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What is the Meniscus and its Importance for the Knee Joint?
The meniscus is a cartilage-like tissue, with the firmness of an auricle, found two meniscus in each of our knee joints, one on the inner side and one on the outer side of the knee.
Its most important function is to prevent damage to the unique cartilage covering that forms the surfaces of the bones that make up the upper part of the knee (femur) and the lower part of the knee (tibia) by being located between them. So how do our menisci do this? They do it in two ways:
The most important function of the meniscus is load sharing across the knee joint. The meniscus is located between the femur and tibia, increasing the contact area between the two bones, distributing the loads evenly throughout the joint instead of concentrating them in a specific area, and sharing the load stress.
Secondly, it reduces contact stress on the joint cartilage on the femur and tibia that form the knee joint.
The secondary important function of the meniscus is to increase joint congruence, provide joint stability, and reduce the load and stress on the knee joint ligaments. It also helps with lubrication on the surfaces of the joint. One of the most common injuries an orthopedist encounters is a meniscal tear.Acute meniscal tears are quite frequent, with approximately 60 out of every 100,000 people tearing one of their menisci each year. Arthroscopic meniscectomy, the cleaning surgery of an irreparable meniscal tear, is one of the most common surgeries performed in orthopedic practice worldwide.
How Do Meniscal Tears Occur?
In young people and active individuals, most meniscal tears occur during sudden stops, sudden stops followed by forced rotation of the knee joint, or sudden changes of direction. In middle and older ages, they occur during squatting or as a result of a fall.
What are the Symptoms of a Meniscal Tear?
Pain:
The pain can be located along the knee joint line, depending on the location of the tear, and can be in the front, side, or back of the knee. The pain often increases during squatting.
Swelling:
A large proportion of patients with acute meniscal injuries develop swelling (effusion) in the knee joint. Swelling in the knee joint occurs more quickly in anterior cruciate ligament injuries (within a few hours), while it starts later in meniscal tears.
Mechanical Symptoms such as Catching and Locking:
Some meniscal tears, such as flap tears, some complex tears, and bucket-handle tears, are large and can cause mechanical symptoms like catching and locking due to the torn meniscal fragments.
Mechanical symptoms can be felt by the patient during daily life or during a sports activity, as well as during the examination with some tests that I will perform.
The most important feature of mechanical symptoms is the need for surgery. If mechanical symptoms are present, seeking non-surgical solutions would not be the correct approach.
How is a Meniscal Tear Diagnosed?
Based on the patient's history and knee examination, the diagnosis of a meniscal tear is made using MRI imaging. However, not every meniscal tear seen on MRI can explain the patient's pain.
For example, if a patient has knee pain stemming from a cartilage problem under the kneecap and a tear is seen in the meniscus on the MRI, it is not the correct approach to attribute the patient's pain to the tear and even plan meniscal surgery. If the examination findings indicate a meniscal tear and there is a tear in the MRI images examined after the MRI is taken, treatment is planned for the tear.
How to Decide on the Treatment of Meniscal Tears?
The main philosophy of meniscal tear treatment is related to whether it causes symptoms. If there are no mechanical symptoms like catching and locking, and the patient only has pain due to the tear, the primary treatment is to adjust the activities necessary for daily life and sports activities and start physiotherapy quickly.
In addition, during this process, if pain control is not achieved, joint injections such as PRP and PRGF, which are obtained from the patient's own blood and facilitate the healing of the tear, can be performed.
If the patient has no mechanical symptoms and the only problem is pain, non-surgical methods should be applied for 4-6 months before deciding on meniscal surgery. We know that the pain of most meniscal tears subsides over time. However, some do not, and if the pain persists after 4-6 months, surgery may be needed.
The second important issue is whether the tear can be repaired and sutured with stitches. If there is a chance of repairing the tear, it is the right decision to opt for surgery as soon as possible.
Because initially repairable tears can turn into more fragmented (complex tears) over time, making repair impossible. In this case, we are left with only one surgical option; cleaning the tear, also known as arthroscopic meniscectomy.
What Types of Surgeries are Performed in the Treatment of Meniscal Tears?
Meniscus surgeries can be simply divided into two categories:
Meniscus tear cleaning surgery
Meniscus tear repair surgeries with stitches
Meniscus Tear Cleaning Surgery (Arthroscopic Meniscectomy)
The surgery for irreparable meniscus tears is the Arthroscopic Meniscectomy, simply referred to as cleaning the tear. You can click this link for a detailed read: Parsiyel Menisektomi
Also, you can watch the video of this surgery with this link: https://www.youtube.com/watch?v=NIdSagzLxGg&t=1s
The characteristic of this surgery is that the patient can walk without using crutches and bear weight on the operated side a few hours after surgery.
Meniscus Tear Repair Surgeries
With the advancement of technology and the development of stitching techniques and materials, we are now able to repair and heal an increasing number of torn menisci with stitches.
There are multiple meniscus stitching techniques, and the location of the tear and how the tear was formed are important factors when deciding which technique to apply.
Meniscus tear repair surgeries:
Inside-out stitch method: Repair with the Inside-Out Method
Outside-in stitch method: Repair with the Outside-In Method
All-inside stitch method: Meniscus Repair with All-Inside Method
Repair method for root tears: Meniscus Root Tears
