What is the meniscus and what does it do?
Before arthroscopic methods, menisci were thought to be useless remnants, and meniscus tears were considered in every patient with knee pain and menisci were removed during surgery. However, in recent years, it has been understood that the menisci have very important functions for the normal function of the knees. The menisci located between the two bones (thigh and tibia) act as a cushion and protect the articular cartilage from abnormal loads. They are very important in the transport and transfer of loads from the knee. They also increase the compatibility of the joint surfaces and allow the intra-articular circulation of joint fluid.
they contribute. In the absence of menisci, the loads on the knee joint are transferred directly to the articular cartilage, leading to premature wear, namely calcification (osteoarthritis). Today, protecting the menisci has become a top priority.
How do meniscus tears occur?
The way meniscus tears occur in young and elderly individuals is different. In teenagers, trauma is required to rupture the meniscus. This usually occurs during the rotational movement on the fixed foot. Tears that occur in sports such as football, basketball and skiing are examples of this. As the years pass, the menisci begin to deteriorate by losing their strength and flexibility. Deteriorated menisci can tear much more easily. In elderly individuals, meniscus tears can occur with a simple squat or snagging on the carpet. The outer meniscus is more mobile than the inner meniscus, so inner meniscus tears are more common. Although rare, congenital deformities of the menisci may occur. This type of menisci is more prone to tearing and can give symptoms even in childhood.
What are the symptoms of meniscus tears?
While meniscus tears occur, patients often feel a sudden pain, stinging or tearing. Depending on the torn meniscus, the pain is more pronounced on the inside or outside of the knee. Within a few hours, swelling occurs in the knee joint due to the collection of fluid or blood in the knee. Generally
It is possible to step on the injured knee, but there is a limp and athletes often have to quit the sport. If the injury is severe, meniscal tears may also be accompanied by ruptures of the cruciate or lateral ligaments of the knee joint. In this case, symptoms such as insecurity and a feeling of emptiness in the knee may also occur. Sometimes the torn piece of meniscus gets stuck between the bones that make up the knee joint, preventing knee movement. In this case, known as locked knee, early surgical treatment is required.
As time passes, the widespread pain in the knee decreases and becomes punctuated on the involved meniscus. Pain occurs especially during sudden turns and squatting. Torn meniscus pieces can enter between the joint surfaces and cause symptoms such as snagging and locking in the knee. This can also lead to crackling-like sounds that were not previously present in the knee.
How is the diagnosis made in meniscus tears?
In order for your doctor to reach the diagnosis of meniscus tear, he will first ask you to explain how the event occurred. He or she will then examine your knee and look for signs of a meniscus tear. At this time, it also examines your lateral and cruciate ligaments. After a good history and physical examination, the diagnosis of meniscal tear is high.
extent occurs. Your doctor may order X-rays to evaluate the amount of wear and tear in your knee and to see if there are any other problems with bone structures. In recent years, the most reliable method to confirm the diagnosis of meniscal tears is magnetic resonance imaging (MRI) of the knee joint.
The accuracy rate of MRI in detecting meniscal tears is over 95% if it is duly performed and evaluated in experienced hands. However, MRI is not the only determinant in deciding the treatment. In some cases, the appearance of a tear may be obtained without a tear (false positive result), or it may be completely
conversely, the tear may be undetectable on MRI (false-negative result).
Especially if surgical treatment for the meniscus has been performed before, the margin of error increases and further diagnostic methods may be required. Therefore, when deciding on your treatment, your doctor considers not only MRI findings, but also your history and physical examination findings. In some cases this diagnosis
All methods may be insufficient. In this case, the diagnosis is confirmed by arthroscopy.
What treatment options are available for meniscus tears?
Treatment of meniscal tears in young people is mostly surgical. Menisci do not have the ability to heal themselves, except for some small tears that are very rare and not full thickness. In patients with obvious complaints, the meniscus tear is tried to be repaired by surgical intervention, if the tear is not suitable for repair, the torn part is removed. In elderly patients, meniscal tears are usually accompanied by knee arthrosis (wear, tear, calcification). In this case, only intervening in the meniscus tear may not completely solve the problem. In this case, your doctor will decide on suppression of symptoms with drug therapy, intra-articular injections, arthroscopic surgery, or one of the bone corrective surgeries with arthroscopy.
Is the meniscus sutured, how is the meniscus repaired?
The first option in meniscus tears is repair, so that they can fulfill their role, which is very important for the long-term health of the knee. Due to the vascularity of the menisci, their healing abilities are not very high and roughly one-fifth of meniscus tears are suitable for repair. Meniscus repair today
performed with arthroscopic surgery. Depending on the strength of the repair and whether there are other intraarticular interventions (eg, cruciate ligament surgery), you may need to use crutches and avoid squatting for a few weeks after the surgery. Return to sports can take between 4 weeks and 4 months. The success rates of meniscus repair vary between 70 and 95%, depending on the type of tear and the type of surgery performed. Despite the repair, the meniscus may not heal or may tear again. In other words, a second surgery may be required in 5-30% of meniscus repaired patients. Although the failure rate seems high, this risk is acceptable considering the wear that will occur in the knee in the absence of menisci. If the repair is unsuccessful, the torn meniscus can be removed with a simple operation.
What is the cleaning of the torn part of the meniscus (menisectomy)?
If your doctor decides that your meniscus tear is not suitable for repair, the torn piece of meniscus is removed. This procedure is called meniscectomy. During this procedure, only the torn part is removed and the remaining intact part of the meniscus is preserved. This includes partial meniscectomy
is called. The more meniscus tissue that can be preserved, the better for the long-term health of the knee. Because the remaining meniscus tissue continues to carry a load, albeit partially. The early results of partial meniscectomy are very good. A serious rehabilitation program is needed after surgery.
there is none. It is possible to return to normal life and sports within a few days or weeks after exercises at home. In follow-ups longer than 15 years, approximately one-fifth of patients who underwent partial meniscectomy may develop signs of wear on the knee. These findings are more severe especially in patients whose external meniscus is removed than in those whose internal meniscus is removed.
What is a meniscus transplant, is there an artificial meniscus?
Studies continue on the production and transplantation of synthetic meniscus tissue instead of tissues taken from another person. With today’s technology, synthetic meniscus tissues can be used only in partial meniscus losses.
