The knee is the largest and most mobile joint of the body. The lateral ligaments and cruciate ligaments provide the stability of the knee.
The cushions located between the thigh bone (femur) and shin bone (tibia) in the body are called meniscus. Menisci are two half-moon or C-shaped tissues in the cartilage structure of each knee, one on the inside and the other on the outside.
Menisci increase the compatibility between the thigh bone (femur) and shin bone (tibia) and ensure that the body weight is balanced in the knee joint. They play a role in transferring and reducing the impact of impact (shock absorption).
In the absence of menisci, 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.
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
Anterior cruciate ligament injuries and internal collateral ligament injuries along with meniscus tears. 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 allows meniscus tear to be easily distinguished from other knee problems.
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, having a meniscus tear only on MRI is not the only reason. It is not enough to decide on arthroscopy.
In every knee injury, early application of cold, rest and immobilization are the first practices that should be performed. Painkillers are used to relax the patient and reduce edema.
In the second step, it is decided whether the patient requires surgery for meniscus tears.
If there is pain in meniscus tears and it affects daily life, surgery should be considered.
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There are two options that can be applied frequently in meniscus tears:
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).
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 Treatment:
The cruciate ligaments are inside the knee joint. It connects the thigh (femur) and shin (tibia) bones together 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).
The anterior cruciate ligament can be injured in the following ways;
Sudden change of direction, knee rotation
Slow down while running or sliding
When landing after jumping
Direct blow to the knee
As soon as there is a described trauma to the knee, the activity (sport, walking, etc.) should be stopped.
Cold application with an ice bag around the knee should be applied for 20 minutes and the application should be continued every 2 hours.
It will be evaluated by an Orthopedics and Traumatology Specialist and the definitive diagnosis will be made by MRI (MRI). Weight bearing should be avoided as much as possible until it is diagnosed with imaging tools such as Magnetic Resonance.
The diagnosis can only be made after the necessary examination and MRI imaging, which is the gold standard.
Surgery. Non-treatment;
• Incomplete (partial) tears
• Age or general Those with low physical activity
• Surgical treatment may not be required for knees with good general stability in stability tests (such as the pivot shift test).
Surgical treatment may not be required for such patients.
The lifespan of such patients It is recommended that they do regular exercises to develop the front and back muscles of the thigh (quadriceps and hamstring) and use special knee pads in risky activities.
Surgical Treatment;
Anterior cruciate ligament. It is necessary for patients with ruptures who are active and want to do sports. It is recommended from time to time for people with less active knee rotation to restore confidence in the knee and prevent cartilage damage.
In surgical treatment, the original anatomy of the anterior cruciate ligament is usually used arthroscopically, using a tendon (or a part of it) around the knee. An appropriate reconstruction is provided.
However, the most important factor that determines the patient's future is the condition of other injuries such as meniscus and cartilage accompanying the cruciate ligament.
Apart from the general risks of surgery, even if it is performed with good technique. Unique to this surgery, complications such as infection, deep vein thrombosis (blood clot), and inability to heal the ligament to the bone may occur, albeit at very low rates.
The next day after the surgery, the patient is given weight bearing as much as he can tolerate with the help of double Kanedian crutches. He can walk.
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, 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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