Meniscal tear

The meniscus of the knee joint serves as a structure decreasing the incongruence between the joint surfaces (tibia and femur) and increases the contact area during load transmission. Tear of the meniscus is one of the most frequent injury in sports medicine that would cause pain, swelling, clicking or locking of the joint.

The biochemical and histological composition of the menisci is significantly different from the articular cartilage. In the menisci fibrocartilage is the dominant structure which provides higher resistance to continuous loading. In the knee joint two separate menisci are found, the inner – medial meniscus, that is C shaped, and the outer – lateral, that is ring shaped. Menisci are fairly loosely attached to the capsule, thus have freedom in moving around the joint. If impinged between the tibal and femoral articular surfaces, menisci may tear and that usually needs surgical treatment. Lack of menisci, however, in the long run induces degenerative changes in the joint.

Prevalence

There are two distinct major population affected. The young athletes injure the menisci during strenuous physical activity and the complaints develop right after the accident. In the elderly, no the other hand, along with the degenerative changes chronic degenerative meniscal tear may develop rather insidiously and complaints build up gradually.

Complaints

Very variable complaints accompany the meniscal tears. Pain, swelling (physical activity-related), clicking, locking of the knee are the typical complaints. Squatting is usually not possible or very painful.

Usual protocol for examination:

·        Assessment of the axis of the extremities

·        Checking stability, range of motion

·        Measuring muscle strength of the limb

·        Checking for any hypersensitivity

·        Checking pain provoked by rotational test

·        Taking x-ray if

·        Magnetic resonance imaging (MRI) offers the best diagnostic value, however its predictive value is still not 100%

Options for treatment

Ice, rest, compression bandage and elevation of the limb are the mainstream primary treatment options. NSAID drugs and dietary supplements are recommended. According to the physical examination and the changes during the primary treatment arthrosopy is often inevitable.

During arthroscopy meniscal tear is assessed and suturing or partial removal  of the menisci are chosen, accordingly. Torn meniscal parts are excised and shaved with special arthroscopic tools, shavers or even thrermocoagulators. Meniscal reattaching with sutures may be applied only in a small portion of tears in young patients. Complete healing of these meniscal tears after suturing in only expected in about 70-80% of patients. In cases where meniscus was completely removed meniscal transplant may be an option, though its use is still preliminary and the result is debatable.