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About the meniscus tear and the ways to treat it either with conservative means or surgically with arthroscopy, Dr. Grigorios Avramidis, Orthopedic Surgeon and Curator of the 3rd Orthopedic Clinic of HYGEIA
The menisci are crescent-shaped (crescent-shaped) structures composed of collagen. Their anatomical position is between the articular surfaces of the thigh and the tibia, improving the contact between them and increasing the stability of the knee. At the same time, they absorb and reduce the pressures that are constantly exerted on the knee joint, protecting the articular cartilage. Finally, they contribute to the uniform diffusion of synovial fluid within the joint and to better nutrition of the articular cartilage.
What is a meniscus tear?
Rupture of the meniscus, i.e. the interruption of its continuity, may be due to some injury, especially in young patients, while at older ages it may occur without particular violence, due to degeneration of the tissues. The tear in most patients occurs in the medial meniscus, and more rarely in the outer meniscus or both at the same time. Finally, it occurs more often in knees that are unstable, such as, for example, in patients with an anterior cruciate ligament tear.
What are the symptoms?
The most common symptoms of a patient with a meniscus tear are:
- Pain on the inner or outer surface of the knee.
- Edema that appears late or is intermittent in nature, i.e. it comes and goes.
- Stiffnessdifficulty moving.
- Lock (blockage) and inability to move the knee, indicative of a bucket handle tear, where part of the meniscus is trapped between the bones of the knee.
- Weakness full extension or flexion of the knee.
- Click on the knee
How is the diagnosis made?
A detailed history taking and clinical examination by an orthopedic surgeon specialized in knee diseases raises the suspicion of the diagnosis. Confirmation is done with imaging tests, including plain X-rays and MRI of the knee.
When is conservative treatment indicated and what does it include?
Tears that are small in extent, stable and without severe symptoms, can be treated conservatively.
Conservative treatment includes:
- Anti-inflammatory treatment
- Appropriate program physical therapy with special strengthening exercises around the knee
- Intra-articular infusions Biological Factors
When is surgical treatment indicated?
Meniscal tears that are large in extent, unstable, that create an obstacle to the movement of the knee (locking) or are particularly painful can be treated surgically with knee arthroscopy. It is a routine operation for a specialized orthopedic surgeon, with the patient staying only a few hours in the hospital. During arthroscopy, no large surgical incisions are made, only holes of a few millimeters, through which a special camera, arthroscope and special arthroscopic tools enter the knee joint. In this way, the orthopedic surgeon can see the inside of the knee joint on a very high resolution screen and, at the same time, correct the problem.
Arthroscopic suturing or removal of the meniscus
Arthroscopy is the method of choice, both for suturing and for removing the affected part of the meniscus.
The immediate restoration and preservation of the largest possible part of the menisci is particularly important for the function and preservation over time of a healthy knee.
Suturing, healing and saving the torn meniscus is always our priority. The likelihood that the torn part of the meniscus will heal after a suture is greater in young patients with recent meniscal tears than in older patients or in cases where the tear has occurred some time ago. In the event that the diseased part is not considered suitable for suturing due to chronicity or degeneration, then we perform removal of the diseased part, i.e. meniscectomy.
How long does recovery take after a meniscus tear?
Recovery is faster than in the past. The return to the patient’s daily life is immediate, while the return to mild sports activity takes place within a few weeks. In patients with more severe injuries and in large-scale tears, the interval of avoiding sports activity is longer.