Treatment options for meniscus tears

Menisci are C-shaped cartilage-like structures located in the knee joint. They are located between the femur and tibia, the two main bones that make up the knee joint. There are two menisci in each knee, one inside and one outside.

Schematic and arthroscopic images of the inner and outer meniscus, a tear is observed in the inner meniscus

WHAT DO MENISCULS DO?

Forty years ago, menisci were thought to be useless scraps. For this reason, a meniscus tear comes to mind in every patient with knee pain, and even if the meniscus was intact during the operation, it was completely removed in case it would be torn in the future. However, in recent years, it has been understood that the menisci have very important functions for the normal function of the knees. The menisci, which are located between the two bones, act as a seal 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 contribute to the intra-articular circulation of the joint fluid. In the absence of menisci, the loads on the knee joint directly fall on the articular cartilage, causing premature wear, namely osteoarthritis. In the light of this information, protecting the meniscus has become the first priority of orthopedists.

HOW DO MENISCUS REAR OCCUR?

Meniscus tear may occur during the rotational movement on the fixed foot during football.

The way meniscus tears occur in young and elderly individuals is different. In young people, severe trauma is required for the meniscus to rupture. This usually occurs during the rotational movement on the fixed foot. Tears in sports such as football, basketball and skiing are examples of this.

Over the years, the menisci lose their strength and flexibility and “degenerate”. Degenerated 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 meniscus is more prone to tearing and can give symptoms even in childhood.

WHAT ARE THE SYMPTOMS OF MENISCUS REAR?

While meniscus tears occur, patients often feel a sudden pain, stinging or tearing. Depending on which meniscus is torn, 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. It is usually 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, surgical treatment should be performed in the early period.

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 MENISCUS REAR DIAGNOSIS?

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 largely established. 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 the 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 tear may appear as if there is no tear (false positive result) or, on the contrary, it may not be detected in MRI even though there is a tear (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, all of these diagnostic methods may be insufficient. In this case, the diagnosis is confirmed by arthroscopy.

See the “What is arthroscopic surgery” section on this website.

WHAT ARE THE TREATMENT OPTIONS FOR MENISCUS REAR?

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.

HOW IS MENISCUS REPAIR DONE?

The first option for 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 is currently performed with arthroscopic surgery.

After your doctor decides that the tear is suitable for repair, you can repair your meniscus tear with long needles inserted through special cannulas. Sutures are placed on both the upper and lower sides of the meniscus at 3-4 mm intervals along the tear.

Repair using a special sewing device developed for external meniscus repair.

An additional small incision is needed where the sutures are taken out of the joint and attached. Meniscus repair has become much easier with some implant-suture combination devices developed in recent years. The use of these self-knotting implants attached to small plastic anchors is demonstrated in Video 2. When these implants are used, there is no need for a second incision other than the knee.

Depending on the strength of the repair and whether there are other interventions (eg, cruciate ligament surgery) performed within the joint, you may need to use crutches and avoid squatting for a few weeks in the postoperative period. Return to sports can take between 4 weeks and 4 months. The success rate of meniscus repair varies 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, 5-30% of patients with meniscus repair may require a second surgery. Although the failure rate seems high, this risk is acceptable considering the wear on the knee in the absence of menisci. If the repair is unsuccessful, the torn meniscus can be removed with a simple operation.

WHAT IS MENISECTOMY?

Partial meniscectomy

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 is called a partial meniscectomy.

The more meniscus tissue that can be preserved, the better for the long-term health of the knee. Because the protected meniscus tissue continues to carry a load, albeit partially. The early results of partial meniscectomy are very good. There is no need for a serious rehabilitation program after surgery. 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 was removed than in those whose internal meniscus was removed.

WHAT IS MENISCUS TRANSPLANT?

synthetic meniscus

In patients whose menisci are severely damaged and need to be removed completely, transplantation of meniscus tissue has come to the fore to prevent wear on the knee. Frozen meniscus tissues from cadavers can be transplanted after testing to prevent disease transmission. The success of this procedure, which is still very limited in our country, is between 60-80% in 10-year follow-up. Along with the meniscus transplant, which requires a fairly large surgical procedure, surgery to the bone may also be necessary. Despite the tests, there is a risk of carrying the disease around three million.

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.

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