Learn about how important the knee meniscus is in protecting the knee from stresses and strains that might otherwise damage the joint surfaces and lead to irreparable arthritis. Understand those issues that face both you and the clinical team if you damage your meniscus, and become more confident in making the right decisions about treatment.
Putting anatomy into context
A sympathetic explanation of the anatomy of the menisci and the ligaments that help to support them, lead the student to a clearer understanding of the functional consequences of a meniscus tear or an avulsion. Highlighting the key differences between the medial and lateral meniscus will clarify for you why management decisions may differ in these two structures. The take-home message focuses on how apparently minor injury of a meniscus can lead to major consequences, unless managed appropriately and in a timely fashion.
Richly illustrated, clear explanations
Simple explanations, but never condescending, are supported by unique illustrations. Most of the 23 lectures (in 6 sections) integrate illustration into video via whiteboard animations. Medical publications and online references at an appropriate level offer extra value via the Resources sections of each Lecture.
Who will benefit from this course?
The course is intended for people who have a meniscus problem of their own, and who want to understand the issues and to be able to discuss matters confidently with a doctor in order to allow them make sensible decisions.
It will also benefit members of the medical profession who have a need to understand knee orthopaedics, such as nursing staff, physiotherapy students, and junior doctors.
The course will probably take two hours for a beginner to complete, but the additional reference material in the Resources section will of course add extra value.
Meet your instructor, Dr Sheila Strover, and find out why she is passionate about helping people understand about knee problems. Also find out about a confusing terminology issue, so that you can use the correct terminology when searching for information online.
Learn how to exploit the extra value in the Resources section, how to take notes and 'timestamp' videos, and also involve yourself in discussions about meniscus problems. Remember that there may be useful downloadables in the Resources.
Start to grasp the basic meniscus vocabulary, and distinguish the important differences between the medial and lateral meniscus. This will help set the stage to expand on the anatomy concepts a little later in the course.
Learn how the internal structure of the meniscus contributes to its function in terms of cushioning impact and enhancing knee stability and spatial awareness. This will help you to understand the serious consequences when a meniscus tear is not properly managed.
Find out how the blood supply of the meniscus is critical to determining which meniscus tears are likely to heal and which are not. Learn about the red and white zones, and how the surgeon will try to optimise the opportunity for healing.
Gain an understanding of how the menisci are tethered, allowing some movement but in a restrained way. Learn how the medial and lateral menisci differ in their movement and tethering. The meniscal roots, the coronary ligaments and the popliteus are important but tears here may be missed - an understanding of the anatomy may assist you in seeking the right opinions.
Find out about this normal variant that often causes meniscus problems in children. This is a very important issue as early arthritis can be an outcome if the discoid meniscus patient is not recognised early and followed through adulthoood.
Gain awareness of the various kinds of damage inside the knee that can affect the several functions of the meniscus, and how the lack of full competence can lead to instability, arthritis and even deformity.
Find out about the different kinds of meniscus tears, and why the differences matter. In this lecture you will learn about circumferential and radial tears, vertical and horizontal tears, and stable and unstable tears of the meniscus. In particular you will learn about how a bucket handle tear can lead to locking and further damage.
Learn about the ligamentous supports of the menisci, and how damage to these ligaments can mimic meniscus tears. This is a really important lecture, because these problems may be missed at arthroscopy, and symptoms of instability may continue despite the meniscus appearing intact.
Understand how important the meniscal roots are to knee stability. Early arthritis is inevitable if a meniscus root tear or avulsion is missed, and patients must not be afraid to ask for second opinions about their MRI scan.
Find out why popliteus integrity matters, and how tears of the popliteus can easily be missed, with consequences to long term meniscus function. This is a problem specific to the lateral meniscus.
Understand how wear-and-tear can weaken meniscus structure and lead to extrusion of the meniscus over the edge of the tibia, leaving the joint surfaces unprotected and vulnerable to arthritic change.
Discover those particular activities that may lead to meniscus damage, and make sure that you offer the doctor a good explanation of the exact position of the joint at the time of injury, and any other precipitating factors such as a direct impact on the knee.
Find out how the doctor uses stress tests to try and confirm the diagnosis of meniscus injury, and how this is really an inexact science. Learn more about MRI interpretation in cases of meniscus injury.
Learn the basic exercises to keep things moving while you consider your options. A downloadable sheet is available for you as an extra Resource, containing details of the exercises and the repetitions.
Become informed to better share the decision-making process with your surgeon. See how the type of injury dictates the options for surgery, and the probability of preserving useful meniscus function and preventing arthritis.
Understand the surgical options for repairing the meniscus. Learn about meniscus repair with sutures, fixation devices or 'glues', and how the type and situation of the tear will dictate the likely outcome.
Find out when it is impossible to save the meniscus tissue because of the nature of the tear or its position. Also learn the terminology for the various procedures when meniscus tissue is removed.
Understand what the long term outcome may be of not having a functioning meniscus. Gain an awareness of knee compartments, and how an incompetent compartment may lead initially to a functional gait abnormality and then later to a true structural deformity of bow legs or knock knees.
Find out how unloader braces and osteotomy can help to relieve symptoms or early arthritis relating to meniscus loss. This is a neglected set of options in the treatment armamentarium, and patients really need to press their surgeon for information before considering 'amputative' surgery such as partial knee replacement.
Learn about newer techniques of replacement of the destroyed meniscus, including bio-engineered scaffolds and meniscal transplantation.
Learn how partial and total knee replacement are salvage procedures, representing a failure somewhere along the treatment pathway.
Dr Sheila Strover (BScHons MBBCh MBA) is Director of ftmg Associates Ltd in the UK and responsible for key strategy and the development of the clinical content on the KNEEguru website. She is a medical practitioner (ex anaesthetist), with many years' experience working in a medical managerial capacity with the knee surgeons and physiotherapists at the Droitwich Knee Clinic and The Knee Foundation in the UK, although she left those two organisations in 2003, and no longer has any commercial involvement with them.