Meniscus Injuries

Meniscus of the knee are crescent-shaped wedges that fill the gap between the tibia and femur. The menisci provide joint stability by creating a cup for the femur to sit in. The outer edges are fairly thick while the inner surfaces are thin.

 

There are two meniscus

 

The one on the inner side is called medial meniscus and one on the outer as lateral meniscus. The medial meniscus, located on the inside of the knee, is more of an elongated “C”- shape, as the tibial surface is larger on that side. The medial meniscus is more commonly injured because it is firmly attached to the medial collateral ligament and joint capsule. The lateral meniscus, on the outside of the knee, is more circular in shape. The lateral meniscus is more mobile than the medial meniscus as there is no attachment to the lateral collateral ligament or joint capsule.

 

The outer edges of each meniscus is attached to the tibia by the short coronary ligaments. Other short ligaments attach the ends of the menisci to the tibial surface. The inner edges are free to move because they are not attached to the bone. This lets the menisci change shape as the joint moves. The front portion of the meniscus is referred to as the anterior horn, the back portion is the posterior horn, and the middle section is the body.

 

A meniscus tears in a variety of ways:-

 

Type of injury depends on location

 

Location – A tear may be located in the anterior horn, body, or posterior horn. A posterior horn tear is the most common. The meniscus is broken down into the outer, middle, and inner thirds. The area in which the tear is located will determine the ability of the tear to heal, since blood supply in that area is critical to the healing process. Tears in the outer 1/3 have the best chance of healing.

 

Pattern – Meniscal tears come in many shapes. Examples of the various patterns are:

  • Longitudinal
  • Bucket-Handle
  • Displaced bucket handle
  • Parrot beak
  • Radial
  • Displaced flap
  • Horizontal
  • Degenerative

 

A complex tear – includes more than one pattern.

 

Complete tear – A tear is classified as being complete or incomplete. A tear is considered complete if it goes all the way through the meniscus and a piece of the tissue is separated from the rest of the meniscus. If the tear is still partly attached to the body of the meniscus, it is considered incomplete.

 

Symptoms

 

Acute tears are often sports related and usually the result of a twisting injury in the younger, active adult population. Symptoms of an acute tear are usually pain, swelling, and movement irregularities. When the tear gets in the way of normal knee motion, the knee can “catch” or “lock” as it moves.

 

Degenerative tears are more common in the older population. The patient may experience repeated swelling, but often can’t recall any specific injury. The swelling also may be the result of an injury caused by a very minor movement. Mechanical symptoms, such as knee catching or locking, often exist. Or, the patient may simply experience pain.

 

Treatment

 

Non-operative Treatment Many small meniscal tears will heal without surgical treatment. Also, some tears may have no symptoms.

 

Partial tears, degenerative tears, and stable tears may be observed for 2 – 3 months.
If symptoms disappear, no surgery is needed. The use of a knee brace and restriction of activities may be recommended to prevent further injury.

 

Surgical Treatment
Surgical treatment for a meniscal tear may be indicated if:

 

  • Symptoms last for more than 2 – 3 months
  • A displaced tear causes the joint to lock
  • The anterior cruciate ligament is also injured – In this case, the knee is highly unstable and excessive motion exists within the joint. The meniscus is unlikely to heal without treatment.
  • The patient is a high-level athlete

 

If surgery is recommended, the procedure chosen is usually dependent on the location and type of meniscal tear. Procedure is performed using an arthroscope and usually don’t require an overnight hospital stay.

 

  • Trephination/ Abrasion Technique
  • Partial Resection
  • Complete Resection
  • Meniscal Repair
  • Meniscal Replacement

 

Trephination/ Abrasion Technique

 

This procedure is used for stable tears located on the periphery, the meniscus and joint capsule junction, where there’s a good blood supply. Multiple holes or shavings are made in the torn part of the meniscus to promote bleeding, which enhances the healing process.

 

Partial Resection

 

This surgical procedure is used for tears located in the inner 2/3 of the meniscus where there is no blood supply. The goal is to stabilize the rim of the meniscus by removing as little of the inner meniscus as possible. Only the torn part of the meniscus is removed. If the meniscus remains mostly intact with only the inner portion removed, the patient usually does well and does not develop early arthritis.

 

Complete Resection

 

This procedure involves the complete removal of the damaged meniscus. This technique is not performed now a days. Removal of the entire meniscus frequently leads to the development of arthritis.

 

Meniscal Repair

 

Repairs are performed on tears near the outer 1/3 of the meniscus where a good blood supply exists, or on large tears that would require a near-total resection. The torn portion of the meniscus is repaired by using either sutures or absorbable fixation devices. These devices include arrows, barbs, staples, or tacks that join the torn edges of the meniscus so they can heal.

 

Meniscus tear, depending on their grade & symptoms needs addressal.

 

The reparability of a meniscus depends on the type of tear and the zone they are in, like tear in red on red zone, where there is good blood supply, tends to heal well after surgery.

 

Radial tears sometimes can be repaired, depending on where they are located.

 

Horizontal, flap and long standing degenerative tears, those caused by years of wear & tear are generally cannot be repaired.

 

Three different kinds of surgical techniques are used to repair the meniscus

 

  • Outside in
  • Inside out
  • All inside

 

Post surgery you are not allowed to move your knee for 2-3 weeks. A long knee brace is given for immobilization. Physio should begin immediately after surgery which includes.

 

  • Static Quads
  • Ankle Pumps

 

Non-weight bearing walking, range of movement exercises are started after 3 weeks targeting 0-30° of flexion only.

 

Meniscal repair should be considered in young patients to improve the functional recovery of the knee joint, if the meniscus is repairable.