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Meniskskada i knäleden

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Sakkunnig:
Definition:
Innebär bristning eller avslitning av den mediala eller laterala menisken till följd av skador eller degenerativa processer.
Förekomst:
Vanligt vid kontaktidrott och generellt i befolkningen, men många har inga symtom.
Symtom:
Smärta, stelhet, instabilitet och eventuellt låsning.
Fynd:
Smärta över ledspringa, svullnad, smärta eller klickande ljud vid rotationsrörelser, eventuellt nedsatt rörlighet
Diagnostik:
Kliniska tester är osäkra. MR har hög diagnostisk säkerhet men är sällan indicerad. 
Behandling:
Meniskskador behandlas konservativt. Vid akuta skador, idrottsskador och låsningar kan artroskopisk kirurgi vara aktuellt. 
  1. Englund M, Guermazi A, Gale D et al. Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med 2008; 359: 1108-15. New England Journal of Medicine  
  2. Kaarre J, Helou D, Karlsson J, Samuelsson K. ABC om Meniskskador Del 1: Akuta meniskskador. Läkartidningen. 2022;119:21233. cms.medibas.se  
  3. Kaarre J, Helou D, Karlsson J, Samuelsson K. ABC om Meniskskador Del 2: Degenerativa meniskskador. Läkartidningen. 2022;119:21241. lakartidningen.se  
  4. Stärke C, Kopf S, Petersen W, et al. Meniscal repair. Arthroscopy 2009; 25: 1033-1044. pmid:19732643 PubMed  
  5. Lohmander LS, Englund PM, Dahl LL, et al. The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis. Am J Sports Med. 2007;35:1756-1769. PubMed  
  6. Scholten RJPM, Devillè WLJM, Opstelten W, Bijl D, et al. The accuracy of physical diagnostic tests for assessing meniscal lesions of the knee, A meta-analysis. J Fam Pract 2001; 50: 938-44. PubMed  
  7. O'Donnell K, Freedman KB, Tjoumakaris FP. Rehabilitation Protocols After Isolated Meniscal Repair: A Systematic Review. Am J Sports Med 2017; 7: 1687-97. pmid:28256906 PubMed  
  8. Eren OT. The accuracy of joint line tenderness by physical examination in the diagnosis of meniscal tears. Arthroscopy. 2003 Oct. 19(8):850-4. www.ncbi.nlm.nih.gov  
  9. Lee JH, Lim YJ, Kim KB, Kim KH, Song JH. Arthroscopic pullout suture repair of posterior root tear of the medial meniscus: radiographic and clinical results with a 2-year follow-up. Arthroscopy. 2009 Sep. 25(9):951-8. www.ncbi.nlm.nih.gov  
  10. Blyth M, Anthony I, Francq B, et al. Diagnostic accuracy of the Thessaly test, standardised clinical history and other clinical examination tests (Apley's, McMurray's and joint line tenderness) for meniscal tears in comparison with magnetic resonance imaging diagnosis. Health Technol Assess 2015; 62: 1-62. pmid:26243431 PubMed  
  11. Munk B, Madsen F, Lundorf E, Staunstrup H, Schmidt SA, Bolvig L et al. Clinical magnetic resonance imaging and arthroscopic findings in knees: a comparative prospective study of meniscus, anterior cruciate ligament and cartilage lesions. Arthroscopy 1998; 14: 171-5. PubMed  
  12. Ryzewicz M, Peterson B, Siparsky PN, Bartz RL. The Diagnosis of Meniscus Tears: The Role of MRI and Clinical Examination. Clin Orthop Relat Res 2007; 455: 123-33. PubMed  
  13. Roberts T, Singer N, Hushmendy S, et al. MRI for the evaluation of knee pain: comparison of ordering practices of primary care physicians and orthopaedic surgeons. J Bone Joint Surg Am 2015; 97(9): 709-14. pmid:25948516 PubMed  
  14. Phelan N, Rowland P, Galvin R. A systematic review and meta-analysis of the diagnostic accuracy of MRI for suspected ACL and meniscal tears of the knee. Knee Surg Sports Traumatol Arthrosc 2016; 24(5): 1525-39. pmid:26614425 PubMed  
  15. Bernthal NM, Seeger LL, Motamedi K, et al. Can the reparability of meniscal tears be predicted with magnetic resonance imaging? Am J Sports Med 2011; 39: 506-10. PubMed  
  16. Shetty AA, Tindall AJ, James KD, Relwani J, Fernando KW. Accuracy of hand-held ultrasound scanning in detecting meniscal tears. J Bone Joint Surg Br 2008; 90-B: 1045-8.
  17. Siemieniuk RAC, Harris IA, Agoritsas T, et al. Arthroscopic surgery for degenerative knee arthritis and meniscal tears. BMJ 2017; 357: j1982. PMID:28490431. PubMed  
  18. Katz JN, Brophy RH, Chaisson CE, et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med 2013;368:1675-84. PMID:23506518. PubMed  
  19. Sihvonen R, Paavola M, Malmivaara A, et al. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med. 2013: 26; 369: 2515-24. doi: 10.1056/NEJMoa1305189 DOI  
  20. Khan M, Evaniew N, Bedi A, et al. Arthroscopic surgery for degenerative tears of the meniscus: a systematic review and meta-analysis. CMAJ 2014. doi:10.1503/cmaj.140433 DOI  
  21. Kise NJ, Risberg MA, Stensrud S, et al. Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up. BMJ 2016; 354:i3740. pmid: 27440192. PubMed  
  22. Yim JH, Seon JK, Song EK, et al. A comparative study of meniscectomy and nonoperative treatment for degenerative horizontal tears of the medial meniscus. Am J Sports Med 2013 May 23. PMID: 23703915 PubMed  
  23. Bergenstock M, Min W, Simon AM, et al. A comparison between the effects of acetaminophen and celecoxib on bone fracture healing in rats. J Orthop Trauma 2005; 19: 717-723.
  24. O'Connor JP, Lysz T. Celecoxib, NSAIDs and the skeleton. Drugs Today (Barc) 2008; 44: 693-709.
  25. Mutsaerts EL, van Eck CF, van de Graaf VA, et al. Surgical interventions for meniscal tears: a closer look at the evidence. Arch Orthop Trauma Surg. 2016 Mar;136(3):361-70. pmid: 26497982. PubMed  
  26. Skou ST, Hölmich P, Lind M, et al. Early Surgery or Exercise and Education for Meniscal Tears in Young Adults. N Engl J Med 2022. doi:10.1056/EVIDoa2100038 DOI  
  27. Beaufils P, Becker R, Kopf S, et al. Surgical Management of Degenerative Meniscus Lesions: The 2016 ESSKA Meniscus Consensus. Knee Surg Sports Traumatol Arthrosc 2017; 25: 335-346. pmid:28210788 PubMed  
  28. Sihvonen R, Paavola M, Malmivaara A, et al. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear- N Engl J Med 2013; 369: 2515-24. PMID:24369076. PubMed  
  29. Artroskopisk kirurgi saknar effekt vid artros i knä och leder till höga kostnader. SBU Prioriteringsstöd. 2014-10-15. www.sbu.se  
  30. Persson F, Turkiewicz A, Bergkvist D. The risk of symptomatic knee osteoarthritis after arthroscopic meniscus repair vs partial meniscectomy vs the general population. Osteoarthritis Cartilage 2018; 26(2): 195-201. pmid:29146386 PubMed  
  • Remy Waardenburg, specialist i allmänmedicin, medicinsk redaktör Medibas

Tidigare sakkunniga

  • Katarina Lönn, specialistläkare, Verksamhetsområde ortopedi, Akademiska sjukhuset, Uppsala