Why is FA so insistent on saying the terrible triad include the lateral meniscus

[PokerDoc]

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It even underlines lateral and says (NOT medial).. am I going completely off the wall here or is this more incorrect than (insert inappropriate joke here)

pg 366 in FA 2010

 

[kissmyasthma99]

It even underlines lateral and says (NOT medial).. am I going completely off the wall here or is this more incorrect than (insert inappropriate joke here)

pg 366 in FA 2010

The unhappy triad can include the lateral or medial meniscus.

 

[luti84]

Some articles came out >15 years ago looking at ACL and MCL injuries and suggest that most ACL and MCL tears are either not associated with a meniscal tear, associated with a lateral tear, or are only associated with a medial tear in the presence of a lateral tear. However, when O'Donoghue came up with his triad, right or wrong, he named it ACL, MCL, Med menis., and most current ortho texts still refer to the unhappy triad/O'Donoghue's triad as the original ACL, MCL, med menis combo.

Arthroscopy. 1992;8(1):19-22.
What is the terrible triad?
Barber FA.

Division of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas.
Abstract
In 1936 Campbell asserted that "impairment of the anterior crucial and mesial ligaments is associated with injuries of the internal cartilage." O'Donoghue in 1950 called attention to "that unhappy triad (1) rupture of the medial collateral ligament, (2) damage to the medial meniscus, and (3) rupture of the anterior cruciate ligament" and recommended early surgical intervention. In 1955 he reported 33 cases with both medial collateral (MCL) and anterior cruciate ligament (ACL) tears, but there were only three lateral meniscus tears reported. Based on a recent report by Shelbourne and Nitz that questions the validity of this unhappy triad, a review of all arthroscopically confirmed acute injuries of second degree or worse to the ACL and MCL was undertaken. Of a total of 52 knees reviewed, 50 knees had third-degree ACL tears and two had second-degree ACL tears. One of the second-degree tears was associated with a second-degree MCL and one with a third-degree ACL tear. Neither had an associated meniscus tear. Forty-five third-degree ACL tears were associated with third-degree MCL tears (group 1) and five with second-degree MCL tears (group 2). Eighty percent (36 knees) of group 1 had lateral meniscus tears. Only 29% of group 1 (13 knees) had associated medial meniscus tears. None of these medial meniscus tears was isolated. Eighty percent (four knees) of group 2 had lateral meniscus tears with only one associated medial meniscus tear. Again, there were no medial meniscus tears in the absence of a lateral meniscus tear. We did not find the combination of injury originally described as the unhappy triad.

 

[PokerDoc]

do you have some source for that other than FA? Every other book I've ever read specifically says medial meniscus.


edit: this post was for kissmyasthma

 

[go lakers]

http://en.wikipedia.org/wiki/Unhappy_triad

 

[greg1184]

Because the unhappy triad has changed. Even in my med school lecture about this topic was Lateral emphasized.

 

[2001bmw330xi]

The uWorld question explanation was actually updated on 4/27/2010 to include lateral meniscus because of the change; but they leave it open and say that both can be involved. If I remember right the question itself made you pick ACL - and I'm hoping neither comlex/usmle ask you to pick between lateral and medial meniscus because you could argue either one IMO.

I think FA is incorrect in stating that the medial meniscus is not involved.

 

[PokerDoc]

Man if I have to chose between those two on test day... FML

 

[2001bmw330xi]

I honestly think it would be unreasonable for them to ask that. Especially since schools are still teaching it the 'old' way.

But then again - they might ask it as one of the "experimentals" just to see how many people have gotten the memo that it changed.

 

[2001bmw330xi]

FWIW, somebody on usmle-forums posted this:

"1990's, they did the research and studies of sports knee injury, which showed, LATERAL meniscus was also injured in those injury....and was stated as 56% for lateral meniscus and 44% for medial meniscus......I hope this answer your question.."

So I guess if it does come up on the real thing and I am forced to choose between the two, I'll go with Lateral since it's the "newest" information and "more likely" (which is usually how these questions are phrased).

 

[TexasTriathlete]

The explanation we got in lecture this year is that it used to be the medial meniscus and then someone did a study and found out that the lateral meniscus is more commonly involved, so they changed it recently.

We actually had a lecture in one class this year where it was medial and another lecture where it was lateral.

That is what the medical community gets for trying to make everything a freaking triad.

 

[majik1213]

DIT said there as lilke a 44%/56% split of medial/lateral lemniscus (don't quote me on those numbers, but it was in the ballpark) ..

now as for WHY first aid did that, here is a question to ponder .. suppose you are given a clinical vignette of a football player with a posterolateral blow to a firmly planted and flexed right knee during a game. Next, you are shown an MRI and asked, "The structure that most likely requires surgical repair in this patient most likely attaches to which of the identified sites?" In this coronal view, you freak out because the ACL and medial lemniscus attachment sites are not labeleled, but the lateral lemniscus is (as is the MCL, which doesn't need surgery). So, remembering that first aid insisted you be aware of that option, you pick it the lateral lemniscus.

that's my guess anyway. I don't think the boards would ever be so cold as to make you select between the two lemnisci, but then again i'm guessing so take my suggestion with a (hefty-sized) grain of salt.

=)

 

[cofcemt]

The O'Donoghue's "unhappy triad" is the ACL, MCL, and MM.

The problem is new research has proven it to be nearly equitable or more slated to the LM. What I don't get is it really doesn't matter...your findings would be found on physical exam and then it still doesn't matter as long as the ACL is torn as you would do arthroscopic surgery to replace the ACL. Then look around to ensure the menisci are clean. If so, then no need to fix them, if not, you would just resect.

Always laughed about this when I was an athletic trainer. We were always taught to just ignore this because it was basically clinically irrelevant.

 

[turkeyjerky]

Here's why I think the new edition of FA has the change. Someone on the "first aid team" ran across this article and got their panties in a bunch over the fact that had been taught the wrong information. So they went ahead and changed it. Obviously, this isn't a new thing--the article was published in the early 90's. And how exactly are they gonna ask a question where 90% of the schools are teaching the wrong information? What'd you think, that the boards people read first aid and realize they gotta change the test?