WHAT IS A MENISCUS, ITS SYMPTOMS AND DIAGNOSIS?
WHAT IS A MENISCUS? WHAT ABOUT A MENISCUS INJURY?
What is the meniscus?
A meniscus is a crescent-shaped fibrocartilage tissue that fills the space between the femur and the knee.
Its function is to stabilize the joint and serve as a “cushion” to protect the cartilage of the knee. They are responsible for absorbing the shock impact between the articular surfaces, increasing the contact surface and allowing a better load distribution.
In each knee there are two menisci; medial meniscus, or internal meniscus, and lateral meniscus or external meniscus. Each meniscus has different parts, or zones: anterior part or anterior horn, body or central part, and posterior part or posterior horn.
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What is a meniscus injury and what causes it?
Meniscus tears are a unique injury that we classify as either:
- Degenerative: Caused by age and by repetitive micro-traumas which causes the quality of the meniscus to worsen. Degenerative injuries occur when, over time, the meniscus lose part of their elasticity, thus making them more prone to breakage and tears.
- Traumatic: Caused by sudden impact and twisting or turning movements; more frequent in young patients and athletes. We name them according to the shape of the break: transversal, vertical, radial, etc.
The most frequent meniscus injuries are those of the medial meniscus; specifically, posterior horn tears of the medial meniscus.
How do meniscus tears occur?
As part of its natural movement, when the knee flexes and extends the meniscus is displaced alongside the bones. But if the knee is suddenly flexed in combination with an internal rotation while your foot remains planted on the ground, the meniscus can tear.
Sometimes, if the injury occurs with a lot of force, there may be a more serious injury to the knee, referred to as the terrible knee triad. This occurs when there is a forced valgus injury (that is, the inside of the knee is forced inward). It is the combination of internal collateral ligament tear, anterior cruciate ligament injury, and medial meniscus injury.
Other related knee injuries:
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SYMPTOMS AND DIAGNOSIS OF A MENISCUS TEAR
Localized pain in the knee. It is a dull, crushing pain that increases when pressure on the meniscus is increased, such as when squatting down.- Lack of movement – Inability to fully flex the knee
- Swelling and/or accumulation of fluids in the joint.
- “Cracking” or “blocking” sensation. ‘Blockage’ is characterized by sudden pain in the knee and the inability to move it.
Localized pain in the knee. It is a dull, crushing pain that increases when pressure on the meniscus is increased, such as when squatting down.Read more
The diagnosis of meniscus injury is made via:
- Medical history and examination
- X-rays
- MRI
IF THE INJURY IS NOT TREATED IN TIME
Ignoring a knee injury and not treating it can disrupt a patient’s daily life.
Work
Inability to carry out work that involves bending the knees and exerting effort.
Sport
Lack of treatment can mean the end of aggressive sport activities in which the knee plays an important role.
Complications
If the knee cannot be fully extended or flexed, this may be an indication of a meniscus block, which requires emergency intervention and treatment.
TREATMENT
WHAT IS THE CONSERVATIVE (NON-SURGICAL) TREATMENT FOR A MENISCUS TEAR?
After suffering an acute meniscus tear, ice and a compression bandage or knee brace should be applied, the patient should also rest and try to elevate the affected leg (RICE protocol). You will also want to take anti-inflammatory medication. In some cases, it is advisable to use crutches so that no weight is placed on the damaged knee. An orthopedic surgeon should be consulted to establish the extent of the injury.
Mild injuries will resolve themselves with rest and physical therapy, that is, with conservative treatment. Non-surgical treatment involving injections (of hyaluronic acid, corticosteroids or platelet-rich plasma) is sometimes also used.
Only in the event that the aforementioned conservative treatment does not achieve the expected results, should you undergo arthroscopic surgical treatment.
HOW IS A MENISCUS TEAR TREATED SURGICALLY?
There are currently two arthroscopic surgery procedure options for this type of injury:
- Partial or Selective Menisectomy, or the extraction of the damaged fragments only.
- Meniscus Suture, or the stitching together of the damaged fragments.
Timing relating to when the injury occurred and how quickly it has worsened, the location, and the type of injury will determine appropriate surgical treatment for each patient. It is advisable, if possible, to opt for Meniscus Suture treatment in order to potentially avoid future osteoarthritis, since with the alternative (a meniscectomy) natural biomechanics of the knee is altered.
You can see an animation of a Meniscus Suture here:
FREQUENTLY ASKED QUESTIONS
How long does an arthroscopic meniscus surgery take?
The time it takes to complete an arthroscopic meniscus surgery varies based on a number of factors, including the surgeon’s experience, the type of injury involved, and patient characteristics. On average, however, an arthroscopic meniscus surgery can usually be completed in 30 to 60 minutes.
What is recovery like after arthroscopic meniscus surgery?
Recovery after arthroscopic intervention for a meniscus injury requires a follow-up program of physiotherapy, proprioceptive rehabilitation, and muscle reinforcement.
In the first week following surgery, the patient:
- Will control pain and inflammation by using the RICE protocol and taking anti-inflammatory medication.
- Will begin mobilization of the knee and start to use their quadriceps muscles, under direction of their orthopedic surgeon.
Depending on the procedure that has been carried out (suture or repair), the postoperative period varies, since after a Meniscus Suture bearing weight on the operated leg and mobility are limited during the first weeks. In the cases of a Meniscectomy, the average recovery time is 4 to 6 weeks. However, with a Meniscus Suture, the recovery time is between 3 and 4 months.
Possible complications of an arthroscopic meniscus surgery
Although complications occurring after this type of intervention are infrequent, the following may occasionally occur:
- Re-tearing of the meniscus
- Infection
- Excessive inflammation, bleeding, and damage to the small vessels and nerves near the operated area
- Inflammation in the veins; mild thrombosis of the legs.
REFERENCES
Lee WQ, Gan JZ, Lie DTT. Save the meniscus .Clinical outcomes of meniscectomy versus meniscal repair.
J Orthop Surg (Hong Kong). 2019 May-Aug;27(2):2309499019849813. doi: 10.1177/2309499019849813.
PMID: 31117923
If you want to learn about arthroscopic knee surgery in regards to a meniscus injury or repair, contact Dr. Villanova directly by clicking here:
This post is also available in: Spanish
