The knee is one of the most complex and largest joint in the body, and is highly susceptible to injury. Meniscal tears are among the most common injuries to the knee joint. It can occur at any age, but is more common in athletes playing contact sports.

The meniscus is a small, “c”-shaped piece of cartilage in the knee. Each knee consists of two menisci, a medial meniscus on the inner aspect of the knee, and the lateral meniscus on the outer aspect of the knee. The medial and lateral meniscus act as cushion between the thigh bone (femur) and shin bone (tibia). The meniscus has no direct blood supply, and for that reason, healing cannot take place when there is an injury to the meniscus.

The meniscus acts like a “shock absorber” in the knee joint. Meniscus tears are the most common indication for Knee Arthroscopy. There is a higher risk of meniscus tears in knees that have ACL tears. Normally, medial (inside) meniscus tears are more common than lateral (outside) tears. In the presence of ACL tears, lateral tears are more common. Degenerative tears are tears that occur in older patients with wear and tear of the medial meniscus.

CAUSES

Meniscal tears often occur during sports. These tears are usually caused by twisting motion or over flexing of the knee joint. Athletes who play sports such as football, tennis and basketball are at a higher risk of developing meniscal tears. They often occur along with injuries to the anterior cruciate ligament, a ligament that crosses from the femur (thigh bone) to the tibia (shin bone).

The exact mechanism of injury of a meniscus tear is tearing during inner rotation of the femur bone (top bone) on the tibia (larger lower bone) with the knee in a partially bent position. The femur torques the meniscus towards the center and back of the knee. In the back of part of the knee, the meniscus is caught between the two bones and tears when the joint suddenly straightens.

Various types of meniscal tears that can occur are longitudinal, bucket handle, flap, parrot-beak and mixed or complex.

SYMPTOMS

The symptoms of a meniscal tear include:

  • Knee pain when walking
  • A “popping” or “clicking” may be felt at the time of injury
  • Tenderness when pressing on the meniscus
  • Swelling of the knee
  • Limited motion of the knee joint
  • Joint locking can occur if the torn cartilage gets caught between the femur and tibia preventing straightening of the knee
  • Diagnosis

A careful medical history and physical examination can help diagnose meniscal injury. The McMurray test is one of the important tests for diagnosing meniscal tears. During this test, your doctor will bend the knee in, then straighten and rotate it in and out. This creates pressure on the torn meniscus. Pain or a click during this test may suggest a meniscal tear. Your doctor may order imaging tests such as knee joint X-ray and knee MRI to help confirm the diagnosis.

NON-OPERATIVE TREATMENT:

This is indicated for degenerative tears. If there is significant arthritis present, the patient is not an ideal candidate for arthroscopic intervention. Immediate management includes:

  • Rest: Avoid activities that may cause injury
  • Ice: Ice application to reduce swelling- 20 minutes per hour. Make sure there is a towel protecting the skin from ice burns
  • Pain medications: If medically warranted then Nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce swelling and pain
  • Physical Therapy: This may be recommended for muscle and joint strengthening, pain control, range of motion and to lower swelling

INDICATIONS FOR KNEE ARTHROSCOPY:

  • If symptoms persist and conservative treatments fail
  • If the meniscal tear is displaced
  • If the knee locks or buckles
  • If the patient is young and active

KNEE ARTHROSCOPY:

PARTIAL MENISCECTOMY

This is the resection of the torn, non-viable fragment off of the remaining healthy meniscus. Indications include tears that are not amenable to repair such as complex, radial and degenerative tears. These tears are in the white zone of the meniscus which has no blood flow and has no potential of healing. Predictors of success is normal alignment of the joint and minimal or no arthritis.

MENISCUS REPAIR

This is the suturing of the torn meniscus to allow it to heal. The best indications for repair are tears that are in the peripheral red zone. This zone is a vascular region where blood flow reaches the meniscus and has the potential of healing. Acute repair in conjunction with an ACL reconstruction have particularly good rates of healing because of the abundance of blood flow as a result of the procedure.

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