What is Meniscus?

How Is The Treatment Of Meniscus Rupture?

Known as an athlete injury in common, torn meniscus can be experienced by everyone. The questions like “How is the meniscus pain?”, “Why does the meniscus disease occur?”, “How long does it take to have meniscus operation?”, “How long is the healing process after meniscus operation?”, “How is meniscus pain?”, “What are the indications of meniscus rupture?”, “What is meniscus?” are the frequently asked questions.

What is Meniscus?

The main knee joint is consisted of 3 bones: Femur, tibia and patella. Because the joint faces are not very compatible with each other, the knee joint is empowered with the ligaments, cartilages and meniscuses.

There are 2 meniscuses in each knee, namely medial and lateral. In the shape of a “C”, meniscuses are the elastic structures which have dense collagen fibre to enable resistance against compression. Working as a shock absorber between the knee joint bones, they increase the compatibility between the bones, scatter the burden onto a wider area and protect the joint cartilages from the high pressure.

What are the indications of meniscus rupture?

• Knee pain. The pain right after the occurrence of the rupture may not be so severe and the persons engaged in sportive activities may even continue their activities. When the joint liquid increases because of the mechanical disorder and the area swells, the pain becomes severe.
• Voices coming from inside of the knee
• Swelling and toughness
• Locking or sticking at one point in knee
• Movement restriction(Being unable to bend the knee completely)

What are the reasons of meniscus injuries?

Meniscus ruptures happen due to traumatic reasons, deterioration in time or as congenital problems in prevalence. They may occur in every part of society anytime.

• Meniscus ruptures may happen in activities which cause sudden stops, twists, bending or twisting the knee coercively.
• Crouching down especially while lifting a heavy item may cause meniscus ruptures.
• Meniscus injuries may be experienced during the sports like football or basketball which necessitate pair contact or volleyball, tennis which include sudden manoeuvres.
• They can be seen in every age. In young people, meniscus is torn by serious traumas because the tissue is solid, but with the advancement of age, the degenerative alterations in knee may also cause meniscus ruptures. Even a simple bending while standing up from a chair may cause them. It can be seen more than 40% of the persons above the age 65.

Meniscus ruptures due to forceful overload are generally seen in young ages. Traumatic ruptures are seen between the ages 10 and 40, degenerative ruptures are mostly seen after the age of 40.

How is meniscus diagnosed?

Actually meniscus is the name of the normal structure of the knee and does not indicate the illness. Although people in common complaint like “I have meniscus”, the correct usage should be “I have a rupture or problem of meniscus in my knee”. A doctor examination is important in the diagnosis of meniscus ruptures. The orthopedics and traumatology doctor controls if there is sensitivity along the joint line of the meniscus. In young persons, the story is mainly about a pain or locking after a sprain or twist in the knee. In the mature ages, the degenerative ruptures may occur as the feeling of locking or sticking because of the simple acts like crouching down or bending down. The doctor evaluates the pain area, its relation with the movement and the severity of pain during the examination.

Your doctor will apply the tests like McMurray, Apley and Steinman. They will evaluate the existence and severity of meniscus by bending, straightening and twisting the knee.

Screening Methods in the Diagnosis of Meniscus

The different problems in the knee may have similar symptoms, so the diagnosis can be confirmed via different screening methods.

• Magnetic resonance (MR): MR which is used to image the hard and soft tissues in the knee is the best screening method in the diagnosis of meniscus
• X-Ray: The meniscus with cartilage structure cannot be screened via x-ray. But in order to eliminate the diseases like osteoarthritis, the loose bodies in the knee (knee joint mice), patella alignment issues, tumour which causes the similar problems in the knee, x-ray screening may be beneficial.
• Arthroscopy: In some cases a device named as arthroscope can be used to examine the inner knee. The arthroscope which includes a small-light camera is placed in the knee with a small cut and the inner knee is reflected on the screen as zoomed. This method is not really used for diagnosis nowadays because of the advancements of the diagnosis methods in screening.

Meniscus treatment

Previously, total meniscectomy was applied in the meniscus ruptures, that is, all the meniscus was taken off. It was proved scientifically that this method causes degeneration in the cartilage surface in 10-15 years and the knee-protector duty of meniscus has been acknowledged.

Before deciding the treatment:

• Age of the patient
• Level of physical activity
• Occupation and expectancies from the social life
• Location Structure, type and length of the meniscus rupture
• Existence of different injuries besides the meniscus rupture are investigated.

Non-surgical treatments of meniscus ruptures

If the area of meniscus rupture is red, that is, the rupture is in the area of blood build up and the rupture itself is small, it can heal by itself. In order to accelerate the process of healing, non-surgical methods can be used.

• Rest: The activities which cause severe pain, like bending or twisting the knee should be abstained. If the pain is so severe, even the walking activities should be abstained and using a walking stick should be beneficial.
• Applying ice: This helps the alleviation of swelling and also pain. The ice can be applied for 15-20 minutes. This can be repeated for 3-4 times a day.
• Bandage: Wrapping the knee with a suitable bandage may cause positive results against the pain and swelling.
• Elevation: Putting a pillow or something like that under the leg may provide positive results by keeping the knee on the heart level.
• Medications or injections applied in the knee (hyaluronic acid): The anti-inflammatory medications which are not steroids may alleviate the pain and swelling. Besides, some supportive vitamins may be used despite their unproven activity. It is an undeniable fact that these pills have some placebo effect. Even if these pills do not have any healing effect, it is proven that pain has been alleviated or terminated in most of the patients.  The products like shark cartilage, hyaluronic acid, chondroitin sulphate, and collagen preparates alleviate the frequency and severity of the pain even if their benefits have not been proved scientifically. This effect may be described as the belief of the patients in the pills, which we name as placebo effect.

• Physical therapy: Strengthening and stretching exercises may alleviate the stress in the knee. A physiotherapist may be consulted for these exercises.
• PRP and stem cell: The direct activity of healing of these kinds of treatments was not detected but these treatments may be used as adjuvant therapies.

These treatment methods may not be always sufficient. If the meniscus rupture causes major, unstable indications or locking, surgical treatment may be needed.

Surgical Treatment of Meniscus Ruptures

If the complaints like locking and pain continue to affect the daily life, surgical treatment is taken to the agenda.

In the surgical treatments;

• Total meniscectomy which includes taking overall the entire meniscus. This process causes decent results in the short term but then causes arthritis in the long run.
• Partial meniscectomy which includes taking only the torn piece of meniscus.
• Meniscus repair. In some cases, the torn pieces can be stitched to each other and repaired. The repair depends on the type of rupture and general condition of the meniscus. This process has decent results but the healing process is longer and the repair is limited to the suitable patients. It is recommended for the patients who have an active life and a decent meniscus tissue. Orthopaedist surgeon always plans to stitch the meniscus but if the meniscus is ruptured so much then they choose partial meniscectomy.
• Meniscus transplantation can be also performed in some suitable patients.

Which Specialist and Department Should be Consulted Regarding Meniscus Injuries?

The meniscus ruptures, which may be seen in every part of society, may be encountered with in every age. An orthopedics and traumatology specialist should be consulted in case of meniscus injuries. In order to protect the cartilage structures and prevent the joint degeneration in the long run, methods of repair are preferred in the young age. In the ruptures which are not suitable for repair or in the repetitive ruptures, partial meniscectomy is applied to protect the remained meniscus. Taking the entire meniscus off is only applied in special cases and injuries. It is important to prefer a specialist doctor of orthopedics and traumatology who is also an expert of surgical treatment. If there are pain, swelling or movement disabilities in the knee, it is needed to consult a specialist doctor of orthopedics and traumatology as soon as possible.

Meniscus Rupture Arthroscopy

Instead of the open surgical methods, the closed ones named as arthroscopic surgery are used in the meniscus operations. It is method to look in the joint. From a small 1-cm cut, a tiny camera is put into the joint. The surgeon also puts some other materials into the knee by opening on or more small cuts to shave, clean or repair the ruptures and cartilage damages.

The cuts opened for arthroscopy in the skin are quite small, as generally each 1 cm. The cuts are closed with a suture outside or under the skin.

The torn meniscus can be cleaned by various devices like small shavers or scissors. The arthroscope also allows the surgeon to see the rest of the knee joint, the loose cartilage pieces and other problems in the area.

While the arthroscopic surgery may be performed under general anaesthesia, local, epidural or spinal anaesthesia may be also used.

What is meniscus transplantation?

Different treatment methods are taken to the agenda in recent years regarding the meniscus ruptures. One of them is meniscus transplantation. Meniscus tissues from cadavers may be transplanted in cases of big injuries of selected patients.

How long is the duration of staying at the hospital after meniscus operation?

After arthroscopic surgery, the patients are stood up on the day of operation and discharged from the hospital on the following day. The patients need to start the knee strengthening exercises after staying at home for 1-2 weeks for rest. The patients should abstain from work for 1-2 weeks if they are working in an office, and 4-6 weeks if they are doing heavy work.

Prepared by the Medical Editorial Board. Our health library contents have been prepared for informational purposes only and with the scientific content on the registration date. For all your questions, concerns, diagnosis or treatment about your health, please consult your doctor or health institution.