What are the functions of meniscus :
The menisci are two crescent-shaped structures of fibroelastik cartilage that are located inside each knee joint that act like a cushion between the shinbone and thighbone. The integredity of the meniscus is mandatory for a healthy knee joint.
Meniscus have numerous important functions, which are mainley:
- Absorption of shock
- Transmission of weight during hiking, walking, squatting
- Stability of the joint
A meniscus injury can be referred as a tear involving the meniscus. A torn meniscus can result from either a prominent acute trauma ( usually related to sports activities) or age-related degeneration of the knee joint with minor or no history of trauma.
What are the symptoms of meniscus tears ?
- Lockingor catching of the knee
- A popping sensation (especially in acute tears)
- Inability to fully bend and straighten the knee
- Swellingand stiffness of the knee joint
- History, symptoms
- Physical examination ( Mc murray Test, Apply Test, Thessaly Test, tenderness over the lateral or medial tibiofemoral joint, restriction in extension of the knee)
- Imaging studies ( X-Ray, MRI )
Treatment of a meniscus tear varies and depends on several factors such as:
- Pattern of the tear ( horizontal, vertical, radial, bucket handle, degenerative)
- Localization of the tear
- Concominant pathology of the knee joint and surrounding soft tissue ( ligaments, .)
- Age of the patient
- Activity level of the patient
- Severity of symptoms
Treatment generally consists of 2 modalities:
- Non -Surgical Treatment : ( usually a combination of these methods)
- Activity modification
- Stabilization of the knee joint
- Nonsteroidal anti-inflammatory drugs– steroid injections ( acute phase)
- Injection of platelet-rich plasma ( PRP)
- Stem Cell Therapy
- Isometric strenghtening , range of motion and propioception exercises.
- Surgical Treatment
Surgery is recommended in :
- Acute (ideally less than 10 weeks)
- traumatic symptomatic displaced
- Vertical, bucket handle, some horizontal tears in the red-red and red-white zone of the meniscus.
- Chronic tears with concomitant cartilage injury and ongoing symptoms despite non-surgical methods
Arthroscopic surgical procedure is based on inserting a mini camera and working surgical instruments through two – three 0.5 cm incisions in the knee joint.
There are two main types of arthroscopic surgery for a meniscus tear:
1.Partial meniscectomy : Excision of the torn part the meniscus with is not amenable for repair. Can be performed as an outpatient procedure. Immediate weight bearing and full range of motion is allowed following surgery .
- Meniscus repair: Meniscus repair involves using special stitches to repair the torn pieces of a meniscus back together using an all-inside technique. Duration of healing is postoperative 6-8 weeks . Following surgery a rehabilitation program consisting of exercises to improve range of motion and strengthening knee muscles is advocated.