Meniscus tears can often cause complaints such as tenderness in the joint line, locking in the knee, increasing pain after activity and swelling in the knee, depending on its location. For this reason, it causes sudden locking while walking and severe pain when stepped on, negatively affecting the social life of the person. Early diagnosis is very important.
The knee joint is a closed space formed by the union of certain parts of 3 bones (femur, tibia, patella). There are structures in this space that both enable the knee joint to move stably and ensure equal distribution of the load on the joint. Menisci, anterior and posterior cruciate ligaments, articulation cartilages and glands called synovium that form the fluid inside the knee constitute these structures. Menisci are cartilaginous structures of medium hard consistency located in both the inner and outer spaces of the knee and provide suspension of the load on the joint. Anterior and posterior cruciate ligaments provide a connection between the shin and femur, preventing the knee from slipping forward or backward. The cartilages at the ends of the bones that form the knee ensure painless joint movement and contribute to suspension. The gland called Synovia provides nutrition to the structures that make up the knee joint, thanks to the synovial fluid it produces, and also ensures the smooth continuation of joint movement with the fluid it produces.
In the knee joint. Sudden traumas or microtraumas caused by misuse of the knee can cause damage to the structures inside the knee. As a result of these traumas, internal meniscus/external meniscus tears, anterior cruciate/posterior cruciate ligament tears, cartilage death due to injury or lack of blood supply in certain parts of the cartilages (osteochondritis dissecans)observable. In addition, many patients have some of these injuries together. Apart from this, an increase in the synovial structure (synovial hypertrophy, polyvillonodular synovitis) and an increase in synovial fluid may be observed secondary to some synovial diseases or rheumatic diseases.
Meniscus tears often cause tenderness at the joint line, depending on where they are located. k on the knee It may cause complaints such as numbness, increasing pain after activity and swelling in the knee. While meniscus tears that occur at young ages often manifest as a single tear area, meniscus tears that occur on the basis of calcification at older ages occur with a crushing mechanism that increases over time and are multi-part tears. Tears are divided into 4 stages according to their size, and surgical treatment is preferred especially in stage 3-4 tears. In patients with meniscus tears, cysts (Baker cyst) may form in the posterior space of the knee after the increased joint fluid leaks behind the knee.
In cases of anterior and/or posterior cruciate ligament injuries, the knee rotates while walking or sudden knee movements. A feeling of discharge and falling in the knee joint is observed. In patients with ligament rupture, sports activities may cause bone edema (bone bruise) around the cartilage of the bones forming the knee joint due to an unstable knee. These patients often have accompanying meniscus tears, and the findings of meniscus tears cause additional complaints in the patient.
There is approximately 4-5 mm of cartilage structure on the joint-facing surfaces of the bones that form the knee joint. Cartilage can be injured due to trauma, death of certain areas of cartilage (Osteochondritis dissecans - OCD), cartilage damage behind the front of the knee bone, which was also called "chondromalacia patella" in the past, and "osteoarthritis", also called calcification in older ages. In these patients, depending on the area of cartilage damage, pain, swelling around the joint, and a feeling of getting stuck if there is a broken piece may also be observed.
In patients who apply to the outpatient clinic with various complaints in the knee joint, the patient's past history is first questioned. The location and duration of the complaint, the timing of the pain and its relationship with the activity, and whether there is trauma are questioned. Afterwards, the intra-knee structures are evaluated in terms of the source of the pathology using their own examination techniques. To reach a definitive diagnosis, knee radiography and knee joint MRI are usually requested. The treatment method is decided by evaluating the patient's history, clinical and radiological results together.
Treatment methods vary depending on the disease.
- In meniscus tears, the patient's age, trauma mechanism and the size of the tear in MRI are important. Stage 3-4 tears that occur as a result of trauma at a young age, especially those that lock, are treated with arthroscopic surgery, called the closed method. Surgery may not always give positive results in degenerative tears that occur in older ages, that is, fragmented tears that occur as a result of crushing. In this case, you need to discuss the pros and cons of surgery in detail with your doctor. Non-surgical methods are often preferred for early-stage tears.
- The most commonly used treatment method for anterior cruciate ligament or posterior cruciate ligament tears is surgical creation of a new ligament. The most commonly used technique when creating a ligament is to create a new ligament with tendons taken from you. This newly created ligament is placed in its anatomical place using the arthroscopic, that is, closed method, and the knee is restored to its previous stability. These patients are often accompanied by meniscus tears and meniscus surgery is also performed.
- Cartilage injuries are usually seen in a certain region of the knee, but may vary. In the early stages, non-surgical methods (such as rehabilitation, weight-bearing, device use, ice, medical treatment, PRP, etc.) can be used depending on the amount of the complaint. In advanced stage and life-threatening patients, arthroscopic surgery to enrich the cartilage (Microfracture), cartilage transplantation from the non-load-bearing area of the knee to the diseased area (Mosaicplasty) or stem cell transplantation are surgical techniques that can be applied.
- In synovial diseases, excess synovium is often performed arthroscopically. Although it is cleaned, the possibility of recurrence is common.
In this method, the inside of the knee is entered through 1 cm holes opened on both sides of the knee. First of all, the inside of the knee is inflated with serum to create an environment where the instruments inserted into the knee can be used comfortably. Intra-articular pathologies are treated by inserting a camera through one hole and surgical instruments through the other hole. With this method, cleaning of the torn meniscus, meniscus stitching, anterior/posterior cruciate ligament surgeries, shaving or bleeding for cartilage injuries (microfracture), synovial cleaning in case of increased synovium, and sometimes extra and cartilage removal in the knee. Cleaning of threadlike formations (Plica) that damage the body can be achieved. The most important features of this surgery are cosmetic benefit, early recovery and ability to enter social life. As with every surgery, complications of this surgery can occur. In this respect, it is very important that you agree to the surgery by talking to your doctor in detail before the surgery.
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