*The knee is the largest articulation in the body and one of the most complex. Due to the fact that it is used so much and has to constantly bear great pressure and weight, it is extremely prone to injury.
*Deterioration in the menisci can bring on as a consequence the wearing down of the articular cartilage, which over time, can lead to osteoarthritis.
The menisci are wedge-shaped pieces of fibrocartilage present in certain articulations such as the knee. They are inserted in the tibia (shinbone) and they accompany the femur (thighbone) in its rotation on the tibia. They adapt to the femur and the tibia. They are concave above and flat below. There are two menisci in the knee: the internal one, which is C-shaped, and the external one, which is like an almost-closed O.
They function as shock absorbers upon impact, they distribute the weight and lubricate the articulation. Meniscus injuries usually affect the internal meniscus more than the external and they are more frequent in men than women.
The loss of meniscus over time causes greater pressure per cm2 on the tibial saucers (the upper part of the tibia) and in the long run, degenerative changes (hence the importance of carrying out the least invasive meniscectomies). If the injured meniscus is the external one, the consequences are more serious, since it bears 70% of the weight in its section.
Meniscus injuries can be divided into two main groups:
● Traumatic: they usually appear in association with the practice of sport (above all contact sports) or with trivial accidents (as is the case of the frequent “miner’s tear”, which happens when you get up quickly after you have been kneeling for a long time).
● Degenerative: this usually occurs from the age of 45, either through age (the menisci lose their elasticity and tear more easily), or on account of anatomical deformities (patients with genu varum, that is, with O-shaped legs, or with genu valgum, with their knees forming an X –knock-kneed–, suffer more wear and tear because of the extra pressure on the internal meniscus and the external, respectively, since they receive much greater stress caused by the deformity).
There is another type of deformity exclusive to the meniscus which causes wear and tear and, in the long run, a lesion in it: we refer to the so-called discoid menisci, in which, as its name indicates, the meniscus has the shape of a closed disc. It is much more frequent in the external side, as it bears all the pressure of the weight on the knee.
Meniscus injuries usually cause pain in the interior or the lateral part of the knee joint, depending on which meniscus has been damaged. You can feel a pop or a sensation of locking or blockage of the knee. It also may happen that the knee is unstable, and it could even give way. So, one may have a swollen knee.
If there is a degenerative injury to the internal meniscus, a clear symptom is nocturnal pain.
The correct diagnosis of meniscus injuries requires the following to be carried out:
● Keep a clinical record: the most important thing is that the patient can explain what he/she feels and where it hurts.
● Physical examination:: by manipulating it in a certain way, the specialist can “trap the meniscus” between the condyle (the distal part of the femur) and his finger, reproducing the patient’s pain; that way he is able to be surer that it is torn.
● Magnetic resonance: this allows the specialist to confirm his suspicions and visualise the meniscus tear in its exact location.
The approach to a meniscus injury depends on two factors: the age of the patient and the type of lesion. So, if the patient is over 50 and has an injury that does not trouble him too much, the best treatment may be no treatment, whereas in a young patient with a traumatic injury, the ideal solution would be to perform an arthroscopy.
At HC Marbella we perform two types of surgical operation, always via arthroscopy (it is not necessary to “open up” the knee):
● Meniscal suture: this consists of passing some threads through the two sides of the tear in the meniscus and tying them inside or outside the joint. On other occasions absorbable darts are used, which help in the process of suturation.
● Meniscectomy: this is performed above all in elderly patients and consists of extracting the fragment of meniscus that is affected, while attempting to reduce the invasion to a minimum.
The operation lasts from 10 to 15 minutes if it is a simple meniscectomy and a little more for a meniscal suture. The patient is discharged after 3-4 hours.
Generally speaking, the mid-term and long-term results are better when we have managed to conserve as much meniscal tissue as possible.
● In the case of a meniscectomy, the recuperation is rapid, and the patient can put weight on the leg immediately.
● After an arthroscopic meniscal suture, the patient starts the active recuperation immediately and should walk with crutches for 4 or 5 weeks, after which he can start to walk normally, cycle, jog or swim two months later and practise contact sports four months later. After this time, the joint can be considered to have gone back to normal.
● In cases where young patients have had a meniscectomy and have lost their meniscus, if they do not adapt to their new situation, they can be offered the chance of a new procedure: a meniscal transplant.
Come and consult us.
Although it is an operation not without its complications,
we can say that today one has a very favourable prognosis.
Sources: American Academy of OrthopAedic SurgeonS (AAOS) / HC Marbella Traumatology Unit
Hip and Knee Specialist.
February 18, 2019
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