Menisci are cartilaginous discs that connect the femur to the tibia. They act as shock absorbers and keep the knee joint stable.
In some sports, such as football and hockey, a torn meniscus is one of the most common injuries. However, you can get it without doing sports, such as kneeling, squatting or lifting something heavy. The risk of injury increases with age as the bones and tissues around the knee wear down.
Functions and structure
The meniscus is a trihedral cartilage formation located between the tibia and femur. It is approximately 70% composed of collagen fibers. It also contains special protein compounds. In the outer part of the meniscus thickens. It interacts with the transverse, anterior and posterior meniscofemoral ligaments.
There are two types of menisci in the knee joints: external (lateral) and internal (medial). The outer one has an annular shape. It is more mobile, so injuries to the lateral meniscus are less common.
The shape of the medial meniscus is C-shaped. Sometimes it has the shape of a disk - in such cases it is slightly larger in size. Since the tibial collateral ligament is located in the middle, the mobility of the meniscus is limited, which leads to more frequent injuries.
The cartilage disc is attached to the capsule of the knee joint. It consists of a body, an anterior horn, and a posterior horn.
These cartilage structures provide stability and help distribute body weight by keeping bones from rubbing. In addition, they help to concentrate nutrients in the tissues that cover the bones of the thigh and lower leg. As shock absorbers, the meniscus relieves pressure on the knee joint.
They also stabilize the motor ability of the knee joint, distribute the load and reduce pressure on its surface, reduce friction between the tibia and femur, and limit the range of motion.
Symptoms and Diagnosis
A torn meniscus usually causes swelling and localized pain in the knee. The pain is aggravated by twisting or squatting. Sometimes a fragment after a rupture can move inside the knee and "block" it, limiting mobility.
Besides this, symptoms are:
- squat crunch thatindicates that the posterior horn of the medial meniscus has been torn;
- the presence of bleeding in the joint area (more often occurs when the medial meniscus is torn).
Sometimes a torn lateral meniscus causes symptoms to be confused with those of knee arthritis with softening of the articular cartilage. In some situations, chronic joint inflammation causes similar symptoms. In this case, additional clarifying diagnostic procedures are needed.
When establishing a diagnosis, the patient's complaints, the degree of manifestation of symptoms are taken into account, the damaged area is examined. At the same time, attention is drawn to the possible causes of the gap. Diagnosis is confirmed by instrumental examinations:
- radiography with contrast agent;
- ultrasound examination (ultrasound);
- computed tomography (CT);
- Magnetic Resonance Imaging (MRI).
Diagnostic arthroscopy may also be done.
Types of injury
The break can occur in one or more directions. Traumatic injuries are usually vertical, while those resulting from degenerative changes in the lateral meniscus of the knee joint are usually horizontal.
The most common type of injury is a radial tear. It is directed from the medial to the lateral rim and runs along the radius. Such damage is also curved. It can run along the meniscus, around the circumference. Another type is a gap "in the form of a bucket handle." Hethe danger is that the "bucket handle" can flip over and get on the other side of the head of the femoral joint, causing the joint to become locked.
Gap can also be:
- longitudinal vertical;
- patchwork oblique;
- radially transverse;
- with damage to the anterior or posterior horn.
Degenerative tears can occur not only due to the aging process, but also as a result of repeated trauma. Also, damage can be complete and partial, with or without displacement. Rupture of the anterior horn of the lateral meniscus is less common than a similar injury to the posterior one. The chronic course of the disease and untimely treatment can lead to damage to the cartilage and the anterior cruciate ligament.
Groups and risk factors
Tears of the lateral meniscus are most common in athletes. Traumatic injuries usually occur as a result of significant transverse loading and twisting of the lower leg, as well as hyperflexion (excessive flexion). Degenerative tears are more common in people over 40 and can occur without much trauma. Smokers are at higher risk for such damage.
Most often this kind of violation in the body occurs in people over 30 years old. In those who are younger, such injuries are found less frequently, since the meniscus is still quite elastic. It weakens with age and injuries are more common, even from simple movements such as crouching or walking on uneven ground.
Besides, thisdamage to the lateral meniscus can occur in the following cases:
- with too sharp abduction of the lower leg;
- in the presence of rheumatism and gout, which lead to degenerative changes and trauma;
- due to secondary injuries, bruises or sprains;
- with significant physical activity combined with high body weight;
- in case of congenital weakness of joints and ligaments;
- for chronic inflammation of the knee joint.
Therapy
Treatment of a lateral meniscus tear will depend on its size, type and location. Your doctor will likely recommend rest, pain medication, and ice packs to reduce swelling. Physical therapy may also be offered. This will help strengthen the muscles around the knee and keep it stable.
During the first few days after injury, cold is applied every 4 hours for 15 to 30 minutes. This helps to minimize pain and discomfort. Using an elastic bandage and taking non-steroidal anti-inflammatory drugs such as ibuprofen will also help relieve swelling. With this treatment, you can gradually return to normal activities.
If these procedures do not help or the injury is too severe, the doctor may recommend surgery. For diagnosis, magnetic resonance imaging (MRI) may be done or an examination using an arthroscope can be done. This instrument is equipped with a camera that allows doctors to view the joints from the inside.
During the examination, the degree of damage is established. Damage to the lateralThe meniscus of the 2nd degree, as well as tears of the 1st degree, most often do not require surgical intervention. Medications can temporarily reduce pain and swelling, but they cannot help the injury heal on its own. For more serious injuries, such as a grade 3 injury to the anterior horn of the lateral meniscus, surgery is very likely. If surgery is not performed, at best, swelling and pain will be eliminated, and the patient will be able to resume their usual activities. In the worst case, the damage will "lock up" the knee, significantly limiting its mobility.
Features of surgical treatment
When the lateral meniscus is torn, the operation is to remove or cut off the torn segment using an arthroscope and specially designed instruments. Because only its outer quarter has a blood supply, suture will be successful when a rupture occurs in this vascular area. Tears in the non-vascular area are unlikely to heal and therefore need to be removed.
Degenerative changes in the anterior horn of the lateral meniscus are a source of discomfort for a significant number of patients. The effectiveness of treatment in conditions of chronic degeneration remains low. Complex ruptures can develop over time. Non-surgical NSAID therapy and physiotherapy can relieve pain as well as improve the mechanical function of the knee joint. For patients refractory to conservative therapy, arthroscopic partial meniscectomy mayprovide short-term pain relief, especially when combined with an effective regular physical therapy program. Patients with overt symptoms and meniscal pathology may benefit from arthroscopic partial meniscectomy, but the operation is not guaranteed to be successful, especially if there is associated joint pathology.
In a total arthroscopic meniscectomy, the entire meniscus is removed.
Contraindications
The doctor may refuse to perform the operation in the following cases:
- in the state of he alth of the patient, in which it is impossible to use anesthesia (diseases of the cardiovascular, respiratory, urinary systems in the stage of decompensation);
- in the presence of infectious diseases of the knee joint;
- in old age;
- in the presence of purulent infections in the body;
- in case of significant damage to the capsule of the knee joint, as well as contracture, ankylosis, adhesive disease, complete rupture of the ligaments;
- with a history of stroke or heart attack;
- in the presence of cancer.
Types of transactions
Depending on the degree and location of damage, the age of the patient and some other factors, different types of surgical intervention are performed:
- arthroscopic surgery;
- arthroscopic partial meniscectomy;
- arthroscopic total meniscectomy.
An operation can also be performed to restore the meniscus, which allows you to save its structure andperformance. Internal bonding is carried out without incisions. To do this, use special clamps. If the cartilage is completely destroyed and other treatments fail, a meniscus transplant can be performed.
Preparation for surgery
Before the day of the procedure, the patient must undergo an examination, including blood tests, x-rays, MRI, ECG, and fluorography. If you have any he alth problems before surgery, such as a cold, fever, infection, rash, you should notify your doctor.
During the week before the operation, it is advisable to adjust your lifestyle: follow a light diet, give up bad habits.
Knee arthroscopy
This method of surgical treatment is considered minimally invasive. During this operation, the doctor makes small incisions. An arthroscope is inserted into them, allowing a detailed examination of the gap, which is then sewn together.
This operation is performed if:
- recent injury;
- the rupture occurred in an area that is well supplied with blood;
- the patient is young.
The location of the rupture is important because if it occurs in an area where there is no blood supply, there is a high probability of a suture divergence, the edges will not be able to heal on their own, another operation will be necessary.
This operation preserves the functions of the meniscus and joint, good prognosis for further treatment, minimal risk of arthrotic changes.
The disadvantages of this method of treatment are associated with difficulties in determining the necessary indications, laboriousness and high cost, as well as a high risk of complications and a long recovery period.
When performing arthroscopic stitching, the joint is not opened, which reduces the possibility of infection and trauma to the joint. This type of surgery is most often used when the posterior horn of the meniscus is torn.
Operating
The procedure is performed under general anesthesia. The leg is bent at a slight angle, then small incisions are made through which an arthroscope and instruments are inserted into the joint cavity. The joint is washed to remove blood clots, after which the edges of the torn meniscus are sewn together. To do this, use a surgical thread or absorbable staples.
If there are no complications, the patient is discharged after a few days. Further rehabilitation takes place on an outpatient basis. The recovery period after such an operation is approximately one month.
The most common complications of this treatment include tissue infection or poor quality sutures.
The arthroscopic procedure for diagnosing and repairing a torn meniscus lasts approximately one hour. If the surgeon can see the lesion with an arthroscope, he can determine if there is a chance of suturing it, or whether partial or complete removal will be necessary. In the event that recovery is possible, the procedure is completed by arthroscopic surgery. More being doneone incision, and the doctor inserts surgical instruments there to repair the meniscus. The operation involves suturing the torn edges, which further promotes its healing. Only 10% of such injuries are recovered using this method. In most cases, a partial meniscectomy is required, where the damaged part is removed and the he althy tissue is left intact.
If the cartilage is in good condition, despite a partial tear of the lateral meniscus, restoration of its integrity is preferable to removal, even partial. Tears at the outer edges, called peripheral capsular injury, can be repaired with arthroscopic surgery. In addition, tears that run vertically through the meniscus can often be sutured with arthroscopic surgery, leaving the meniscus intact.
Arthroscopic meniscectomy
In case of more serious damage, a more complex operation is performed, respectively. It is called an arthroscopic meniscectomy, which can be partial or complete.
This type of surgery is considered a minimally invasive procedure used to treat a torn meniscus cartilage in the knee. This removes only the broken segment. Some patients require physical therapy after surgery. The average time to return to all activities is 4-6 weeks after surgery.
Efficiency
Removal of a torn segment, in particular, with damage to the anterior horn of the lateral meniscus of the 3rd degree, veryeffectively restores knee function for a long period. With total removal, there is a possibility of arthritis in 10-15 years.
The torn segment must be removed relatively quickly (within a few months) so that it does not damage the articular cartilage. Delay can lead to muscle atrophy and joint contracture, making it harder for the patient to eventually regain normal function after surgery.
Complications and risks
Patients should understand that not all the consequences of a rupture of the lateral meniscus of the knee joint are restored. The cartilage in the knee may simply be worn down over time, preventing the surgeon from stitching it back together. In this case, the doctor will remove it completely and fix any other problems in the knee.
Complications of arthroscopic meniscectomy include infection and deep vein thrombosis (clots). There is also some risk when using anesthesia.
The risk of infection reduces the use of intravenous antibiotics. If a clot forms, the patient is given anticoagulants to prevent it from growing or moving.
Surgical procedures and risks associated with an anterior horn lateral meniscus injury will depend on the patient's condition and individual needs. Patients should be aware that their age plays an important role in the success of the procedure. Reconstructive surgery is usually most effective for people under the age of 30 who have had the procedure within the first two months of an injury. ForFor people over 30 years of age, the success rate of surgery decreases because the meniscus tissue begins to naturally deteriorate and weaken with age.
Recovery and rehabilitation
The process of restorative therapy, for example, after surgery for a torn posterior horn of the lateral meniscus, depends on the general physical condition of the patient after surgery. As a rule, a patient's physiotherapy program after arthroscopic knee surgery can be divided into three stages:
- regain control of leg muscles and wean off crutches;
- restoring full motion and strength to the knee;
- return to normal activity.
Sometimes, a physical therapy program or conservative treatment is recommended as an alternative to surgery to control inflammation, pain, and swelling.
Your doctor may also recommend compression stockings after surgery to help prevent blood clots.
