Meniscus Tears and Treatment:
· The knee is the largest and most mobile joint of the body. Side ligaments and cruciate ligaments provide the stability of the knee.
· The pads located between the thigh bone (femur) and shin bone (tibia) in the body are called meniscus. Menisci are two cartilaginous half-moon or C-shaped tissues in each knee, one on the inside and the other on the outside.
· Menisci increase the compatibility between the thigh bone (femur) and the shin bone (tibia) and ensure that the body weight is balanced in the knee joint. They play a role in transferring the impact and reducing the impact (shock absorption).
· In the absence of meniscus, the joint surfaces between the femur and tibia are not fully compatible with each other, so the load will increase excessively at certain points and the load will not be distributed to other points. In this case, it will be inevitable to encounter premature wear problems and calcification in areas where load is applied. Therefore, it is important for the menisci to function in terms of knee health.
Figure 1: Types of meniscus tears
· Menisci are often injured as a result of trauma (seen in young athletes). However, tears due to calcification (seen in elderly patients) are not uncommon.
· The most common mechanism of occurrence is the rotation of the body on the knee while the foot is fixed on the ground
· Meniscus tears along with anterior cruciate ligament injuries and internal injuries. Lateral ligament injuries may also occur together and should be evaluated together for treatment.
· The first symptoms encountered in meniscus tear are pain and swelling. Locking in the knee (inability to fully open or close the knee) is one of the accompanying findings and indicates that the torn meniscus prevents joint movements.
· Tenderness when pressing on the meniscus, noise during movements from the joint, and limitation of movement in the knee are other possible findings.
>· Every patient with knee pain should be evaluated for meniscus tear. A good patient history and knee examination will rule out a meniscus tear from other knee problems. It makes it easy to distinguish.
· Knee X-ray and Magnetic Resonance Imaging (MRI) are the most commonly used examination tools. Calcification and related changes in the knee are evaluated with a knee x-ray. MRI is very valuable for imaging the meniscus. However, just having a meniscus tear on MRI is not enough to decide on arthroscopy.
· Early application of cold, rest and immobilization are the first practices that should be performed in every knee injury. Painkillers are used to relax the patient and reduce edema.
· In the second step, it is decided whether the patient requires surgery in terms of meniscus tear.
· If there is pain in meniscus tears and it affects daily life, surgery should be considered.
· There are two options that can be applied frequently in meniscus tears:
o Meniscus Repair: Repair is possible depending on the shape of the meniscus tear. Not every patient is suitable for repair. Arthroscopic repair is possible. However, the healing process is longer than in patients in whom the torn part of the meniscus is removed (meniscectomy).
o Meniscectomy: It is the method in which the torn part of the meniscus is removed. It is applied to tears in the inner part of the meniscus that have no chance of healing. When performed arthroscopically, there is a very rapid recovery process and the patient can stand up on the same day.
Anterior Cruciate Ligament Rupture and its Treatment:
· The cruciate ligaments are located in the knee joint. It connects the thigh (femur) and shin (tibia) bones to each other like a short rope. They provide the necessary stability when the knee is bent and straight. The one in the front is called the anterior cruciate ligament (ACL), and the one in the back is called the posterior cruciate ligament (PCL).
Figure 2: Anterior Cruciate Ligament tear
· Front The cruciate ligament can be injured in the following ways; · As soon as there is a described trauma in the knee, make sure The specified activity (sports, walking, etc.) should be stopped.
· Cold application with an ice pack around the knee should be applied for 20 minutes and the application should be continued every 2 hours.
· Orthopedics and Weight bearing should be avoided as much as possible until the patient is evaluated by a Traumatology Specialist and the definitive diagnosis is made by imaging tools such as MRI (Magnetic Resonance).
· The diagnosis can only be made after the necessary examination has been performed and the gold standard MR imaging has been performed.
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Non-Surgical Treatment;
• Incomplete (partial) tears
• Those with age or generally low physical activity< br /> • Surgical treatment may not be required for knees with good general stability in stability tests (such as the pivot shift test). It is recommended that they work out regularly and use special knee braces in risky activities.
Surgical Treatment;
· It is necessary for patients who are active and want to do sports with anterior cruciate ligament rupture. From time to time, it is recommended for people with less active knee rotation to restore confidence in the knee and prevent cartilage damage.
· In surgical treatment, the original ligament of the anterior cruciate ligament is used, usually arthroscopically, using a tendon (or a part of it) around the knee. A reconstruction appropriate to the anatomy is provided.
· Anterior Cruciate Ligament surgery has a very low complication rate when performed by experienced surgeons.
· However, the most important factor that determines the patient's future is the accompanying cruciate ligament. It is the condition of other injuries such as meniscus and cartilage.
· Apart from the general risks of surgery, even if it is performed with good technique, infection, deep vein thrombosis (blood clot), albeit at very low rates, and the healing of the ligament to the bone, are specific to this surgery. Complications such as insufficiency may occur.
· The next day after the surgery, the patient can walk with the help of double Kanedian crutches, bearing as much weight as he can tolerate.
· He can return to a desk job within 4-7 days.
· He can start driving within 3 weeks.
· Provided that physiotherapy is started immediately after the surgery, in the 2nd week. At the end, the aim is to walk with one crutches, and at the end of the 3rd week, to walk without crutches.
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