Tears are classified as partial or complex; anterior, lateral, or posterior; traumatic or degenerative; and horizontal, vertical, radial, "parrot-beak," or "bucket handle" [1].

Menisci tear in different ways. Tears are noted by how they look, as well as where the tear occurs in the meniscus. Common tears include bucket handle, flap, and radial.

Sports-related meniscus tears often occur along with other knee injuries, such as anterior cruciate ligament tears.

(Left) Bucket handle tear. (Right) Flap tear.
(Left) Radial tear. (Right) Degenerative tear.

 

Meniscal injuries can occur in isolation or in association with collateral or cruciate ligament tears.

 

 

Acute meniscal tears occur most often from twisting injuries; chronic degenerative tears occur in older patients and can occur with minimal twisting or stress.

 

 

 

Meniscal injuries of the knee are common.

 

 

 

 

 

Complications of Injecting Drug Use

  • Local problems—Abscess (Figures 240-2 
    Image not available.

    A 32-year-old woman with type 1 diabetes developed large abscesses all over her body secondary to injection of cocaine and heroin. Her back shows the large scars remaining after the healing of these abscesses. (Courtesy of ­Richard P. Usatine, MD.)

    and 240-3; Abscess), cellulitis, septic thrombophlebitis, local induration, necrotizing fasciitis, gas gangrene, pyomyositis, mycotic aneurysm, compartmental syndromes, and foreign bodies (e.g., broken needle parts) in local areas.2
    • IDUs are at higher risk of getting methicillin-resistant Staphylococcus aureus(MRSA) skin infections that the patient may think are spider bites (Figure 240-4).
    • Some IDUs give up trying to inject into their veins and put the cocaine directly into the skin. This causes local skin necrosis that produces round atrophic scars (Figure 240-5).
  • IDUs are at risk for contracting systemic infections, including HIV and hepatitis B or hepatitis C.
    • Injecting drug users are at risk of endocarditis, osteomyelitis (Figures 240-6and 240-7), and an abscess of the epidural region. These infections can lead to long hospitalizations for intravenous antibiotics. The endocarditis that occurs in IDUs involves the right-sided heart valves (see Chapter 50, Bacterial Endocarditis).2 They are also at risk of septic emboli to the lungs, group A β-hemolytic streptococcal septicemia, septic arthritis, and candidal and other fungal infections.

 

Left untreated, large complex tears can impair smooth motion of the knee, cause joint effusions, and may lead to premature osteoarthritis.

Content 13

Content 11

 

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