Is It Your Meniscus?

The knee is one of the joints of the body that’s most prone to injury. Most injuries occur in sports collisions, falls, or accidents, while others arise due to wear and tear. Sometimes, the knee injury is actually damage to one of the menisci, a pair of crescent-shaped cartilage that sits on top of the femur. The menisci help with shock absorption, especially when jumping, running, and twisting while facilitating smooth movement of the knee. A meniscus injury causes severe pain and swelling while limiting movement. The meniscus will sometimes require surgery in the form of repair or meniscectomy. Choosing the right course of action is essential to the long-term health and function of the knee.


Is surgery necessary?

Anyone with a knee injury should see an orthopedist as soon as possible. The doctor will review the knee using imaging technology before deciding on the next steps. Surgeons often prefer to try non-surgical means first, as the body has excellent healing abilities. Common strategies include physical therapy, oral medication, and steroid injections. The injury will also benefit from periodic rest, ice, compression, and elevation (RICE), which prevents inflammation. Over several weeks of treatment, patients find the knee regains stability and there’s significantly less pain. Of course, this will all depend on the type of meniscus injury. A knee injury that does not respond to conservative treatment will require surgery.

Types of meniscus injuries

The menisci are notorious for having a low blood supply. The outer rim has the highest blood supply, which decreases significantly in the inner parts. A meniscus can tear in several ways, influencing the type of surgery the surgeon chooses to use. Vertical longitudinal tears occur along the length of the thicker outer rim, running across the fibers. Severe cases create a wide space in the thickest part of the meniscus, known as a bucket handle tear. Horizontal tears are smaller, running across the thinner inner rim. A vertical radial tear and oblique tear affect the meniscus's width, causing a fibers split. These injuries can cause flap tears. Degenerative tears are also possible, with the fibers fraying, also leading to flap tears. Imaging will reveal the exact type of tear and the best action.

Choosing surgery

A meniscectomy is a surgical procedure that removes the damaged part of the cartilage. The surgeon will use arthroscopy to access the joint. This minimally invasive procedure limits the size of the incisions on the knee. This technique also allows the patient to leave the surgical center or hospital on the same day. With meniscectomy, the surgeon uses special tools to remove frayed cartilage or flap tears, smoothing down the remaining cartilage. A meniscectomy requires extensive physical therapy to strengthen the surrounding muscles, as these will now compensate for the missing cartilage.

Repair vs remove

Some injuries can benefit from repairing the cartilage instead of removing the damaged parts altogether. In this case, the tear will benefit from stitching together the meniscus. Like meniscectomy, the surgeon will access the joint arthroscopically. Meniscal repair also requires extensive physical therapy. The patient will have limited movement at first but will gradually see improvement. Within an 8-12 week period, there should be an improvement in range of motion (ROM) and swelling.

Which one is right for me?

Choosing the best procedure for a knee injury depends on the extent of the damage. A complete horizontal tear, vertical radial tear, or degenerative tear may need a meniscectomy. The stray pieces of cartilage get caught in the knee while bending, which can be painful. Removing the cartilage will allow for better function of the knee. On the other hand, meniscal repair works for longitudinal tears or partial horizontal and radial tears where much of the meniscus is still intact. After surgery and physical therapy, patients can regain the function of the knee and resume sports or other activities with ease.

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