The Meniscus

 

Two wedge-shaped pieces of cartilage act as “shock absorbers” between your thighbone and shinbone. These are called meniscus. They are tough and rubbery to help cushion the joint and keep it stable.

Meniscus Injuries


Meniscus tears are among the most common knee injuries. Athletes, particularly those who play contact sports, are at risk for meniscus tears. However, anyone at any age can tear a meniscus. When people talk about torn cartilage in the knee, they are usually referring to a torn meniscus.

Sudden meniscus tears often happen during sports. Players may squat and twist the knee, causing a tear. Direct contact, like a tackle, is sometimes involved.

Older people are more likely to have degenerative meniscus tears. Cartilage weakens and wears thin over time. Aged, worn tissue is more prone to tears. Just an awkward twist when getting up from a chair may be enough to cause a tear, if the menisci have weakened with age.

Symptoms

 

Stiffness and swelling.

Catching or locking of your knee.

The sensation of your knee “giving way”

You are not able to move your knee through its full range of motion.

Nonsurgical treatment with rest, ice, compression, elevation, and physical therapy. This may include wearing a temporary knee brace.

Normal meniscus

With a minor tear, you may have slight pain and swelling. This usually goes away in 2 or 3 weeks.

A moderate tear can cause pain at the side or center of your knee. Swelling slowly gets worse over 2 or 3 days. This may make your knee feel stiff and limit how you can bend your knee, but walking is usually possible. You might feel a sharp pain when you twist your knee or squat. These symptoms may go away in 1 or 2 weeks but can come back if you twist or overuse your knee. The pain may come and go for years if the tear isn’t treated.

In severe tears, pieces of the torn meniscus can move into the joint space. This can make your knee catch, pop, or lock. You may not be able to straighten it. Your knee may feel “wobbly” or give way without warning. It may swell and become stiff right after the injury or within 2 or 3 days.

Torn meniscus

Surgical Treatment

 

Tears at the outer edge of the meniscus (red zone) tend to heal well because there is good blood supply. Minor tears may heal on their own with a brace and a period of rest. If they do not heal or if repair is deemed necessary, the tear can be sewn together. This repair is usually successful in the red zone.The inner two-thirds (white zone) of the meniscus does not have a good blood supply, so it does not heal well either on its own or after repair. If torn pieces float into the joint space, which may result in a “locked” knee or cause other symptoms, the torn portion is removed (partial meniscectomy) and the edges of the remaining meniscus are shaved to make the meniscus smooth.When the tear extends from the red zone into the white zone, there may be enough blood supply for healing. The tear may be repaired or removed. This is something the orthopedic surgeon decides during the surgery.Also, the pattern of the tear may determine whether a tear can be repaired. Longitudinal tears are often repairable. Radial tears may be repairable depending on where they are located.

The choice of type of surgery is based on the size and location of the tear, your age and activity level, the surgeon’s experience, and your preferences. Orthopedic surgeons most often perform meniscus surgery with arthroscopy, a procedure used to both examine and repair the inside of a joint. A thin tube (arthroscope) containing a camera and light is inserted through small incisions near the joint. Surgical instruments are inserted through other small incisions. Arthroscopic surgery may limit knee damage from surgery and may promote fuller recovery. But some tears may require open knee surgery.

Meniscus Root tears 

 

These are tears of the meniscus from their anchor point on the tibia (shin bone) and a repair is vital to preserve meniscus function. If not repaired or excised these can lead to early onset arthritis and cartilage loss.

Linear tear of the meniscus

 

These are longitudinal tears which if extensive can cause displacement of the meniscus body into the joint, the so called ‘bucket handle tear’. If located in the red red zone an arthroscopic repair leads to excellent results.

In a total meniscectomy, the entire meniscus is removed. In a partial meniscectomy, the surgeon removes as little of the meniscus as possible. Unstable meniscal fragments are removed, and the remaining meniscus edges are smoothed so that there are no frayed ends.

Ligament Reconstruction with Meniscus Repairs

 

Some individuals have complex injuries in the knee joint, typically an Cruciate ligament tear associated with a  meniscus tear. Both the injuries can be addressed in the same sitting with a ligament reconstruction and meniscus repair. In such setting Meniscus repairs show excellent healing and individuals are able to return to their pre injury function.

What To Expect After Surgery

Rehabilitation (rehab) varies depending on the injury, the type of surgery, your orthopedic surgeon’s preference, and your age, health status, and activities. Time periods vary, but meniscus surgery is usually followed by a period of rest, walking, and selected exercises. Most people who have arthroscopic meniscectomy can bear weight a day or two after surgery and can return to full activity within 2 to 4 weeks. After the full range of motion without pain is possible, you can return to your previous activity level.

With regards to Meniscus repair surgery a restriction on weight bearing is advised for six weeks. Knee range is limited to 90 degrees flexion. After six weeks ful knee range of movement and weight bearing is started .

The timetable for returning to walking, driving, and more vigorous activities will depend on the type and extent of the surgery and your success in rehab.

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