Why would a meniscus injury occur if I am not injured? Most patients understand the concept of meniscus injury as a result of trauma (such as sprains, falls, bruises, etc.), but they do not know that the knee meniscus, which is an important stabilizing and cushioning structure for the lower extremity of the body, can also suffer degenerative ruptures and injuries due to overload wear and tear in daily work, labor, and life. The knee joint “ages faster”. Most of these injuries are closely related to the patient’s occupation and lifestyle behaviors. For example, welders, masons, steel workers, auto mechanics and electrical engineers who need to squat for long periods of time are more likely to suffer from posterior meniscus injuries, and police officers, firefighters, athletes, couriers, waiters and other occupational groups who need to stand, walk or even climb high and low for long periods of time are also more common. This does not affect the development of the disease and the damage to the joint, and should be taken seriously. In addition, there is a special type of meniscal injury called “discoid meniscus injury”, which will be described in a later section. Is surgery necessary once the meniscus is damaged? Is conservative treatment effective? Is there anything that Chinese herbal medicine can do for this? The human knee meniscus has evolved into an “inner C and outer O” shaped meniscus, which is thinner near the center of the joint and has a poorer blood supply, making it difficult to repair itself once it is injured. This special structure makes it impossible to generalize about the self-repair after meniscal injury. Unfortunately, most clinical studies to date have concluded that because the meniscus itself is cartilage, and cartilage has a poor ability to repair after injury, conservative treatment of any kind generally only relieves pain, swelling, and improves muscle strength around the knee joint, reducing claudication and difficulty climbing stairs, but has limited effect on promoting healing after meniscal injury. Chinese herbal medicine may also play a role in this process, but many patients have reported that there is a certain probability of medical infection during traumatic treatments such as micro-needling and acupuncture, and that the lack of strict sterilization of needles or unhygienic treatment environments and bacteria in the pores of the patient’s skin are all causes of knee infections in patients. We do not recommend the use of Chinese herbal ointments or creams for external application because of the complex composition of Chinese medicine and the possibility of skin ulceration around the knee joint due to drug allergy in some patients. III. What is disc meniscus? The exact term for the discoid meniscus of the knee should be “developmental discoid meniscus”. In the course of human evolution, the upper and lower extremities evolved in different directions due to the emergence of standing and walking and the use of two-handed tools: the upper extremities evolved in the direction of flexibility and fine movement, while the lower extremities evolved in the direction of stability and strength. Specifically, the meniscus is almost always a “large disc” of cartilage at birth, but as it begins to stand and walk, the “disc” will soon evolve in the direction of the “meniscus”. development, and this process will be completed in the infant stage. However, in some individuals, this process is terminated and the disc-shaped cartilage plate will exist as a “meniscus” in the knee cavity and perform the functions of a “meniscus”, such as lubricating the joint, reducing shock, and cushioning stability. Because of its size and thickness, this disk of cartilage is prone to rupture in daily life, and once ruptured, it is difficult to heal itself and causes persistent pain and a “popping sound” in the lateral joint space of the knee. This “popping” sound is so low and dull that it can be heard by anyone sitting next to the patient. Once the disc meniscus has ruptured, it requires surgical treatment, but this is a complex disease that I will describe in my article “Disc Meniscus Injury and Treatment”. Fourth, how to diagnose meniscus injury? Once a doctor diagnoses a meniscus injury, do I need surgery? When should I do it? When you experience knee pain with difficulty in movement (such as walking and turning, going up and down stairs, squatting to go to the toilet, etc.), or even feel a “rattling sound inside the knee joint”, especially after a knee trauma or after fatigue or occupational behavior, you should highly consider the possibility of meniscal injury. Generally speaking, MRI of the knee is very useful in diagnosing meniscal injuries, not only to determine the location and extent of the meniscal injury (although this is an approximate description and may be inaccurate), but also to detect any combination of cruciate ligament tears, articular cartilage damage, synovial cysts, etc. If you have any of these discomforts and the MRI report of the knee suggests a meniscal injury greater than second degree (from mild to severe I, II, III, IV), you will need to consider surgery, and I will describe the specific treatment in my article “Arthroscopic meniscal surgery of the knee – are you ready? I will introduce the topic in my article “Arthroscopic meniscus surgery for the knee – are you ready? If the diagnosis is clear and there is no combination of rheumatism, gout, or other systemic connective tissue disease, it is important to treat the meniscus as soon as possible in order to reduce the wear and tear of the ruptured meniscus on the normal structures of the joint, especially the cartilage of the femoral condyle and tibial plateau (which is the interface between the large and small leg bones). V. How is meniscus surgery done? Is the surgery safe? What are the risks? With the development of medical science and technology and the increase of people’s care for their health, arthroscopic surgery has been chosen by joint surgeons and joint disease patients as the first choice of treatment for joint diseases. Ten years ago there may have been orthopedic surgeons doing open meniscectomies for patients with meniscal injuries, but today this procedure, which does not preserve the structure and function of the remaining meniscus, destroys the stability and balance of the ligaments around the joint, and leaves patients with scars of more than ten or even twenty centimeters, is still in the textbooks, but must now go into the museum. In a sense, it is now inhumane and even “illegal” to perform meniscus surgery without arthroscopy and using traditional incisional surgery. Arthroscopy, with its unique “small window, large field of view” feature, allows for a clear microscopic diagnosis of the patient’s exact meniscus rupture and the extent of the damage and individualized treatment. Although different patients may all have meniscal damage, the arthroscopic presentation and severity may be completely different, resulting in different surgical approaches. article. The entire procedure takes between 40 minutes and an hour, and because general anesthesia is used to ensure safe anesthesia and reduce “tourniquet reactions,” it is a very safe procedure for patients who have no significant physical abnormalities on routine preoperative examination. However, because the patient must receive anesthesia, the risks and complications of anesthesia cannot be theoretically avoided, but can only be said to be much smaller compared to other surgical procedures, and we have experienced patients with postoperative anesthetic reactions during specific clinical procedures, but in general a low probability of occurrence and not serious. Six, what are the most common surgical sequelae of meniscal injury? How to avoid them? The most common sequelae are damage to the articular cartilage that cannot be effectively repaired, especially for middle-aged and elderly patients, female patients, patients who do not usually do physical work and have poor muscle strength, and patients who have had meniscal injuries for a long time and have been diagnosed by a doctor as requiring surgery but have delayed surgery (>3 months). If a middle-aged or older patient (>55-60 years old) has a deformed knee joint with a reduced or absent joint space, and painful walking and weight-bearing on the ground is the main painful manifestation, and MRI and radiographs suggest extensive cartilage debridement in the joint, we recommend that the patient consider artificial knee replacement (unicondylar (i.e., half replacement) or total joint replacement), or try arthroscopic joint cavity cleaning first. We recommend that the patient consider an artificial knee replacement (unicondylar (that is, half replacement or total replacement)), or try arthroscopic cavity cleaning first and observe the results, and then replace it if it does not work. Intractable muscle atrophy tends to be more common and is a common complaint of most patients with poor recovery after surgery, as I will describe in the article “Common rehabilitation after knee arthroscopy”. 7. How much does meniscus surgery cost? How long will it take to heal? Is it reimbursed by health insurance? Depending on the specific surgical plan of meniscus surgery, a case of arthroscopic surgery at the First Affiliated Hospital of Anhui Medical University (Sports Trauma and Minimally Invasive Arthroscopy Center) costs about 15,000-20,000 RMB, including anesthesia (0.4-0.5 million), surgery (0.7-0.9 million), pre-surgical examination (0.1-0.2 million), pre-operative and post-operative medication (0.2 million), and a medical fee (0.5 million). Post-operative medication (0.2-0.5 million) varies. Generally, patients can be discharged from the hospital three to five days after surgery if they recover well, but special cases need to be extended to about one week after surgery. Since our hospital is a provincial-level tertiary hospital, the reimbursement level of medical insurance and rural cooperative medical care is slightly lower than that of county-level hospitals and municipal hospitals, generally around 40%-60%, depending on the specific policies of the medical insurance office and rural cooperative medical care office in the patient’s location.