The meniscus is a fibro-cartilaginous pad present between the bony heads of the knee. Its main function is to cushion forces in the knee joint by decreasing the pressure on the cartilage. Other functions include joint lubrication, proprioception (set of functions deputed to control position movement) and knee stability.
Meniscal tears can be traumatic or degenerative in nature: while the former mainly affect people under 40 years of age, the latter generally affect patients over 50 years of age. Both are treated with arthroscopic surgery.
Meniscus injury: how does it happen?
Traumatic meniscal tears result from major trauma combining flexion, torsion, and compression. The most frequently affected anatomical portion is the posterior horn of the medial meniscus.
Degenerative meniscal pathologies affect people over 45-50 years of age, the trauma is usually minor (if present), and they tend to be complex injuries of the body and posterior horn of the medial meniscus.
Meniscus injury: the symptoms
If the meniscus ruptures due to a major trauma, in the acute phase, the clinical picture is characterized by widespread knee pain, often associated with joint effusion.
More rarely, the knee may be in mechanical lockout (the so-called “bucket-handle rupture”); in this case, the part of the ruptured meniscus comes between the femur and tibia, preventing normal flexion-extension of the knee.
If the meniscus ruptures due to minor trauma (e.g., a trivial rotation of the knee to pick up an object) or without trauma, the injury will be due to its physiological degeneration; the pain will be minor, dull and chronic, localized most often in the inner (medial) part of the knee. The pain tends to increase com rotational movements and with prolonged standing.
The diagnosis of meniscal tears
Diagnosis is made by clinical and instrumental tests (especially MRI) to confirm the clinical suspicion.
With MRI and later witharthroscopy, we can classify meniscal lesions according to shape as can be seen in the image.
Another important classification of meniscal lesions is according to the site of the lesion, that is, whether it is central or peripheral. While the peripheral zone of the meniscus is characterized by the presence of blood vessels (called the“red zone,” precisely), the central zone, on the other hand, has no vascularization (calledthe “white zone“). Between the two zones, there is one with intermediate capacity (“white-red” zone).
This makes us understand how while red areas if stabilized by arthroscopic suturing have a very good chance of healing, white areas have poor healing capacity so often, if injured, they are excised.
The treatment of meniscal tear
The first treatment choice is conservative and nonsurgical: rest, ice, oral anti-inflammatories, possible infiltration with cortisone or hyaluronic acid, use of orthotics, muscle strengthening, and physical therapies (e.g., laser, TECAR). This treatment is effective for small traumatic injuries or degenerative injuries in sedentary patients, often over 50 years of age.
For all traumatic injuries not responsive to conservative therapy or degenerative pathologies with joint locking, surgical treatment by arthroscopy is opted for, almost always in a one-day surgery setting.
Arthroscopy
Knee arthroscopy consists of a surgical procedure to evaluate and treat joint injuries through two small incisions: one to pass the arthroscopic camera, the other to pass the surgical instruments. Scars over time will become almost invisible.
During arthroscopy, a regularization of the injured and, therefore, unstable and painful meniscal portion (meniscectomy) is often performed; this involves the removal of a more or less large part of the meniscal structure. This is done for the most frequent central injuries, that is, affecting the “white zone,” as seen earlier.
If allowed by the site of the injury (vascularized area or “red zone”) and theage of the patient (age less than 35-40 years), an attempt is always made to preserve the native meniscal tissue by performing stabilization of the injury with a MENISCAL SUTURE.
Although the recovery time is longer, this treatment allows the maintenance of joint stabilizing but especially cushioning function of the meniscus.
Maintenance of the meniscal “cushion” is a strongly protective factor of cartilage wear or over a lifetime and, therefore, a protective factor of osteoarthritis.
Postoperative rehabilitation
Postoperative rehabilitation depends on the treatment performed:
- if a meniscus removal or regularization (meniscectomy) has been performed, loading is allowed immediately to the extent tolerated, seeking abandonment of crutches in the first 7-10 days. The use of knee braces is not expected, and flexion-extension is free immediately. At stitch desuture (about 15 days), rehabilitation with muscle strengthening exercises and proprioceptive recovery is begun. Return to contact sports is about 1 month after surgery.
- whether a SUTURE OF THE MENISCUS the postoperative course is longer and more demanding than the previous one: a postoperative knee brace is provided for the first month and free flexion-extension is progressively allowed during the first 20-30 days, depending on the type of injury and suture. Loading is only skimmed in the first month and is progressively allowed until full loading during the second month. Return to contact sports is about 4-5 months after surgery.
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