Menisci are the most commonly affected structures in knee joint injuries. Meniscus injuries can occur due to direct trauma such as sports injuries and traffic accidents, and tears can also occur after loss of meniscus elasticity and degeneration with age. There are two menisci in each knee, lateral (outer) and medial (inner). The mouth of the medial (inner) meniscus is more open than the lateral (outer) meniscus. It is semicircular in shape and approximately 3.5 cm long. Medial meniscus width is 6 mm in the front and 12 mm in the back. The inner meniscus is less mobile than the outer meniscus. Since the external meniscus is more mobile, its injuries are much less common.
Duties of the Menisci:
Menisci, which were previously thought of as useless organ remnants, become less effective in the normal functions of the knee over time. Studies have shown that it has an important place. Both menisci take up space in the joint and compensate for the incompatibility between the femur (thigh bone) and tibia (shin bone) joint surfaces.
The main function of the menisci can be considered as distributing the incoming loads in the knee joint. Since 70% of the weight of the meniscus is water, this water content rises into the joint space after the compressive load on the meniscus. As a result, the meniscus lubricates the joint and helps nourish the cartilage by facilitating the distribution of joint fluid.
Another important function of the meniscus is to contribute to joint stability (balance and solidity).
Meniscus receives and distributes the information of the knee joint sensation, therefore deep It has been shown to contribute to sensory function. During loading, 70% of the load in the lateral compartment (part) and 50% of the load in the medial compartment are transmitted by the menisci. When the knee is in extension (the knee is fully open-straight), the menisci carry 50% of the loads on the joint. The load bearing rate in a knee in 90 degree flexion (knee bending movement) reaches up to 85%.
Tearing of the meniscus:
Injuries to the meniscus; It develops through 95% indirect and 5% direct mechanisms. Direct mechanisms include blows to the knee and traffic accidents. I indirect injury mechanisms; Varus, valgus and rotational loads above physiological limits prevent the movements of the meniscus and cause tears. Meniscus tears that occur in young patients are generally associated with sports injuries. The sport with the highest risk of meniscus lesion formation is football, followed by athletics, American football and skiing. In this patient group, meniscus tears can often be accompanied by anterior cruciate ligament injuries and osteochondral (small bone tissue separated from the joint) injuries. Degenerative tears become more common with advancing age. The elasticity (flexibility) of degenerated meniscus tissue is decreased. This makes the meniscus prone to tearing. Degenerated meniscus can tear even in the absence of significant trauma.
Incidence of Meniscus Injuries:
Today, the incidence of meniscus injuries is 60-70 per 100,000. The male/female ratio is 2.5/1. Meniscus tears are more common in men between the ages of 20 and 30, and in women between the ages of 10 and 20. Internal meniscus tears are 3 times more common than external meniscus tears. While traumatic tears are common in patients under the age of 30, degenerative complex tears increase in patients over the age of 30. Approximately 60% of the population over the age of 65 may develop meniscus tears due to degeneration. Additionally, meniscus tears are rare in children under 10 years of age. An increase in the frequency of meniscus tears is observed in the post-adolescent period.
Meniscus Tear Evaluation:
Trauma history is often guiding in making the diagnosis. Meniscus tears; It gives symptoms according to the location, shape and size of the tear. Complaints such as fluid accumulation in the knee, muscle atrophy, locking, joint sensitivity, sound inside the knee and inability to fully flex the knee (bend the knee) or extension (make the knee fully straight) often indicate meniscus injuries. Suitable for meniscus tears. Although the history taken may first suggest a meniscus tear, reaching the diagnosis is not that easy. In this case, it is necessary to address each finding one by one. Mechanism of injury and time elapsed It is eminent. In meniscus lesions, this preliminary information obtained from the patient is at least as important as the clinical examination.
Meniscus tears tend to cause intermittent (intra-articular) disorders. Characteristically, a bout of pain or swelling occurs with a sharp twisting movement. The symptoms regress within one to two weeks. A 15-23% diagnostic error rate has been reported in meniscus tears based on history and physical examination alone. In addition to these, diagnostic error can be reduced to 5% with auxiliary examinations such as x-ray, MRI and arthroscopy.
Many orthopedic tests can be used by physiotherapists and doctors to diagnose meniscus.
Findings in meniscus tear. :
Findings may vary in patients presenting with a meniscus tear. Practically every meniscus tear causes pain in the knee joint. In newly formed tears, the pain is very strong and may radiate below the knee. Due to this pain, the patient cannot put weight on that knee and cannot continue his sports. In terms of diagnosis, the most significant finding of the anamnesis is locking. It can be defined as the knee suddenly getting stuck in different degrees of flexion and not moving at all. Joint locking is rarely seen at the time of initial trauma. Generally, after the trauma, a mild limitation of movement begins that increases over time and eventually locking occurs. Although knee locking is most often caused by a bucket handle tear and the medial meniscus, it can also be caused by loose objects (joint mice) and tumoral masses stuck between the joint surfaces. Therefore, it is necessary to see that there is no such pathology radiologically.
After a trauma to the knee joint. Effusion (swelling) may develop in the knee. Since the feeling of discharge in the knee can occur in many cases, from osteochondral lesions to ligament injuries, it is of little benefit in making a diagnosis. The patient states that there is a feeling of slippage in the joint during movement. The patient says that his foot feels empty.
Pain at the joint line and quadriceps (upper leg muscle) atrophy (muscle thinning) are also common findings.
Treatment methods for meniscus tear:
Treatment methods for meniscus tear: strong>
Treatment for meniscus tears can be divided into conservative and surgical. Surgical treatment approach It may be in the form of excision (removal) or repair of the residual meniscus piece. While open interventions were preferred in the surgical treatment of the meniscus in the past, today arthroscopic interventions are preferred.
Conservative treatment:
Incomplete meniscus tears generally remain the same and heal. Most stable peripheral tears heal in the same way. Patients with minimal symptoms can be treated conservatively with 6-12 weeks of rest, cold application, anti-inflammatory drugs and physical therapy. If it is accompanied by locking, extreme pain and a feeling of ejaculation, such tears are generally candidates for surgical treatment. Today, most meniscus tears are treated surgically; However, conservative treatment may be considered for patients with degenerative tears, minor symptoms, and sedentary patients.
Surgical treatment:
Recurrent pain, effusion (swelling) following conservative treatment. When symptoms such as ) and locking begin to restrict the patient's daily life and sports activities, the need for surgical treatment for the meniscus begins. It is widely accepted that the treatment of meniscus tears will be surgical. Arthroscopic evaluation of the location, type and length of the meniscus tear is important in deciding on treatment. Today, the most important part of surgery for the knee joint is the protection of the menisci. There is an indication for repair in tears with excessive blood flow. In cases where there is no blood supply, the treatment is generally meniscectomy (removal of the meniscus), although in some special cases, tears in this area can be repaired with healing-enhancing methods. Meniscectomy can occur in three ways; partial, subtotal and total. The purpose of partial meniscus is to remove the torn or pathological meniscus section from the environment. Following adequate surgery, the symptoms disappear and the result is achieved.
Physiotherapy in Meniscus Injury:
The importance of physical therapy in rehabilitation after both conservative treatment and surgical treatment after meniscus injury cannot be denied. Even if the patient has undergone surgery or for protective purposes, He/she needs to undergo physiotherapy. Physiotherapy is very important in controlling edema, preventing muscle atrophy, controlling pain, and helping the patient return to normal life quickly, and is directly effective in improving the patient's quality of life.
In physiotherapy protocols, let's first look at what should be done immediately after the injury. Immediately after the meniscus injury (approximately the first 3 days), applications generally abbreviated as PRICE are performed.
P-Protection (Painful movements and loading are avoided)
R-Rest - Rest (Rest)
I- Ice (To prevent edema, ice is placed in a bag for 8-10 minutes, its mouth is tied and placed between a wet towel and applied to the edematous area for 8-10 minutes)
C- Compression (Bandaging = Edema) To prevent edema, the knee is wrapped with a bandage by a physiotherapist or doctor with the appropriate technique.)
E- Elevation - Lifting up (Knee is kept above heart level to prevent edema)
After these applications are performed and edema control is achieved, pain control is achieved. Applications are made to prevent atrophy and loss of strength. Let's see what these are. It should be kept in mind that these applications should be applied by a physiotherapist or doctor.
ELECTROTHERAPY:
Hot-Pack: It means hot pack and is superficial. It accelerates healing by warming the tissues and increasing circulation.
Tens: Used to relieve pain.
Stimulator: Applied to strengthen muscles and prevent atrophy.
/> Ultrasound: If there is a problem in the deep tissues, it is used to accelerate healing by heating the deep tissue and increasing circulation.
EXERCISES: Exercises are generally used to increase muscle strength and prevent atrophy. and is the most important part of the treatment aimed at improving the quality of life by restoring normal joint movement.
bsp Knee exercises:
1-A towel under your knee put a roll. Contract the muscle in the front of your leg (thigh muscle) by pulling your kneecap upward and pressing the bottom of your knee against the towel roll. Wait in this position for 8-10 seconds and relax.
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