(Disclaimer: This article is for scientific purposes only, and the information in the following content has been processed to protect patient privacy)
Abstract: Lateral meniscal tears are most commonly seen in young male patients, and the occurrence of a meniscal tear usually requires the fulfillment of two conditions: knee flexion and simultaneous rotation. In this case, the patient suffered a knee sprain during exercise 1 week ago, resulting in a tear of the posterior horn of the lateral meniscus. The lateral meniscus was fixed by surgical suturing, and the patient recovered well from the knee function after surgery, and the symptoms of joint pain and swelling were basically relieved.
Basic information】Male, 33 years old
Type of disease】Lateral meniscus tear
Hospital】Harbin First Hospital
Date of consultation】May 2022
Treatment plan】Arthroscopy + meniscus suture + hinge brace fixation + ice + rehabilitation training
Treatment Period】7 days in hospital
Results】Lateral meniscus repositioned and fixed, knee pain relieved, range of motion restored
I. Initial consultation
The patient was 33 years old and complained of a knee sprain during soccer, which caused the knee joint to move from flexion to extension with twisting. Since it is a third degree meniscus injury, the effect of non-surgical treatment is not ideal, and the symptoms of joint interlocking occur frequently, leading to joint effusion and pain, which affects normal life. Therefore, surgical treatment needs to be considered and the patient is advised to try meniscal suture surgery to preserve the integrity and function of the meniscus as much as possible.
II. Treatment history
During the minimally invasive arthroscopic surgery, it was found that the posterior horn of the lateral meniscus was torn to form a laminar fracture, the superior and inferior layers of the lateral meniscus were separated, the posterior horn of the meniscus became less stable, and the surface of the meniscus was rough. After the meniscal file was freshly processed, the meniscus was sutured using a meniscal suture. After 2 stitches depending on the extent of the meniscal tear, the meniscal stability was restored and the symptoms of meniscal-induced joint symphysis completely disappeared. After the surgery, a hinge support was used for immobilization and the knee flexion angle was gradually increased to prevent knee stiffness symptoms. In addition, severe atrophy of the muscles around the knee joint, such as the quadriceps group, occurred, and rehabilitation exercises need to be insisted on to restore the stability of the knee joint.
III. Treatment effect
The patient was able to start quadriceps contraction activities as soon as the anesthesia effect of the surgery wore off. Moreover, when the knee joint started flexion activities 3 days after surgery, the pain symptoms were significantly reduced and no further joint interlocking symptoms appeared. However, joint swelling and joint effusion were still present in the short term, which required continuous ice and rehabilitation to relieve the above symptoms. After 7 days of hospitalization, the patient did not show any aggravation of pain symptoms when resting or turning, and the protrusion of the lateral meniscus in the joint space during knee flexion and extension activities was also improved, so the patient was discharged.
IV. Notes
We are glad that the patient’s condition has initially improved after the suturing of the lateral meniscus. Before the meniscus is completely repaired, the affected limb should not be used for weight bearing, and it usually takes about 6 weeks to reach full recovery, and the patient can gradually remove the double crutches and resume normal walking. The quadriceps strength training should be carried out every day before weight-bearing walking, and resistance training can be carried out with the aid of elastic bands. If the pain suddenly worsens, a follow-up visit to the orthopedic clinic is required, and if necessary, an MRI of the knee joint is needed to confirm whether the meniscus suture site has been re-teared. In addition, patients should pay attention to avoid joint puncture treatment in their daily life and pay attention to prevent respiratory tract infection and urinary tract infection to prevent secondary infection of the knee joint leading to serious consequences.
V. Personal insight
Because of the characteristic pathogenic conditions of lateral meniscal tears, strict protection of the knee joint is required during exercise and avoid sudden knee torsional flexion movements. In normal life, we should strengthen the muscle strength training around the knee joint to improve the stability of the knee joint, and if necessary, we should use knee brace to protect the meniscus of the knee joint before exercise to prevent the meniscus from tearing during exercise. Also, once a tear occurs, avoid weight bearing on the affected limb immediately, seek medical attention and treatment as soon as possible, usually as in this patient, the symptoms can be significantly improved with effective treatment.