These are two C-shaped cushion like structures in the knee between the femur (thigh bone) and the tibia (leg bone). One on the medial (inner) side and one on the lateral (outer) side. They act as shock absorbers of the knee besides having multiple other functions. This structure has poor vascularity and therefore has a limited capacity to heal.
Commonly the meniscus tears following a twisting injury to the knee. This may occur as a sporting injury or even due to a minor domestic trauma. Fractures around the knee are also known to be associated with meniscus tears.
With progression of age, the meniscus may degenerate. The resilience of this structure is therefore compromised. As a result, even normal movements of the knee involved in squatting, negotiating stairs, pivoting, jumping can cause a meniscus tear without any significant injury.
Structural defects in the meniscus since birth, like a ‘discoid meniscus’ have abnormal shape and consistency. These are also prone to tearing without any significant injury.
There is a sharp pain on the inner or outer side of the knee, which increases on twisting, turning, negotiating stairs or squatting. This may be associated with swelling, clicking or locking (knee is unable to straighten completely without pain).
A plain X-ray does not reveal these abnormalities.
An MRI of the knee is essential to reach a diagnosis.
A thorough clinical evaluation is necessary to correlate with the investigation findings to plan the management
All meniscus tears detected on MRI do not require surgery.
One needs a clinically assessment of the knee along with an MRI correlation to decide if surgery is necessary.
Depending on the symptoms, a number of patient factors, associated pathologies and type of meniscus tear the plan of management is decided.
The treatment modality may vary from activity modifications, physiotherapy, injection to an arthroscopic surgical procedure.
Some meniscus tears can be treated conservatively (without surgery). Those that require surgical treatment, if neglected can worsen over a period of time. This is because the tear does not heal due to a poor blood supply of the meniscus and it may increase in size with passage of time. If neglected for long, this may also lead to irreversible damage to the joint with residual pain in some cases even following treatment.
All surgical procedures for meniscus tear are performed arthroscopically. Majority of these are therefore key-hole, sutureless surgeries which do not require hospitalization.
Depending on the nature of tear and various patient factors one opts for either a ‘preservation’ procedure like meniscus repair (torn tissue is stitched back in its original form using special suturing techniques and devices) or selective removal of only the non-functional torn portion of the meniscus (meniscectomy), thus leaving the functioning part of the meniscus intact.
Certain young individuals may require removal of a major portion of the meniscus. A ‘joint preservation’ procedure of meniscus transplantation may be necessary in these to restore normal joint function and prevent long term deterioration.
All arthroscopic meniscus surgeries are either day care procedures or may require 1 day hospitalization. Most often a suture-less surgery There is complete resolution of pain following the procedure, if there are no other associated anomalies.
Meniscectomy :
A painfree, day-care procedure.
Can resume walking to normal activities, without any support within 3 hours of surgery.
Basic home exercises for rehabilitation. No prolonged physiotherapy
Meniscus repair :
A day care procedure.
Non-weight bearing on operated knee for 2 weeks.
Range of knee motion is gradually increased to full normal motion in 6 weeks.
Physiotherapy customized to repair.
Meniscus transplantation :
1 day hospitalization.
Non-weight bearing on operated knee for 4 weeks.
Range of knee motion is gradually increased to full normal motion in 8 weeks.
Physiotherapy customized to type of transplantation.