What is the meniscus?
The meniscus is a piece of fibrous cartilage that sits between the femoral condyle and the tibial plateau of the knee. The medial meniscus is larger and has a “C” shape and is closely associated with the medial capsule; the medial meniscus is less mobile. The lateral meniscus is “O” shaped, mostly not directly connected to the lateral capsule, and is more mobile.
What is the function of the meniscus?
Firstly, the meniscus increases the stability and alignment of the knee joint and carries the basic load between the femur and tibia; secondly, it also serves as a shock absorber, similar to a shock absorber in a car. If damage to the meniscus occurs, it can lead to joint pain and increased wear and tear of the articular cartilage.
Meniscectomy leads to increased wear and tear of the joint, loss of joint space narrowing, exhaustion of cartilage, and early onset of osteoarthritis of the knee.
Incidence of meniscus injury?
Meniscus injury and the level of social development is closely related – the United States more than 1 million meniscus surgery / year, 85% of the line meniscectomy, every 100,000 people have 61 people need surgery for meniscus injury, male to female ratio of 2.5:1, once upon a time, China’s hand industry practitioners, China’s hand trauma incidence is high, as the domestic industrial level improved, the machine can replace the manual labor, hand trauma incidence of high. The incidence of hand trauma only began to decline as machines replaced manual labor. With the improvement of living standards, people’s sports needs are increasing year by year, and sports activities and meniscal injuries are closely related. Many meniscus injuries occur when the ACL is injured, mostly at the same time. Therefore, meniscus injuries and sports activities are closely related to each other.
When is the meniscus susceptible to injury?
It often occurs when the knee joint is twisted in flexion, so soccer, basketball and other sports twisting sports are good; impact sports such as skiing, combat, etc. In addition, it can also occur in special occupations that require squatting work, such as weight lifters repeatedly squatting with weight for a long time, etc. The grinding force is the cause of meniscus injury.
What are the clinical manifestations of meniscus injury?
In the acute phase, the main symptoms are swelling and pain of the knee joint and limitation of movement. After the acute phase, the swelling and fluid may subside on their own, but the joint is still painful when moving, and there is a popping sound when the knee is flexed and extended, and some patients have the “interlocking” phenomenon (the patient often feels a “clacking” sound when moving. The injured knee immediately feels like something is stuck and cannot move, called “interlocking”, and is very painful. After slowly extending and flexing the knee, the patient overhears the “clack” sound and the knee immediately resumes extension and flexion, called “unlocking”, and the pain is relieved).
How to diagnose meniscus injury?
1, medical history: generally have a history of sprain trauma.
2, symptoms: the above clinical manifestations.
3.Signs: fixed pressure pain in the joint space, McMurray’s (McMurray) test, grinding test, etc.
4.Imaging: mainly nuclear magnetic examination.
Normal: the meniscus is uniformly low signal.
Grade 1 injury: small focal round-like signal increase shadow inside the meniscus, not reaching the surface of the meniscus, representing degenerative changes.
Grade 2 injury: linear, moderate signal increase within the meniscus that does not reach the surface of the meniscus, representing higher grade, more extensive degenerative changes. It is most commonly seen in older individuals and, to a lesser extent, in individuals who are overweight or who engage in heavy physical labor or strenuous physical activity.
Grade 3 injuries: Abnormal signs that reach the meniscal surface, which may be linear or irregular, usually represent a complete tear of the meniscus, which is a true meniscal injury.
Grade 1 and 2 damage represents degeneration of the meniscus and does not need to be treated. Only grade 3 damage is the real damage (tear), and I personally suggest that the grading of damage may be more appropriate for grade 1, 2 and 3 signals, where grade 1 and 2 signals are normal or normal degenerative changes and grade 3 signals are complete damage. Because some patients will be afraid to see the many words of meniscal damage on the MRI report, in fact, there is no need to worry, many are some normal degenerative damage. It is the same aging process as wrinkles on your face and graying of your hair.
What should I do after a meniscus injury?
If you suspect a meniscus injury in a sprained knee, you should wear a knee brace and apply local ice, and go to the hospital as soon as possible to get a diagnosis.
Can meniscus injuries be treated conservatively?
The treatment of meniscus injuries is always a concern for patients. The healing of human tissues depends mainly on the site of the injury, if the injury site is rich in blood flow, it may be able to heal better, otherwise it is not easy to heal. Only the red zone and the red-white zone, which are connected to the joint capsule, can get some blood supply from the synovial membrane, while the white zone, which accounts for most of the meniscus, has no blood supply, so it is almost impossible for the white zone to heal itself after meniscal injury. Therefore, except for a very small number of partial edge injuries, longitudinal tears of the red zone or red-white zone less than 10 mm can be repaired on their own with braking (e.g., fixed in a cast or brace), unfortunately, there are very few types of meniscal injuries that can be repaired conservatively in clinical practice, and the vast majority of the remaining patients with 3rd degree meniscus can barely heal with conservative treatment and require surgical intervention.
There is no drug that is effective for meniscus healing!
When do meniscus injuries require surgery?
A 3rd degree meniscus injury, which is a complete tear of the meniscus with corresponding clinical manifestations such as painful strangulation, requires surgery and should be treated as early as possible to avoid aggravation of the tear and secondary wear and tear of the articular cartilage.
In young and middle-aged patients, as long as there is a 3rd degree meniscus injury, most of them should be treated with surgery in a timely manner; while in older patients, over 50 years old with combined knee osteoarthritis, sometimes even if there is a 3rd degree meniscus injury reported by MRI, especially the posterior horn of the medial meniscus with a horizontal lamellar tear, most of them do not need surgery because at this time the meniscus injury is only part of the joint degeneration. Arthroscopic surgery is not effective, and even if the patient has a combination of internal derangement of the knee, surgery to remove part of the medial meniscus may even lead to increased pain, because removal of the medial meniscus increases the internal derangement of the knee and increases the load on the medial compartment. If the degenerative wear and tear of the knee is not severe and it is determined that the meniscus injury is causing the “interlocking” and painful condition, it can be determined that the main cause is meniscal injury and that conservative treatment is ineffective and also requires surgery.
What are the consequences of not treating meniscus injuries?
If left untreated, not only will the damaged meniscus not heal, but the tear will grow larger along with the original fracture and cause wear and tear of the surrounding knee cartilage, leading to premature onset of degenerative arthritis of the knee.
Is open surgery for meniscus damage advisable?
Open meniscectomy used to be the only treatment. With the advent of arthroscopic technology and its continued development, minimally invasive and aesthetically pleasing arthroscopic surgery is now the gold standard for meniscal treatment and open surgery is not advisable and has been completely abandoned!
Can the damaged meniscus be treated arthroscopically?
Arthroscopic surgery is performed through 2-3 tiny 5mm incisions, using a 5mm arthroscopic lens to show the structures in the knee joint, including the meniscus, more clearly than the naked eye, and using specialized fine surgical instruments, a variety of surgical procedures can be performed on the meniscus such as excision and suturing.
Is it better to suture the meniscus than to remove it?
Many people know that the meniscus is very important and they always want to preserve it, so they always think that suturing is better than resection. If the meniscus cannot be sutured, it should not be reluctantly sutured, because even if it is reluctantly sutured, the chance of healing is very slim. The surgeon’s choice will be based on the specific situation during surgery. The majority of simple meniscus injuries in clinical practice are resected and shaped, and only a few can be sutured. The majority of meniscus injuries that are suitable for suturing occur when there is a combined ACL injury, and that type of meniscus usually requires suturing, and the healing rate of this type of suture is high.
What are the principles of arthroscopic meniscus surgery?
Arthroscopic surgeons follow the sequence of suture, partial excision, subtotal excision, and total excision to preserve as much meniscus tissue as possible while ensuring that the residual meniscus edges are stable and smooth.
How much meniscus damage should be removed?
It is not better to preserve more meniscus, but to ensure that the residual edge of meniscus is stable and smooth. As long as the meniscus is treated promptly, even if it is not suitable for suturing, most patients can achieve the goal by using the simplest partial resection to trim the damaged meniscus to a smooth curved shape, and subtotal resection and total resection are rarely needed.
When should a meniscus injury be sutured?
Only about 15-30% of meniscal injuries can be sutured. The shape of the meniscus tear, longitudinal tears are most suitable for suturing, while horizontal tears and flap tears are basically not suturable; 2. Most of them evolve into complex ruptures and are not suitable for suturing. Which meniscus suture method is better?
There are many methods of suturing the meniscus, such as inside-out, outside-in, all-in sutures, all-in sutures with sutures, etc. The suture materials are also various. The choice should be based on the site, type, degree of meniscus injury and the patient’s economic status. In any case, it is better to have a simple and affordable procedure with strong sutures and as little trauma as possible.
What is a meniscus transplant?
Meniscal transplantation refers to the transplantation of the meniscus from a foreign body. It is generally used for patients with irreparable total meniscectomy or subtotal meniscectomy resulting in meniscal failure, who are less than 40 years old, have high athletic requirements, no significant articular cartilage wear in the knee joint, and no abnormal force lines in the lower extremity. It is a highly technically demanding procedure with limited donor, and is rarely performed. At present, only a few large sports medicine centers in China are carrying out the procedure, and the main target is professional athletes.
Can I still play sports after meniscus injury surgery?
Whether the meniscus is removed or sutured, it is possible to play sports after a period of rehabilitation. If the meniscus is severely damaged and needs to be mostly or even completely removed, it is important to avoid strenuous activities and heavy physical work, and to control weight to reduce the wear and tear on the articular cartilage. If the meniscus is partially resected, you can go down to the ground to bear weight 6 hours after surgery. If the meniscus is sutured, it is generally prohibited to bear weight for 6-8 weeks after surgery depending on the size and type of the site and the strength of the suture.