Meniscus Treatment

Meniscus is a C-shaped cartilage-like structure located in the knee joint. They are found between the two main bones that make up the knee joint, the femur and the tibia. There are two menisci in each knee, one on the inner side and one on the outer side.

What is the function of the meniscus?

Menisci serve as shock absorbers in the body’s largest joint, protecting the joint cartilage from abnormal loads. They play a crucial role in carrying and transferring loads to the knee. Additionally, they enhance the congruence of the joint surfaces and contribute to the circulation of synovial fluid within the joint. When the menisci are absent, the loads on the knee joint directly impact the joint cartilage, leading to early wear and tear and ultimately causing osteoarthritis.

How does a meniscus tear occur?

The way meniscus tears occur differs between young individuals and older individuals. In young individuals, a significant trauma is required for a meniscus tear to happen. This often occurs during a rotational movement on a fixed foot. Examples of sports where such tears can occur include football, basketball, and skiing. As age advances, the menisci lose their strength and elasticity, becoming “degenerative.” Degenerative menisci are much more prone to tearing. In older individuals, a meniscus tear can occur with simple activities such as squatting or tripping on a carpet.

What are the symptoms of a meniscus tear?

When a meniscus tear occurs, patients typically experience a sudden pain, popping, or tearing sensation. Depending on which meniscus is torn, the pain is more pronounced on the inside or outside of the knee. Within a few hours, swelling occurs in the knee joint due to the accumulation of fluid or blood in the knee. This swelling is usually not as severe as in ligament injuries. Generally, it is possible to bear weight on the injured knee, but there is a limp, and athletes often have to quit sports. Sometimes, a torn piece of the meniscus gets trapped between the bones that make up the knee joint, hindering knee movement. In this condition, known as a locked knee, early surgical treatment is necessary. Delaying surgery in locked knees, despite restricted movement and pain, leads to cartilage injuries. After a meniscus tear, over time, the widespread pain in the knee diminishes and becomes localized to the affected meniscus. The pain particularly occurs during sudden turns and squatting. Torn meniscus fragments can cause symptoms such as knee catching and locking, along with new sensations of crackling sounds in the knee joint.

What should be done for initial first aid for a meniscus injury on the sidelines?

In the case of a severe pain with a sudden twisting motion in the knee, a meniscus tear and ligament injury should be considered in every athlete. Immediate application of ice to the knee and wrapping with an elastic bandage will help reduce swelling and pain. The athlete should not be allowed to return to the game. The athlete should leave the field without putting weight on the affected leg and use crutches until a definitive diagnosis is made.

How is a meniscus tear diagnosed?

A significant portion of meniscus tear diagnosis is determined by a thorough history and physical examination. Your doctor may request X-rays to assess the amount of wear and tear in your knee and rule out other bone-related issues. Magnetic resonance imaging (MRI) of the knee joint has become the most reliable method for confirming meniscus tears in recent years. The accuracy of MRI in detecting meniscus tears is over 95% when performed correctly and evaluated by experienced professionals. However, MRI alone is not the sole determinant for deciding on treatment. In some

cases, meniscus tears can be diagnosed with a physical examination alone, and imaging may not be necessary.

What are the treatment options for a meniscus tear?

The treatment approach for meniscus tears depends on several factors, including the patient’s age, activity level, tear location, tear pattern, and associated knee problems. In younger patients with acute traumatic tears, surgical repair of the meniscus is often recommended to preserve the meniscus and its functions. In older individuals or those with degenerative meniscus tears, nonsurgical treatment options such as physical therapy, pain management, and activity modification may be considered first. If conservative treatment fails to alleviate symptoms, surgical intervention, such as meniscectomy (partial removal of the meniscus) or meniscus repair, may be required. The type of surgical procedure performed will depend on the specific characteristics of the meniscus tear.

What are the possible complications after meniscus surgery?

The main complications that can occur after meniscus surgery include:

1. Deep vein thrombosis: The formation of blood clots in the deep veins of the legs. It can occur after any surgery, but the risk is increased in prolonged surgical procedures, genetic predisposition, and advanced age. To prevent this complication, patients may be prescribed blood-thinning medications or advised to wear compression stockings and perform leg exercises.

2. Infection: Although rare, infection can occur after meniscus surgery. Symptoms may include increased pain, swelling, redness, warmth, and fever. If an infection is suspected, prompt medical attention is necessary.

3. Knee stiffness: Some patients may experience stiffness in the knee joint following surgery. Physical therapy and rehabilitation exercises are usually prescribed to improve range of motion.

4. Recurrent meniscus tear: In some cases, the meniscus may re-tear after surgical repair or removal. This can happen due to various factors, such as the type of tear, surgical technique, and patient factors. Revision surgery may be necessary if a recurrent tear occurs.

It is important to note that complications after meniscus surgery are relatively rare, and most patients experience a successful recovery without any major issues. However, it is essential to follow postoperative instructions, attend follow-up appointments, and communicate any concerns or unusual symptoms to your healthcare provider.