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Meniscal Repair

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Meniscal Repair

Meniscal tear is one of the most common knee injuries. Any activity that involves rotating the knees under resistance, especially when weight is put on them, can lead to rupture of the meniscus.

Meniscal tears cause pain, swelling and stiffness. Although sometimes conservative therapies such as cooling, rest, and physiotherapy are sufficient for such an injury to heal, often times, meniscus injuries require surgical treatment which is most often performed arthroscopically.

Knee anatomy

  • Femur – thighbone
  • Patella – kneecap
  • Tibia – shinbone (larger bone of the lower leg)
  • Fibula – smaller bone of the lower leg
  • Collateral ligaments - firm, elastic connective tissue that surrounds the joint to ensure its stability
  • Cruciate ligaments - the anterior and posterior cruciate ligaments of the knee form an X shape, they ensure rotational stability and prevent excessive displacements of the shinbone relative to the thighbone
  • Menisci - curved cartilaginous parts in the joint (in the form of letter C) that serve as shock absorbers to absorb the load, increase the contact of the joint surfaces, etc.
  • Muscles – serve for the dynamic stability of the joint

Symptoms

If you have injured your meniscus, you may experienced the following signs and symptoms in your knee:

  • Swelling or stiffness
  • Pain, especially with rotational movements
  • Difficulty stretching the knee
  • Feeling of locked/blocked knee
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Photo: Meniscus tear results in knee pain, stiffness, swelling, as well as difficulties in mobility and fully extending the knee.

Do you feel any of the symptoms? Contact us and arrange an examination.

When to see a doctor?

Talk to your doctor if your knee is painful or swollen as well as if your knee movements are limited after the injury, i.e. after the event that preceded the symptoms.

Causes

Meniscus tear occurs by sudden twisting or other uncontrolled movements during the sport or physical activity. These types of injuries are more common in people over the age of 30. The younger people have fewer injuries because the meniscus is still quite stiff and more resistant, like rubber. As we age, the meniscus weakens and injuries can occur more easily, even from simple movements such as squats, lifting weights, or standing on an uneven surface. In the elderly, meniscus injuries can also occur due to degenerative conditions such as osteoarthritis.

Do you feel certain discomfort during physical activity? Visit us for a specialist orthopedic examination.

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Photo: Rotational movement in the knee (left image) during sports and other physical activities is the most common cause of meniscus injuries. Meniscus tears take different forms for which the treatment is, thus, also different. The right image shows normal menisci.

Risk factors

Some of the risk factors for meniscus injuries are the following:

  • Activities involving rotational movements in the knee (e.g. basketball, handball)
  • Contact sports (e.g. football)
  • Older age
  • Obesity

Complications

Rupture of the meniscus can result in a feeling of knee giving out, reduced mobility, and persistent pain.

Besides, due to meniscus injury, which induces lack of amortization in the knee and consequently a greater transfer of forces from the femur to the tibia, it is more likely a person will develop cartilage injuries and knee osteoarthritis at a later age.

Diagnostics

Examination by orthopedic specialist

In order to decide on the type of treatment, an orthopedic specialist will use a clinical examination to determine the range of motion of your knee, its stability and the potential existence of certain injuries (e.g. meniscus tear). There are several different clinical tests that indicate a possible meniscus tear.

During the orthopedic examination, the orthopedic specialist will ask you some questions in order to make a diagnosis and decide on the treatment:

  • When did the injury occur?
  • What were you doing at the time of the injury?
  • Did you hear a “popping” sound at the time of the injury?
  • Did you feel like something “popped out” at the time of the injury?
  • Has there been swelling in the knee area after the injury?
  • Have you ever had a knee injury in the past?
  • Were your symptoms constant or did they appear occasionally?
  • Are there certain movements that make your symptoms worse (pain, stiffness)?
  • Have you ever had a feeling as if your knee has "locked up", i.e. that the movements you want to make are blocked?
  • Do you feel that your knee is unstable?
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Photo: With the clinical examination of knee joint, an orthopedic specialist checks for signs of meniscus rupture and makes a decision on further diagnosis and treatment.

Radiological diagnostics

In order to verify this injury with certainty, radiological diagnostics is also required. Magnetic resonance imaging (MRI) of the knee joint provides detailed information on all structures inside and outside the knee joint. MRI is also the best radiological method for proving injuries (such as meniscus tear).

Treatment

Treatment options range from anti-inflammatory drugs, physiotherapy and rehabilitation to surgical (arthroscopic) treatment. The orthopedic specialist will discuss all the treatment possibilities and recommend the one based on the patient history, clinical examination, as well as the type and the location of the meniscus tear (visible on MRI of the knee).

Conservative treatment

Treatment of meniscus injuries, depending on the type, size, and location of the tear, often begins conservatively. Non-operative treatment along with physiotherapy will focus first on reducing the pain and maintaining full range of motion in the knee joint.

Your doctor may recommend:

  • Rest
    • Avoid activities that intensify knee pain. In the case of severe pain, relief with the help of forearm crutches can help reduce pressure on the injured knee and also promote healing.
  • Ice
    • Massaging with ice and cold compresses can reduce knee pain and swelling.
  • Medicines
    • o Nonsteroidal anti-inflammatory drugs can help relieve knee pain.

Surgical treatment of meniscus injuries

Treatment of symptomatic meniscus tears may include suturing of a ruptured part of the meniscus, partial removal of the damaged meniscus (partial meniscectomy), and meniscus transplantation. Surgical treatment of meniscus tears is most often performed arthroscopically. Arthroscopic instruments allow careful removal of the damaged parts of the meniscus (partial meniscectomy) as well as suturing of a ruptured part of the meniscus.

Because the meniscus plays an important role in the long-term health and function of the knee, the surgeon will always try to maintain or repair any part of the meniscus that has a blood supply and that can heal. Some meniscus ruptures occur in the "avascular" part (white zone) of the meniscus, i.e. the part of the meniscus that has no blood supply, in which the tissue healing cannot occur, which is why ruptures in that part cannot be sutured. In this case, the torn part of the meniscus is simply removed. Partial meniscectomy relieves the patient of pain and other symptoms associated with meniscus injury, but does not itself help prevent the onset of osteoarthritis of the knee.

If the rupture is located in the part of the meniscus that has a blood supply (red zone), healing is possible and an attempt is made to repair the damage by suturing the meniscus. It is important to say that the age of the patient also depends on the choice of treatment. Namely, meniscus ruptures in patients with 40 years of age and older are often degenerative; degenerative changes in the menisci result in poorer tissue quality, poorer blood supply and often cannot be repaired. In younger patients, an attempt is always made to repair the injured meniscus in order to maintain its full volume, since meniscus serves as a shock absorber between the two supporting bones and since the loss of it is a risk factor for developing knee osteoarthritis. After surgery, high-quality physiotherapy is of the utmost importance. Complete recovery from surgery varies from a few weeks for partial meniscectomy to several months after repair of meniscus rupture by suturing.

In the St. Catherine specialty hospital there are no lengthy waits for the surgical procedures – the first step is a specialist examination. Make an appointment today!

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Photo: Results of surgical treatment of meniscus rupture: partial meniscectomy (left) and meniscus suturing (right)

Meniscus transplantation is a therapeutic option for the treatment of patients younger than 50 years of age with early evidence of posttraumatic arthritis. To be candidates for this treatment, patients must meet the following criteria:

  • Good knee stability (healthy and functional cruciate knee ligaments)
  • No major knee shaft misalignments (no major valgus / varus knee deformities)
  • Minimal to moderately symptomatic posttraumatic arthritis

Meniscus transplantation can also be performed arthroscopically. In meniscus transplantation, the remaining meniscus tissue is removed first. The freshly frozen meniscus of the donor, to which the size of the recipient's knee was preoperatively determined and adjusted, is implanted in the patient’s knee under arthroscopic guidance and attached to the bone by means of bone tunnels and sutures. After the surgery, the patient must use forearm crutches for approximately 6 weeks as well as undergo intensive and high-quality physiotherapy and rehabilitation. Patients can return to heavier physical work after approximately 4 months, while to sports after approximately 6 to 9 months.

With a clinical examination and insight into patient’s medical records, it is possible to alleviate problems and discomforts in a timely manner, so do not delay and make your appointment for an examination today.

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