The posterior horn of the lateral meniscus includes the main body of the lateral meniscus, posterior to the popliteus tendon, and its root attachment on the posterior aspect of the tibia. The lateral meniscus is even more important than the medial meniscus for shock absorption. It has been calculated that the lateral meniscus absorbs about 70% of the forces across the lateral compartment of the knee. Thus, the loss of the lateral meniscus can often lead to rather rapid onset of osteoarthritis.
In most circumstances, we strive to repair the posterior horn of the lateral meniscus, either with sutures, or with a pull through suture if it is a meniscal root detachment. In those circumstances where the tear is not repairable, which is more common than not, the patient should be followed very closely to determine if they are developing arthritis. We commonly counsel patients to let us know if they are experiencing any pain or swelling with activities, because these are the signs of early onset arthritis. The patient should be followed up routinely with standard x-rays, a Rosenberg view, and an assessment of whether they are developing joint space narrowing or bone spur (osteophyte) formation.
If the meniscus cannot be repaired, future treatment options include observation, bracing, activity modification, injections, or consideration for a lateral meniscal transplantation. A complete workup as to the patient’s suitability for any of these treatments necessary through a complete physical exam and any necessary radiographic (x-rays, MRI, etc.) work-ups.
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