TREATMENT OPTIONS FOR MENISCUS TEARS

Menisci are C-shaped cartilage-like structures located in the knee joint. They are located between the femur and tibia, the two main bones that make up the knee joint. There are two menisci in each knee, one inner and one outer.

Schematic and arthroscopic images of the inner and outer meniscus, a tear is observed in the inner meniscus

WHAT ARE THE USES OF THE MENISCES?

Until forty years ago, menisci were thought to be useless remnants. For this reason, a meniscus tear comes to mind in every patient whose knee hurts, and even if the meniscus was intact during surgery, it was completely removed because it would tear in the future. However, in recent years, it has been understood that the menisci have very important functions for the normal function of the knees. Menisci located between two bones function like a gasket and protect the joint cartilage from abnormal loads. They are very important in carrying and transferring loads. They also increase the compatibility of the joint surfaces and contribute to the intra-articular circulation of joint fluid. In the absence of menisci, the loads on the knee joint directly fall on the joint cartilage, causing premature wear, that is, osteoarthritis. In the light of this information, protecting the menisci has become the first priority of orthopedists today.

HOW DO MENISCUS TEARS OCCUR?

Meniscus tears may occur during the rotation movement on a fixed foot during football.

Meniscus tears may occur during the rotation movement on a fixed foot during football

The way meniscus tears occur in young people and older individuals is different. In young people, a very serious trauma is required for the meniscus to tear. This usually occurs during a rolling motion on a fixed foot. Tears that occur in sports such as football, basketball, and skiing are examples of this.

Over the years, meniscus loses its strength and flexibility and "degenerates". Degenerated menisci can tear much more easily. In older individuals, meniscus tears may occur with a simple squatting or tripping on the carpet.

The outer meniscus is more mobile than the inner meniscus. Therefore, internal meniscus tears are more common. Although rare, there may be congenital deformities in the menisci. This type of meniscus is more prone to tearing and may show symptoms even in childhood.

WHAT ARE THE SYMPTOMS OF MENISCULE TEARS?

Schematic view of meniscus tear

Schematic view of a meniscus tear

When meniscus tears occur, patients usually feel a sudden pain, stinging or tearing. Depending on which meniscus is torn, the pain is more pronounced on the inner or outer part of the knee. Within a few hours, swelling occurs in the knee joint due to fluid or blood accumulation in the knee. It is usually possible to step on the injured knee, but there is limping and athletes often have to quit the sport. If the injury is severe, meniscus tears may also be accompanied by ruptures of the cruciate or lateral ligaments of the knee joint. In this case, symptoms such as insecurity and feeling of emptiness in the knee may also occur. Sometimes the torn meniscus piece gets stuck between the bones forming the knee joint and prevents knee movement. In this case, known as locked knee, early surgical treatment is required.

As time passes, the widespread pain in the knee decreases and becomes a point on the relevant meniscus. Pain occurs especially during sudden turns and squatting. Torn meniscus pieces can get between the joint surfaces and cause symptoms such as catching and locking in the knee. This may also cause crunching-like sounds that were not present in the knee before.

HOW ARE MENISCUS TEARS DIAGNOSED?

In order for your doctor to reach a diagnosis of meniscus tear, you must first understand the occurrence of the event. He will ask you to explain. He or she will then examine your knee and look for signs of a meniscus tear. Meanwhile, he also examines your lateral and cruciate ligaments. The diagnosis of meniscus tear is largely made after a good history and physical examination. Your doctor may order x-rays to evaluate the amount of wear and tear on your knee and to understand whether there are any other problems with the bone structures. In recent years, the most reliable method to confirm the diagnosis of meniscus tears is magnetic resonance imaging of the knee joint. (MRI).

Image of internal meniscus tear on MRI

MRI' The accuracy rate in detecting meniscus tears is over 95% if it is pulled properly and evaluated in experienced hands. However, MRI is not the only determinant in deciding on treatment. In some cases, an image may be obtained as if there was a tear even though there was no tear (false positive result), or on the contrary, it may not be detected on MRI even though there was a tear (false negative result).

Especially beforehand. If surgical treatment has been performed for the meniscus, the margin of error increases significantly and more advanced diagnostic methods may be required. Therefore, when deciding on your treatment, your doctor takes into consideration not only MRI findings, but also your history and physical examination findings. In some cases, all of these diagnostic methods may be inadequate. In this case, the diagnosis is confirmed by arthroscopy.

See the "What is arthroscopic surgery" section on this website.

TREATMENT OPTIONS IN MENISCULE TEARS. WHAT ARE THEY?

The treatment of meniscus tears in young people is mostly surgical. Except for some very rare and small tears that are not full thickness, the menisci do not have the ability to heal on their own. In patients with significant complaints, meniscus tears are attempted to be repaired with surgical intervention; if the tear is not suitable for repair, the torn part is removed.

In older patients, meniscus tears are usually caused by arthrosis (wear, tear, calcification) in the knee. ) is accompanied. In this case, simply intervening in the meniscus tear may not completely solve the problem. In this case, your doctor will decide on suppressing the symptoms with medication, intra-articular injections, arthroscopic surgery, or one of the bone corrective surgeries combined with arthroscopy.

HOW IS MENISCUS REPAIR DONE?

The first option for meniscus tears is repair to ensure that the knee can perform its functions, which are very important for long-term health. Due to the vascular properties of the meniscus, their healing ability is not very high, and roughly one-fifth of meniscus tears are suitable for repair. Today, meniscus repair is performed with arthroscopic surgery.

Schematic image of meniscus repair

After your doctor decides that the tear is suitable for repair, it is placed through special cannulas. It can repair your meniscus tear with long needles. Sutures are placed on both the upper and lower sides of the meniscus at 3-4 mm intervals along the tear.

Repair made using a special suture device developed for external meniscus repair.

An additional small incision needs to be made where the stitches are removed from the joint and tied. Meniscus repair has become much easier with some implant-suture combination devices developed in recent years. When these implants are used, there is no need for a second incision other than the knee.

Meniscus repair with stitch-implant combination devices.

The durability of the repair and other interventions performed within the joint. Depending on whether you have had surgery (e.g. cruciate ligament surgery), you may need to use crutches and avoid squatting for a few weeks after surgery. Return to sports may take between 4 weeks and 4 months. The success rates of meniscus repair vary depending on the type of tear and the type of surgery performed, but are between 70 and 95%. Despite the repair, the meniscus may not heal or may tear again. In other words, a second surgery may be required in 5-30% of patients who undergo meniscus repair. Although the failure rate seems high, this risk is acceptable considering the wear that will occur on the knee in the absence of menisci. If the repair fails, the torn meniscus piece can be removed with a simple surgery.

WHAT IS MENISCECTOMY?

Partial meniscectomy

If your doctor decides that your meniscus tear is not suitable for repair, the torn meniscus piece is removed. This procedure is called meniscectomy. During this procedure, only the torn part is removed and the remaining intact part of the meniscus is preserved. This is called partial meniscectomy.

The more meniscus tissue that can be preserved, the better it will be for the long-term health of the knee. . Because the protected meniscus tissue continues to bear the load, albeit partially. Early results of partial meniscectomy are very good. There is no need for a serious rehabilitation program after the surgery. It is often possible to return to normal life and sports within a few days or weeks after exercises performed at home.

In follow-ups longer than 15 years, findings related to wear on the knee may occur in approximately one fifth of patients who underwent partial meniscectomy. . These findings occur more severely, especially in patients whose outer meniscus has been removed, compared to those whose inner meniscus has been removed.

WHAT IS MENISCUS TRANSPLANTATION?

Synthetic meniscus

In patients whose meniscus is severely damaged and needs to be completely removed, transplantation of meniscus tissue has come to the fore to prevent wear on the knee. Frozen meniscus tissues taken from cadavers can be transplanted after testing to prevent disease transmission. The success rate of this procedure, which has very limited application in our country, is between 60-80% in 10 years of follow-up. Bone-related surgeries may also be required along with meniscus transplantation, which requires a fairly major surgical procedure. Despite the tests performed, there is a risk of carrying the disease around three in a million.

Studies continue on the production and transplantation of synthetic meniscus tissue instead of tissues taken from another person. With today's technology, synthetic meniscus tissues can only be used in partial meniscus losses.

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