The goal of meniscal root repair is to restore the joint to a near native function of the meniscus and prevent cartilage degradation associated with nonsurgical treatment or meniscectomy. So the injury as seen in MRI scan means there is an tear in the medial meniscus towards the posterior side, that is towards the back of joint. 1993;9(1):33-51. The meniscus root attachment aids meniscal function by securing the meniscus in place and allowing for optimal shock-absorbi Arthroscopy. (386) 255-4596 Presumptive subarticular stress reactions of the knee: MRI detection and association with meniscal tear patterns. 14 Marzo JM, Kumar BA. The medial meniscus is the portion of the cartilage along the inside of the knee joint (closest to the other knee). 1075 Mason Ave., Daytona Beach, FL 32117, Twin Lakes The lateral meniscus is on the outside of the knee. Lists risks and benefits of surgery for meniscus tear. 2023 Cedars-Sinai. Symptoms of a meniscus tear. Performing activities that involve aggressive pivoting and twisting of the knee puts you at a significantly higher risk of tearing your meniscus. The meniscus is broken down into the outer, middle, and inner thirds. We have also seen complete meniscal root avulsions in the cruciate ligament-injured knee with complete injury of the medial ligament and posterior oblique ligament that opens in full extension. There will also be skin discoloration and visible deformity at the site of the injury. In brief: meniscal tears. . 3rd Edition. With proper diagnosis, treatment, and rehabilitation, patients often return to their pre-injury abilities. Figure 1. Horizontal tear posterior horn medial meniscus, Tear of posterior horn of medial meniscus treatment, Horizontal tear posterior horn and body medial meniscus, Body and posterior horn of the medial meniscus, Homeopathy treatment posterior horn medial meniscus. It is important to describe your symptoms accurately. Oblique tears give rise to flaps which are mechanical unstable and associated with mechanical symptoms. Other symptoms of a meniscus tear include: pain in your knee, which can vary in severity - the pain might only be mild, severe, or the pain may come and go. The RICE protocol is effective for most sports-related injuries. A 501(c)(3) non-profit organization. AJR 2003; 180:93-97. Horizontal cleavage, oblique, and complex meniscal tear patterns have traditionally been poor candidates for meniscal repair. This part of the tibia is also known as the tibial plateau. The absent bow tie sign in bucket-handle tears of the menisci in the knee. Although an X-ray will not show a meniscus tear, your doctor may order one to look for other causes of knee pain, such as osteoarthritis. Before your visit, write down questions you want answered. I have been diagnosed with a subtle oblique tear involving the posterior horn of the medial meniscus and extends to the inferior articular surface of the meniscus. Patients are often aware of movements that aggravate mensical pain, but should also be educated to avoid twisting on a weight bearing, flexed knee. Meniscus tears are either degenerative or acute. Because of their importance and the clinical impact of meniscal tears, assessment of the menisci has become the most common indication for MR of the knee. The anatomic landmark for repair is anterior to the PCL footprint on the tibia. No bone marrow edema. Clinical outcomes following isolated lateral meniscal allograft transplantation. Mui LW, Engelsohn E, Umans H. Comparison of CT and MRI in patients with tibial plateau fracture: can CT findings predict ligament tear or meniscal injury? Knee Surg Sports Traumatol Arthrosc 2009;17:11026. For patients requiring meniscectomy, meniscal autograft has been utilised with good outcomes,2931 but is only performed in specialist centres. Principles and decision making in meniscal surgery. This pattern of tear requires resection to prevent propagation of the tear as the flap gets caught within the joint during flexion. It is caused by direct impact in contact sports or twisting. As stated above, the most common cause of Posterior Horn Medial Meniscus Tear can be trauma to the knee which can be sustained due to a sporting injury, a slip and fall, a blunt trauma to the knee, and in majority of the cases natural degeneration of the meniscus due to the work load of the knee. Survivorship analysis and clinical outcome of one hundred cases. By using our website, you consent to our use of cookies. In the present case, a full-thickness radial tear of the medial meniscus is visualized (Fig 1).An arthroscopic torpedo shaver (Arthrex, Naples, FL, U.S.A.) is used to debride the meniscus tear edges back to a healthy, stable rim (Fig 2).For improved access to the medial meniscus, an 18-gauge spinal . Question options: . Bernstein J. If your MRI indicates a Grade 1 or 2 tear, but your symptoms and physical exam are inconsistent with a tear, surgery may not be needed. Similarly, tears that are not associated with locking of the knee will typically become less painful over time. The primary objective is to control the disease process to avoid the complications . Sekiya JK, West RV, Groff YJ, Irrgang JJ, Fu FH, Harner CD. (14a) A 3D depiction of a flap tear of the posterior body of the medial meniscus illustrates displacement of the upper component of the flap (arrow) from its site of origin. Ercin E, Kaya I, Sungur I, Demirbas E, Ugras AA, Cetinus EM. Meniscal tears often occur in young patients who have suffered a twisting injury to the knee. Your doctor will bend your knee, then straighten and rotate it. Rosemont, Ill. American Academy of Orthopaedic Surgeons. A meniscal tear can heal on its own, but location is important. Each knee has two C-shaped pieces of cartilage known as menisci. The absolute indication for specialist referral is the locked knee loss of joint function necessitates surgical intervention. The one towards the back of leg is the posterior horn. The healing time in children is a little less as the healing process is faster in children than in adults. Oblique tear of the posterior horn and body of the medial meniscus involving inferior articular surface and peripheral meniscal margin. Extrusion of the medial meniscus (MM) is associated with knee joint pain in osteoarthritic knees. Orthop Clin North Am. Case Discussion Longitudinal tears, also known as vertical tears, occur perpendicular to the tibial plateau and parallel to the long axis of the meniscus splitting the meniscus into inner and outer parts. Physical therapy should start immediately after surgery and include early passive range of motion from 0 to 90 for the initial 2 weeks and progress to full range of motion thereafter. For information:Questions and Answers for Patients Regarding Elective Surgery and COVID-19. Meniscus tears simply do not heal on their own, regardless of conservative treatment. Because other knee injuries can cause similar symptoms, your doctor may order imaging tests to help confirm the diagnosis. Knee arthroscopy is one of the most commonly performed surgical procedures. Prospective evaluation of allograft meniscus transplantation: a minimum 2-year follow-up. Other nonsurgical treatment. Arthroscopic total meniscectomy Occasionally, a large tear of the outer meniscus can best be treated by arthroscopic total meniscectomy, a procedure in which the entire meniscus is removed. Medial meniscal root tears: Fix it or leave it alone Orthopedics Today | Medial and lateral menisci are crescent-shaped fibrocartilage structures that provide joint congruity, stabilization and. They will also consider the type, size, and location of the injury. There are numerous treatments for meniscus tears, but treatment generally begins conservatively depending on the location, type, and size of the tear. 9 Lecase LK, Helms CA, Kosarek FJ, Garret WE. 2023 The Orthopedic Clinic. The best known displaced tear that is amenable to repair is the bucket-handle tear. There may be some pain. OKeefe R, et al. Arnoczky SP, Warren RF, Spivak JM. [Epub ahead of print]. There are numerous types of meniscus tears, including: 1. (redirected from Oblique Tear) The most common meniscal tear, a type of radial tear which begins at the free (inner) edge like other radial tears, but then curves into a longitudinal orientationsimilar to longitudinal meniscal tearsas the tear extends toward the meniscal periphery. 5 Jee WH, McCauley TR, Kim JM, et al. The medial meniscus is on the inner side of the knee joint. I have an oblique horizontal tear posterior horn medial meniscus, what does that mean? Physiotherapy at two visits per week for at least 8 weeks is recommended.20 There is little evidence for strapping of meniscal injuries and this is not currently recommended. from the American Academy of Orthopaedic Surgeons, Questions and Answers for Patients Regarding Elective Surgery and COVID-19. Rehabilitation time for a meniscus repair is about 3 to 6 months. This tear is usually best seen on the coronal T2-weighted MRI scan (see figure 1), where a fragment of meniscus (black in appearance) is stuck between the medial tibial plateau and the overlying medial collateral ligament.This tear pattern tends to be persistently painful, as the meniscal fragment becomes entrapped between bone and the adjacent soft tissues. A tear can also develop slowly as the meniscus loses resiliency. Chahla and Geeslin report no relevant financial disclosures. This most often happens when the tear develops over a period of time. Meniscal repairs are more likely to be successful when performed near the time of injury. Several variations in meniscal tear patterns have been granted specific names that recognize the unique characteristics of the tear. Am J Sports Med 2008;36:12839. However, coronal sections may reveal the presence of meniscal extrusion or vertical defects, and sagittal sections may reveal the ghost sign (absence of an identifiable meniscus or increased signal replacing the normal hypointense signal of meniscal tissue). The treatment may be conservative or sometimes surgery may be required to treat the fracture. Grades 1 and 2 are not considered serious. 2nd edn. The menisci are "wedge-shaped" pieces of cartilage that rest between the thigh bone ("femur") and lower leg bone ("tibia") in the knee joint. (16a) Sagittal and (16b) axial proton density weighted images reveal a very large radial tear (arrows) that extends broadly across the entire width of the anterior body of the lateral meniscus. ICD 9 Codes: 717.4 derangement of the lateral meniscus 717.3 derangement of the medial meniscus 836.0 lateral meniscus tear 836.1 medial meniscus tear Case Type / Diagnosis: Functional Anatomy: The menisci are semi lunar shaped cartilages on the medial and lateral sides of the knee joint. Detailed review of funding for diagnostic imaging services. For potential or actual medical emergencies, immediately call 911 or your local emergency service. The McMurray test (shown here) will help your doctor determine if you have a meniscus tear. The anterior horn of the medial meniscus demonstrates half of the normal anatomic 'bow-tie configuration'. Think before you speak. Guides you through the decision to have surgery for a torn meniscus. Missouri: Mosby, 1998. Whats the best way to treat an oblique fracture? 2 Jaureguito JW, Elliot JS, Lietner T. The effects of arthroscopic partial lateral meniscectomy in an otherwise normal knee: a retrospective review of functional, clinical, and radiographic results. Your doctor might move your knee and leg into different positions, watch you walk, and ask you to squat to help pinpoint the cause of your signs and symptoms. In the early days of MR, it was often felt that the role of MR was simply to identify whether a tear was present or not, and treatment of meniscal tears was largely composed of operative resection. What is Meniscus Radial Tear. Although all bucket handle tears are repair candidates,16 the bucket handle tear is an example of when the more severe appearing tear is actually better for the patient. If you are having pain, swelling and catching, then the only reasonable option would be arthroscopic knee surgery. New surgical advances allow surgeons to repair these tears. Posterior medial meniscal root tears are often times degenerative, but these can also occur with multi-ligament knee injuries in the acute setting. The difference in tear type between these populations is explained by the three-dimensional fibrous structure of the meniscus: horizontal delamination occurs in degenerative injuries, while the fibrous structure is ruptured in a vertical fashion in younger patients. Torn meniscus symptoms Symptoms are usually sudden onset, however, can develop gradually over time. Tears are noted by how they look, as well as where the tear occurs in the meniscus. This puts tension on a torn meniscus. This information is not intended as a substitute for professional medical care. (8a) The curvilinear course of oblique tears often results in abnormal vertical signal (arrows) that progresses towards or away from the free edge of the meniscus on consecutive images, as seen in these sequential images of an oblique tear (arrows) of the posterior horn of the medial meniscus. On MRI, meniscal tears are evident as a linear signal intensity that extends through the meniscal substance to a free edge17 (Figure 4). Knee Surg Sports Traumatol Arthrosc 2010;18:5359. Meniscal repair using an exogenous fibrin clot. 6 From January 2018, it was superseded by AJGP: Australian Journal of General Practice, The Royal Australian College of General Practitioners 2021. Brain Res Rev 2009;60:187201. Conservative management of the patient with a meniscal tear. Meniscus tears are among the most common knee injuries. The Thessaly test is the most sensitive and specific clinical test to diagnose meniscal injury. The meniscus shows up as black on the MRI. Arthroscopic treatment is typically required for adequate symptom relief in patients with displaced meniscal flap tears. Severe pain and swelling may occur up to 24 hours afterward. The ghost sign or absence of an identifiable meniscus anterior to the posterior cruciate ligament is also indicative of a root tear (Figure 2). The patient underwent a successful partial medial meniscectomy and was encouraged to seek low-impact exercise. Meniscal tears within the body of the meniscus or at the meniscocapsular junction represent a well-understood and manageable condition encountered in clinical practice. These can occur through either a contact or non-contact injury for example, a pivoting or cutting injury. However, anyone at any age can tear the meniscus. The knee: a comprehensive review. Meniscal tears may be categorized into five common configurations, including horizontal, longitudinal, radial, oblique (parrot-beak), and complex.5 Horizontal tears, the most common meniscal tear pattern, lie parallel to the tibial plateau and separate the meniscus into upper and lower parts (4a,4b). Although the . You might develop the following signs and symptoms in your knee: A popping sensation. Tears to the medial meniscal root change the biomechanics and kinematics of the knee, which cause early degeneration of the joint. controlling the movements of the knee joint. It is estimated that only 10% of the injuries involving the tear of posterior horn medial meniscus are repairable. Knowing where and how a meniscus was torn helps the doctor determine the best treatment.. A gradient-echo T2*-weighted sagittal image demonstrates a tear within the posterior horn of the medial meniscus (arrow). The tear results in a vertical signal abnormality on sagittal MR images. Have swelling, stiffness or tightness in your knee. How to treat an oblique tear of the posterior horn of the medial meniscus? A meniscus tear can occur when the knee is suddenly twisted while the foot is planted on the ground. If the tear is associated with arthritis it will typically improve over time as the arthritis is treated. A meniscal cyst may present with signs and symptoms consistent with typical meniscal pathology. How to treat oblique tear of medial meniscus? This type of tear has an unusual pattern. 1165 Dunlawton Ave., Suite 102 Port Orange, FL 32127, Port Orange East & Walk-In Clinic Rimington T, Mallik K, Evans D, Mroczek K, Reider B. Also write down any new instructions your provider gives you. Know how you can contact your provider if you have questions. These tendons have poor blood supply and will not heal themselves. However, whether they will respond well to surgery depends on the type of tear, the location, and blood flow in the area where the tear occurred. AJSM 2003; 31:216-220. As orthopaedic surgeons increasingly consider meniscal repair, accurate pre-operative assessment with MR becomes more important, allowing proper planning on the part of both the surgeon and the patient. Because the pieces cannot grow back together, symptomatic tears in this zone that do not respond to conservative treatment are usually trimmed surgically. The accuracy of physical diagnostic tests for assessing meniscal lesions of the knee: a meta-analysis. Garrett WE Jr, Swiontkowski MF, Weinstein JN, et al. A referral to an orthopedic physician should result in guidance it means you need to see in orthopedist and get an opinion as to whether. Every care is taken to reproduce articles accurately, but the publisher accepts no responsibility for errors, omissions or inaccuracies contained therein or for the consequences of any action taken by any person as a result of anything contained in this publication. There are numerous types of meniscus tears, including: This type of tear is often a sign of degenerative changes in the meniscus tissue. In older patients, referral is appropriate if conservative management fails to improve symptoms. I have an oblique tear of the posterior horn of my medial meniscus that extends to the undersurface of the cartilage. Includes interactive tool to help you decide. Radial tears, because they are oriented perpendicular to the c-shaped fibers of the meniscus, have a devastating effect upon meniscal function. This is what my MRI says: Radial tear poster medial meniscus, degeneration fraying medial meniscus, moderate bone contusion medial tibial plateau with degenerative changes, moderate bakers cyst.My doctor says I should get a clean-up on my knee. If the test is positive (suggesting a meniscal tear), the patient will feel pain and the clinician will feel and/or hear meniscal movement when the meniscus is compressed between the tibia and femur 32, Figure 2. The posterior horn of the medial meniscus is especially likely to develop tears as we get older. Inferiorly displaced flap tears of the medial meniscus: MR appearance and clinical significance. Types of meniscus tears:(Left) Bucket handle tear. There is no resting pain. This is a large horizontal tear of the meniscus. Gillquist J, Hamberg P, Lysholm J. Endoscopic partial and total meniscectomy. Unhappy Triad: Stress is put on medial side of the knee which potentially tears three related structures A recent study demonstrated 46% of patients with degenerative meniscal tears elected not to have surgery after 4 weeks of nonoperative treatment, and their functional improvement matched patients in the operative group.21 Another study of degenerative tears demonstrated that supervised exercise caused the same reduction in knee pain and the same increase in function and satisfaction as partial meniscectomy plus exercise.23 As degenerative tears are more common in elderly patients, this group is more likely to respond to conservative treatment. Matthew H. Blake, MD, can be reached at the Kentucky Clinic, 740 Limestone, Suite K415, Lexington, KY 40536; email: Darren L. Johnson, MD, can be reached at the Kentucky Clinic, 740 S Limestone, Suite K415, Lexington, KY 40536; email: Jorge Chahla, MD; Andrew G. Geeslin, MD; and Robert F. LaPrade, MD, PhD, can be reached at Steadman Philippon Research Institute, The Steadman Clinic, 181 West Meadow Dr., Suite 400, Vail, CO 81657; Chahlas email. type 3, vertical longitudinal bucket-handle tears; type 4, complex oblique tears; and type 5, bone avulsion fractures of the root attachments. Damaged avascular meniscus must be removed.27 However, meniscectomy causes long term osteoarthritis,28 so is only performed when the patient suffers joint locking or mensical pain that is refractory to conservative management. Complex tears like this are likely to be unstable. During weight-bearing activities, the menisci dissipate axial loads and contain hoop stresses. Meniscal injury and repair: clinical status. AJSM 2002; 30:589-600. 3rd edn. Both of them have 2 causes. Clinical results of meniscus repair in patients 40 years and older. Your doctor will bend your knee, then straighten and rotate it. In addition to the root tear, the MRI often shows chondral loss or fissuring, other areas of meniscal tearing, bone marrow edema or osteophyte formation (Figure 5). Top answers from doctors based on your search: Created for people with ongoing healthcare needs but benefits everyone. Optimal diagnosis and management is essential to prevent long term sequelae. We have two menisci in either knee. Aged, worn tissue is more prone to tears. The procedure begins with a complete diagnostic arthroscopy using a 30-degree arthroscope. Bull NYU Hosp Jt Dis 2010;68:8490. Successful outcome and patient satisfaction after medial meniscal root repair are established initially upon appropriate diagnosis and patient selection. Although C, a vertical tear, is commonly used to describe such an appearance, the better answer is D, a longitudinal tear. Seldom are they the sign of a problem. Knee Surg Sports Traumatol Arthrosc 2007;15:393401. Meniscal pain occurs during torsional, weight bearing knee movements (classically pivoting on the knee while walking) as a sharp stab lasting several seconds, often followed by a dull ache for several hours. Because a torn meniscus is made of cartilage, it won't show up on X-rays. A meniscus tear is an injury to one of the bands of rubbery cartilage that act as shock absorbers for the knee. In circumstances where the flap causes catching in the knee, the flap can simply be removed. The test is positive if symptoms are reproduced on rotation 10. The medial meniscus is an important secondary stabilizer of the knee. Coronal proton weighted MRI of horizontal tear of lateral meniscus (white arrow) with complicating ganglion (black arrow) at the lateral margin of the meniscus, Australian Family Physician was the peer-reviewed, scholarly journal of The Royal Australian College of General Practitioners (RACGP) from 1971 to 2017. If you have a meniscus tear, this movement may cause pain, clicking, or a clunking sensation within the joint. Most likely, your doctor will recommend that you rest, use pain relievers, and. Two months later, the post-operative image (17b) reveals a repaired, normal appearing lateral meniscal body (arrow), with resolution of the previously seen displaced fragment. At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Meniscus tears simply do not heal on their own, regardless of conservative treatment. 2 The risk of osteoarthritis and its progression increase in line with reductions in tibial cartilage coverage. Sources: Meniscus tears can happen during physical activities, but they can also occur from: Sometimes, a torn meniscus can occur due to degenerative changes in the knee, even if there is little to no trauma. 1 article features images from this case Can a torn meniscus heal by itself? A meniscus tear can lead to knee instability, an inability to move the knee normally, and chronic knee pain. This makes the medial meniscus less mobile and is one reason why the medial meniscus is more prone to injury.3 In adults, only the periphery of the meniscus remains vascularized. (11a) A 3D illustration of a bucket handle tear demonstrates that these tears actually are longitudinal in nature (arrows), coursing parallel to the c-shaped fibers of the meniscus. Collateral and cruciate ligaments are intact. The menisci are C-shaped fibrocartilages with concave upper surfaces and flat undersides that match their respective interfaces with the femoral condyles and tibial plateau. growth factors) on meniscus tissue is being investigated.2 These are currently only being trialled in younger patients7 and the routine use of most of these technologies is some time away. An MRI is 70 to 90 percent accurate in identifying whether the meniscus has been torn and how badly. Other established anatomical variants include the transverse meniscal ligaments and the meniscofemoral ligaments, which mimic meniscal tears at their meniscal attachment sites. Nonoperative treatments are often successful in patients with certain types of tear patients who have no loss of joint function, suffer minimal pain or swelling and are willing to reduce their activities temporarily or in the long term. I have an oblique tear of the posterior horn and body of the medial meniscus extending to the inferior articular surface. However, these patients are rare. Anti-inflammatory drugs such as aspirin, ibuprofen, and naproxen help reduce pain and swelling. This is the most common type of meniscus tear. An MRI scan assesses the soft tissues in your knee joint, including the menisci, cartilage, tendons, and ligaments. Depending on your duration of symptoms you can at least start off with physical therapy, a knee sleeve, and if there is arthritis present consider a c Dr. Christopher Ferguson and another doctor agree. Imaging tests X-rays. Location -A tear may be located in the anterior horn, body, or posterior horn.A posterior horn tear is the most common. The clinician applies axial pressure to the foot and rotates the tibia internally and externally. Your doctor will hold your heel while you lie on your back and, with your leg bent, straighten your leg with his or her other hand on the outside of your knee as he or she rotates your foot inward. The parrot beak shape of an oblique tear (arrow) is readily apparent on (7a) a proton density-weighted axial image of the menisci. This presents with a combination of tear patterns. Without nutrients from blood, tears in this "white" zone with limited blood flow cannot heal. Chronic tears may be scarred to the capsule and require release of the meniscocapsular junction to allow anatomic repair. In many cases, rehabilitation can be carried out at home, although your doctor may recommend working with a physical therapist. what is the treatment? In cases where a torn meniscus has locked the knee, walking will be affected. Meniscal injury is common, and the medial meniscus is more frequently injured. Biomechanical studies have demonstrated that repair of medial meniscus posterior root tears leads to improved contact mechanics. Over 2 to 3 days, however, the knee will gradually become more stiff and swollen. pivoting). Am J Sports Med 2006;34:91927. Injury, degeneration, or surgical removal of all or part of the meniscus is associated with an increased risk of developing knee osteoarthritis. Transtibial pullout repair is a new arthroscopic technique to repair meniscal root tears, . Medial meniscal posterior root tears represent an often unrecognized pathology with potentially devastating long-term effects. Flaps cause mechanical instability - meaning they interrupt the smooth function of the knee joint and will make your knee joint feel unstable. The lateral meniscus has a symmetrical C-shape, whereas the medial meniscus is more crescentic (3a), as the posterior horn of the medial meniscus is always larger than the anterior horn. Most oblique meniscus tears are happen in the posterior third of the medial meniscus. what is the best possible treatment? (5a) A longitudinal tear of the posterior horn of the medial meniscus is illustrated. The device is small and contains a light and a camera, which transmits images from inside the knee onto a monitor. Arthroscopic repair of isolated meniscal tears in patients 18 years and younger. The medial meniscus transmits approximately 50% of the total joint load of the knee medial compartment, thus protecting the articular cartilage from excessive force. The procedure can reduce pain, improve mobility and stability, and get you back to life's activities. In fact, the tear will most likely get bigger leading to additional damage if not taken care of soon. How can I tell if I have an oblique fracture? This means that athletes, especially those who participate in contact sports like football, are at a higher risk of sustaining this injury. Intrasubstance/incomplete tear (top left) This type of tear is often a sign of degenerative changes in the meniscus tissue. The tear should be eight millimeters or more in length, as shorter peripheral longitudinal tears are less likely to be symptomatic and may heal spontaneously. summary. The younger population, particularly males with knee instability, is most commonly affected by this type of tear [56]. Although the pain improved, the patient could not flex her knee joint deeply. The degenerative aetiology and reduced vascularisation secondary to ageing also means that meniscal tears in the elderly population are less likely to be amenable to surgical management;7 only about 6% of patients over 40 years of age have operable lesions.24 To prevent re-injury of the meniscus, activity modification is important for example, ceasing sports such as soccer or netball.
Governor Abbott Campaign Contributions,
Emma Arbabzadeh 2020,
When An Aquarius Man Doesn't Like You Anymore,
Articles O