthopaedic surgeon with further training in Canada. His speciality interests are in revision procedures, general trauma including; fractures around joint replacements, close to joints, the pelvis, and soft tissue knee injuries.
Today, we’ll be discussing meniscal tears in the over 40 age group
*We do hope you enjoy this podcast but please remember that the advice here is of a general nature and is not intended as specific advice about a given patient. The views and opinions expressed in this podcast are those of the doctor, not PodMD.
If you do have a patient on whom you require specific advice, then please seek advice from a colleague with appropriate expertise in that area.Terry, thanks for talking with us on Pod MD today.
Terry: Thank you very much for having me today
Question 1
First off, can you give us a quick explanation on what exactly meniscal tears are?Terry: Thanks very much for having me today, Sean. Yeah. So, the meniscus is a cartilaginous structure, and it acts as a shock absorber and a stabilizer of the name is obviously one president perform a medial and the lateral femoral tibial joint. I can be injured by trauma or by degenerative diseases such as osteoarthritis.
Question 2
What is the difference with meniscal tears in the over 40s range?Terry: So, this is more likely to be degenerative in nature. And I often have different tear patterns, which reflect that the number of visuals and specifically the sorts of tad happen that are related to degenerative changes, include things such as horizontal cleavage, Tez, radio tests, or combinations of those sorts of tears or things that are more acute.
Question 3
Is the pathology different in over 40s?Terry: So, it commonly there’s a degree of undiagnosed or asymptomatic osteoarthritis. The meniscus itself is more stiff as you get older, particularly once you already are in particular form and it has a less of an ability to, to repair itself. And once this meniscus is injured, it can often commence a cascade towards symptomatic osteoarthritis. This is even the spot. Uh, the initial injury to the meniscus may appear today a specific traumatic event. There might be some underlying problem that someone didn’t know that for a loss in terms of at least the initial management.
Question 4
And how does the management differ in 40-year-olds?Terry: So, the initial management is obviously particularly consisting of paracetamol and then whatever your favourite non-steroidal anti-inflammatory is a short period of rest. Although this is not rest as entirely mobilization, it should be the am should be to reduce pain and swelling while maintaining range of motion and ability to activate the quadriceps muscle. And once the pine and things start to settle and they should be followed by structuring your muscular strengthening program, which should be implemented at a physiotherapist or even an exercise physiologist, and most of them will settle without surgery.
Question 5
How should GPs treat meniscal tears different in this specific age group?Terry: Uh, so I think it’s always important to get an x-ray to assess the degree of pre-existing osteoarthritis. I know it’s a soft tissue injury and you want to say a specific in this school repair on an x-ray. However, I think it guides management very nicely. You should consider getting an MRI earlier, particularly if the x-ray is normal, but I think it’s still important to commence active range of motion early and stop him on the physiotherapy program. But one exception is probably if you have unmade, that’s locked where you’re unable to, where the patients are unable to completely Stripe. And then these are more urgent.
Question 6
Is there anything specific that should be considered for prevention of meniscal tears in over 40s?Terry: Not specifically, other than the usual things that are required for good knee health. Those include keeping active and maintaining a healthy white are important. And obviously if you do have pre-existing condition, then it’s important to modify your activities not to aggravate it.
Question 7
When should a GP refer?Terry: So clinically, if a patient has a locked knee and ie. This is an inability to completely striking the navies requires relatively urgent referral. If the GPs can have an MRI completed and it shows specific tip, having such as a bucket handle tear, how close to the root or peripheral tears, which maybe lend themselves to be repaired, then they should be referred early, particularly in the setting of a normal knee x-ray. And the third category, I would say, acutely is any tears without the presence of any radio or graphic osteoporotic on a white bearing x-ray should, would warrant an area.
Concluding Question
Thank you for your time here today in the PodMD studio. To sum up for us, could you please identify the three key take home messages from today’s podcast on meniscal tears in over 40s.Terry: So clinically, if a patient has a locked knee and ie. This is an inability to completely striking the navies requires relatively urgent referral. If the GPs can have an MRI completed and it shows specific tips, having such as a bucket handle tear, how close to the root or peripheral tears, which may lend themselves to be repaired, then they should be referred early, particularly in the setting of a normal knee x-ray. And the third category, I would say, acutely is any tears without the presence of any radio or graphic osteoporotic on a white bearing x-ray should, would warrant an area.
Thanks for your time and the insights you’ve provided.
Terry: Thank you for having me
