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Meniscus tears, mostly known as athlete’s disease, can occur during sudden changes of direction and stopping. They can cause pain, swelling, and knee locking and develop due to congenital anomalies from infancy.
Avoid sudden movements
The meniscus is a cartilage structure in the knee joint. It ensures that the knee is stable and the body weight is balanced and spread evenly to the knees. A meniscus tear occurs when the knee suddenly rotates or bends. It is classified into three groups: congenital disorder seen in the outer meniscus, tears that occur in athletes and meniscus aging that develops in advanced ages. It is usually seen in athletes, but a wrong movement or step taken in daily life can cause the knee to sprain and tear the meniscus—the most common symptom of a meniscus tear is pain and feeling of ejaculation and swelling in the knee. In large tears, the meniscus fragment can displace and escape into the knee, causing the knee to lock and making it difficult for the person to walk.
If you hear a sound from your baby’s knee…
The knees of babies with congenital meniscus problems make noise. In this case, an external meniscus anomaly should be suspected, and a specialist should be consulted because the common congenital anomaly in the external meniscus can give symptoms of meniscus tear without any traumatic cause. There are also changes in the meniscus with aging. As the age increases, the meniscus loses its flexibility and becomes fragile; gradually, the water in it decreases, and thus, it can tear easily. Silent tears can also occur without any symptoms and without disturbing the patient. They can be found in MRI examinations of the knee performed for another reason. It is recommended that specialised doctors monitor the patient until the symptoms begin to appear.
Individualised modern treatment methods are applied.
If the complaints do not disappear with rest, cold application, exercise programme, pain-reducing drug treatments, arthroscopy, which is called closed surgery, is recommended. In this procedure, special instruments are inserted into the knee joint, and the intra-articular menisci, ligaments and cartilage are examined in the images displayed on the screen. When a meniscus tear is observed, it is partially removed or repaired, taking into account the shape and location of the tear, the patient’s age, sociocultural status and occupation.
Do exercises to strengthen the muscles
Since the surgical intervention is performed by a closed method, the patient’s recovery process is faster. Patients are discharged the day after the operation. Since arthroscopy is performed through several holes, the wounds heal quickly, and physiotherapy movements can be started promptly. If the torn part is removed during the operation, the patient can return to their daily life soon in the postoperative period. If the meniscus tear is sutured, the patient should walk with the support of crutches without giving load to the knee for about 3-4 weeks and should apply physical therapy and home exercises to avoid losing muscle strength and joint movements. To prevent meniscus tears, it is essential to do exercises that strengthen the muscles around the knee, to avoid movements and activities that force the knee, not to gain weight, and to do adequate warm-ups before sportive activities.
Meniscus Tears in the Knee Joint
Nowadays, knee injuries are becoming more and more common in people of all ages as sports activities and exercises aimed at physical fitness become more popular. The knee joint is the largest in the body. The knee joint consists of 3 bones. The thigh (femur) fracture above, the leg (tibia) bone below, and the front part is the kneecap (patella) bone. Although the knee joint is a hinge-type joint that allows flexion and extension, it also shows rotator joint function during movement. Since the articular surfaces are not very suitable for each other, the joint is strengthened by auxiliary tissues. These are knee joint ligaments (Ligaments) and hollow cartilages (Menisci).
Anatomy
Each knee has two fibrocartilaginous menisci, one internal and one external. The menisci are half-moon shaped; the peripheral parts are in the form of a triangle (in transverse sections) with a convex and thick inwardly thinning (in transverse sections) and are located to cover 3/2 of the tibia joint surface. Menisci are elastic structures with dense, tightly knitted collagen fibres that resist compression and undertake essential tasks. The shock-absorbing function of the menisci provides knee stability by helping to nourish the articular cartilage. It ensures that the load is distributed over a wider area and the articular cartilages are protected from high pressure.
Etiopathology:
Meniscal tears can be seen at any age, but the formation mechanisms differ. Since the meniscus tissue is intact in young people, they are torn as a result of severe trauma. It should not be forgotten that trauma and strains that cause meniscal tears cause injuries in the capsule, lateral and cruciate ligaments. In advanced ages, the meniscus weakens due to degeneration and can be torn even with effortless knee movements. Because the inner meniscus is more expansive, thicker and tightly adhered to the medial-lateral ligament, it is injured and torn 5-7 times more frequently than the more mobile outer meniscus. Meniscal tears are classified according to the tear shape: – Longitudinal tears are parallel to the edge of the meniscus and may be partial or complete. – Transverse tears It is in the form of separation of the superior and inferior faces of the meniscus – Oblique tears – Radial (peripheral) tears – Different types of tears (flap-shaped, bucket handle-shaped, parrot’s crest-shaped, mixed or degenerative meniscus tears) Since the vascular part of the meniscus is in the periphery, healing occurs only in this region. Therefore, with the development of arthroscopic surgery in recent years, repair of peripheral meniscal tears has become one of the repair methods used.
Clinical Signs and Symptoms:
Most meniscal tears have three main symptoms: pain, swelling and locking. Pain is the most critical symptom and often occurs at the joint level on the side of the torn meniscus. The pain increases when climbing stairs and squatting, and the locking occurs when the torn meniscus part is stuck in the joint space, and the bent knee cannot be opened for a long time. There is often fluid accumulation in the knee with a meniscus tear. The patient perceives this as swelling and feeling fullness in the knee. Sensitivity can be found throughout the joint space, indicating tears or strains at the peripheral attachment sites of the meniscus.
Diagnosis:
The diagnosis is reached by anamnesis, physical examination, special tests for the meniscus, MRI and arthroscopy. A meniscus tear can be suspected based on the patient’s history, the type and time of injury, the severity of the trauma, complaints, examination findings, and special tests (McMurray, Apley tests). Plain X-rays do not show the menisci; however, it is recommended that the menisci be taken to see other abnormalities in the knee. The best diagnostic tool is magnetic resonance imaging (MRI), which shows meniscal tears in 80-93% of cases and other joint structures. If the diagnosis cannot be made with these, the diagnosis can be made definitively by looking inside the knee with arthroscopy.
Treatment:
Conservative treatment:
Following an acute knee trauma, the first treatment should be conservative until the diagnosis of pathologies in the knee is established. Firstly, the limb is unloaded and rested. Symptomatic treatment is provided medically with anti-inflammatory and analgesic drugs. After the acute symptoms subside, the knee joint is carefully examined, and the course of treatment is determined according to the findings. Initial treatment is continued for an average of 10 to 20 days, depending on the severity of the injury. After this period, the load is removed. In the next stage, localised palpation pain in the knee persists; however, if the ligament system is intact, conservative treatment is continued if there is no locking and hydroarthrosis. An elastic bandage or knee brace is wrapped around the knee. The patient is told to suspend sportive activities, continue progressive quadriceps exercises, and monitor the patient.
Surgical Treatment:
1-) Following the initial treatment, when symptoms such as recurrent pain and ongoing effusions and locking begin to interfere with daily or sportive life, surgical treatment for the meniscus is performed as surgical removal of the meniscus aiming to preserve the maximum meniscus, i.e. meniscectomies, total meniscectomies involving the removal of the entire meniscus or partial meniscectomies involving the removal of only the torn part.
2-) Meniscal repairs by fixing the tear with sutures in peripheric tears. The last stage in meniscal treatment is meniscal transplantation. It is an alternative method to prevent future degenerative changes in patients with previously removed meniscus and to regain their contribution to knee stability. The principle of transplantation, which has been increasingly applied in recent years, is to maintain the vitality of the meniscal tissue taken from the corpse in the new knee to which it is transplanted.
Arthroscopy
It is used frequently to diagnose and treat extensive joint injuries worldwide. It is a minor surgical procedure that does not harm the patient. Arthroscopy is technically based on the principle of clear visualisation of the inside of the joint on the monitor screen with the help of a fibreoptic camera and with instruments thinner than a pencil inserted into the joint with the help of tiny surgical incisions. Since the structures that ensure the strength of the joint are not damaged, patients can return to their old jobs and activities quickly after arthroscopy. No sutures are applied to the skin at the end of the operation. The majority of patients can be discharged on the same day.
