Meniscus Injuries
Actually, we hear the word meniscus very often. As doctors, the sentences we use most of the time make us smile. 'I have a meniscus', 'I think I have a meniscus', 'Or am I a meniscus, doctor? In fact, what is meant in all of these is the tearing of the fibrocartilage structures in the knee (neither too soft nor as hard as cartilage), which we all have called meniscus.
There are two menisci in our knee, inner and outer. In shape, they resemble a half-moon, letter C or bean shape. Their average width is around 9-10 mm and their average thickness is around 3-5 mm. They wear out and lose their thickness as they get older. During knee movements, the outer meniscus moves more than the inner one. The reason for this is that the inner meniscus is better connected to the structures we call the capsule around the knee.
But what do these menisci do?
The primary function of the meniscus is to distribute the load coming into the knee joint. While standing upright, 50% of the loads on the knees pass through the menisci, when we bend our knees 90 degrees, 85% of the loads are transferred through the menisci. It also has shock absorbing properties. It contributes to the lubricating feature in the joint. The internal meniscus, together with the anterior cruciate ligament, also has a secondary effect that prevents the knee from sliding forward.
Doesn't the so-called meniscus tear occur in people who do sports? Could it happen to me too?
Yes, meniscus tears, which occur especially at young ages, occur after trauma while doing sports. However, in meniscus tears in older ages, menisci that have become worn and thinned over the years can occur during a light step backwards or even while squatting.
How do I know if my meniscus is torn?
In meniscus tears, patients generally feel a sudden stinging pain, mostly in the inner part of the knee and sometimes in the outer part, during trauma or especially during the movement of rotating our body. Most of them complain that they hear a sound coming from their knee at that time. After the incident, they complain of pain when stepping and especially when turning. Some patients even say that they cannot touch their knees together in bed due to pain. None of these findings are actually specific to meniscus tears. It can also be seen in injuries to other tissues. The best thing after such pain is to be examined by an orthopedic doctor.
A friend of mine could not move his knee at all when his meniscus was torn. Why does this happen?
Menisci can tear in many ways. The size, location and shape of the tear can cause various mechanical problems. In cases of bucket handle tears and flap-shaped tears (where a large meniscus piece is mobile), meniscus pieces may enter the joint space, restricting knee movements and causing the knee to remain bent and cause pain. In this case, surgery will become inevitable. People with medial meniscus tears may experience a feeling of pressure and insecurity as the secondary effect of the medial meniscus preventing the knee from moving forward is eliminated.
Can a torn meniscus be treated with medication?
Surgery for every meniscus tear. We do not intervene. Especially in cases of tears that occur without any injury due to aging and wear of the meniscus, which is called degenerative tear in older ages, we first try to eliminate the complaints with edema and pain relieving medications. If the patient's complaints are relieved with medications and exercises that strengthen the muscles around the knee, surgical treatment may be performed. It does not require treatment.
Can menisci heal on their own?
One of the disadvantages of meniscus is that only 10%-25% of the area around the edges is rich in vessels and these areas can be well nourished. As it approaches the middle, its nutrition is only from joint fluid, so its healing capacity is very, very low, except for the well-nourished 10-25% area at the edge.
To increase its healing, supplementary foods, calcium supplements and even drinking soups such as kelle paça< br /> Is it necessary?
People who eat regularly and adequately do not need to take additional protein and calcium. There are no publications showing that any food to drink or eat has a positive effect on healing.
On the contrary, the existence of a food that will reduce healing when eaten has not been scientifically proven.
To understand whether I have a meniscus tear or not. What kind of test should I have?
In fact, many patients who apply to us with complaints of knee pain immediately ask us whether we would like a magnetic resonance imaging (MRI). The most useful things for us to make the diagnosis are the history of the complaints our patient tells us and the findings we detect during the examination.
From now on, the first examination we request is the direct radiographs of our patient. This is a test that we can obtain and evaluate immediately. Since the articular cartilage is damaged along with the meniscus in osteoarthritis, which people call calcification, in older patients, the treatment method for these patients differs from individuals with only meniscus tears. It is withdrawn in cases of doubt or in patients planned for surgery. In studies, the success rate of magnetic resonance imaging in showing meniscus tears is around 75-80%. As can be seen, there is a 20% chance of missing a patient group. There is �. Therefore, examination findings are very important for treatment planning. Since there are many people in the society who are afraid of entering closed spaces, it is sometimes necessary to make treatment planning without MRI imaging.
When is surgical treatment required?
Arthroscopic surgery, especially for meniscus tears that occur with locking in the knee after trauma. action must be taken. Because there is now a mechanical problem here and it needs to be eliminated. Patients who frequently feel stuck in the knee, have recurrent swelling in the knee, and are diagnosed with a meniscus tear are among the patient groups that require arthroscopic surgery. In patients with pain without any obvious mechanical findings (stuck, locking, feeling of pressing on space), if their pain does not go away after 3 months of edema and pain relieving medications, exercise, cold application, and if they have sensitivity in the area where they have meniscus problems, arthroscopic intervention can be performed.
What kind of procedure is arthroscopy?
Arthroscopy is the live observation of the joint with a special camera system by entering through small holes, and in the meantime, the procedures required for treatment are performed with special orthopedic tools through small holes.
Usually, procedures are performed through 2 small holes of 1 cm. Spinal anesthesia (anesthesia from the waist) is usually used during the procedure. General anesthesia is generally applied in cases where spinal anesthesia cannot be performed or when the patient wishes to receive general anesthesia. We enable our patients who want to watch their surgery to watch what we do by explaining their situation on the screen during arthroscopy. This is of course possible in patients receiving spinal anesthesia. In this way, patients can see the problem areas in their knees and watch what we do for them.
What is the procedure during arthroscopy for meniscus tear? Is it being done?
As we mentioned before, menisci are useful structures. When an entire meniscus is removed, the forces on the joint surface on that side increase 2-3 times, and as a result, cartilage damage and osteoarthritis, which people call calcification, occur at an earlier time. For this reason, it is necessary to consider repairing tears especially in tears close to the edges of the meniscus, where the healing capacity is high. In recent years, it has become easier to repair these tears with arthroscopic special suture materials. In cases of tears that are too bad to be repaired, removal of the torn area constitutes the treatment.
How many days will I stay in the hospital after arthroscopy and when can I walk after the surgery?
Arthroscopy can be performed on a daily basis without being hospitalized, and it usually stays in the hospital for 1 day. It is also done by staying. A drain is placed inside the knee to prevent fluid accumulation and is removed after 1 day while dressing. If only part of the meniscus has been removed and no repair has been made, there is no harm in the patient walking. Generally, 1 week of walking with the support of a single crutch is sufficient. If a repair has been made, depending on the type of repair, full weight bearing and some movements may be restricted for a few weeks as determined by the surgeon. Patients are given exercises accompanied by our physiotherapist and are told how to do them at home. Generally, blood thinners are given for 2-3 weeks against the risk of embolism, which may occur even if it is low.
I had tears in both my meniscus and my anterior cruciate ligament. Is it okay if I only have meniscus surgery?
Many anterior cruciate ligament injuries occur together with meniscus tears. What is true is that both meniscus and anterior cruciate ligament tears occur, especially in patients under 50 years of age. Simultaneous intervention is essential.
The results are said to be much better if done this way.
Will my meniscus tear again after meniscus surgery?
If only the meniscus is damaged. If a portion of the meniscus has been removed or repaired, a meniscus tear may occur if an injury occurs. But this does not occur due to arthroscopic intervention, it occurs due to trauma.
Can meniscus transplantation be performed?
In recent years, meniscus transplantations from cadavers can be performed in young patients whose entire meniscus has been damaged due to trauma. Success rates are currently around 75-85% in a 10-year period.
I also have arthritis in my knees and my meniscus is torn. Will I benefit from arthroscopy
surgery?
Meniscus tears that occur due to osteoarthritis (calcification) should be evaluated separately. If there is advanced osteoarthritis, patients will not benefit from the meniscus procedure performed only by arthroscopy. Complaints continue. Different surgeries are required in such patients.
As a result, meniscus tears are a condition that varies from person to person and requires a good orthopedic examination. Patients benefit greatly from the treatments. Patients with such complaints in the knee should immediately consult an orthopedic doctor.
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