TREATMENTS
Treatment of meniscal lesions
Diagnosis and arthroscopic surgery.
MENISCUS INJURY IN FIGURES
of every 10,000 people a year suffer a meniscus tear.
%
of sports injuries are knee injuries.
annual arthroscopy surgeries worldwide.
success rate of meniscal repair.
Meniscal Injury
Meniscus injuries are one of the most common knee injuries, especially athletes and active people.
What are menisci
The menisci are two semicircular fibroelastic cartilage structures located in the knee joint. Their main function is to act as shock absorbers of compressive forces and stabilizers of the joint. The menisci help distribute body weight loads during activities such as walking, running and jumping, and also contribute to the lubrication and nutrition of the articular cartilage. Each knee has two menisci.
Medial meniscus
It is located on the inner side of the knee, it has a more closed “C” shape. It is firmly attached to the joint capsule and medial collateral ligament, which limits its mobility. This attachment makes it more susceptible to injury, especially during twisting movements or sharp turns. Approximately 70% of meniscal injuries involve the medial meniscus.
Lateral meniscus
It is located on the outer side of the knee, has a more rounded shape, similar to an “O”. It is less attached to the joint capsule and has no direct connection to the lateral collateral ligament, which gives it greater mobility. This reduces the risk of injury compared to the medial meniscus.
DIAGNOSIS
Diagnosis of meniscal lesions
Medical history
Symptoms, how the injury occurred and if you have had previous knee injuries.
Physical examination
Signs of pain, swelling, instability and limitation of motion in the knee. You can also perform specific tests such as McMurray, Steinmann or Apley.
Imaging techniques
1/ Magnetic Resonance Imaging (MRI): It is the most common and accurate. It detects the type of lesion and its location.
2/ Ultrasound: may be useful in some cases to evaluate the structure of the meniscus and detect lesions.
3/ Arthroscopy: it allows to see directly the inside of the knee joint and to confirm the injury.
TYPES OF MENISCAL TEARS
The meniscal tear can be:
1. Degenerative (no clear trigger due to chronic natural wear and tear of aging).
Traumatic (determined with certainty the moment in which the meniscus is injured due to abrupt turns or forced movements).
Longitudinal tear
It extends along the meniscus, parallel to its curvature.
Longitudinal tear
It extends along the meniscus, parallel to its curvature.
Radial tear
It occurs from the inner edge of the meniscus outward, like the spokes of a wheel.
Horizontal tear
It divides the meniscus into an upper and lower layer, often associated with degenerative lesions.
Longitudinal breakage
It extends along the meniscus, parallel to its curvature.
Broken bucket handle
Longitudinal tear in which part of the meniscus is displaced towards the center of the knee, forming a sort of “loop”.
Broken parrot beak
Tear with a free portion of the meniscus.
Complex tear
Combination of different types of tears, such as longitudinal and radial, resulting in a more complicated tear pattern.
Other types of meniscal tears
There are other types of meniscal tears, less well known, which often go unnoticed not only in diagnostic imaging but even in diagnostic knee arthroscopy in inexperienced surgeons. It is important to detect them as they are a cause of pain, difficulty to full motion and sometimes knee instability. We highlight:
Internal meniscal ramp injury
It refers to a tear in the area where the meniscus attaches to the tibia in its most posterior aspect. posterior aspect. It is a less common, but significant injury that is usually related to a torn anterior cruciate ligament (ACL).
Meniscal root injury
Refers to the injury or avulsion at the the insertion of the meniscus in the tibia, either in the anterior or posterior zone. It can affect the internal or external meniscus. This type of injury is more serious because in the long term it carries the risk of developing osteoarthritis.
Suturing the meniscus preserves its function, promotes better recovery and reduces the risk of long-term osteoarthritis. Look for a surgeon who is an expert in meniscal arthroscopy for the best results.
Deciding whether a meniscal injury requires conservative or surgical treatment depends on several factors:
Type of breakage
Partial ruptures or intrasubstance degeneration. Generally, they are treated conservatively.
Complete tears or dislocation of the meniscus. They usually require surgical intervention.
Location of breakage
Peripheral or red zone: Have high success rate in this zone.
Central or white zone. Poor blood supply, meniscal resection or treat conservatively.
Age and activity level
Young, active patients: benefit from surgical repair to restore full functionality.
Older or less active patients. Conservative treatment is usually chosen initially.
Other associated lesions
Ligamentous injuries, chondral lesions, severe pain or joint locking could tip the balance towards surgery.
TYPES OF MENISCAL TREATMENTS
Conservative treatment
It includes the following measures:
Patient education
Information about the disease and modification of activities to avoid joint overuse.
Weight loss
Reducing body weight significantly reduces the load on the knee and relieves pain.
Physical exercise
Muscle strengthening programs, especially of the quadriceps, and low-impact exercises such as swimming, cycling, elliptical or yoga.
Physiotherapy
Modalities such as manual therapy, ultrasound or local heat may be helpful.
Drugs
Analgesics (paracetamol) or non-steroidal anti-inflammatory drugs (NSAIDs)
Infiltrations
Hyaluronic acid, PRP, stem cells or intra-articular corticosteroids.
Surgical treatment: arthroscopy
Each treatment has its own indications and will depend on the location, type and severity of the meniscal injury, as well as the patient’s needs and activities. It is important to discuss all options with a knee specialist to determine the best approach.
Partial Meniscectomy
Remove the irreparable fragment of the meniscus, preserving as much healthy tissue as possible. Recovery is usually very fast, requiring 1 or 2 months to resume sports practice.
Meniscal transplant
In cases where a large part of the meniscus has been resected, a biological meniscus from the authorized tissue bank is grafted to replace its function. In these cases, sports activity is not recommended.
Meniscal suture
Repair the injured meniscus to allow it to heal, approximating its edges. Meniscal healing is slow, usually requiring 4 to 6 months to resume sports practice.
There are several meniscal suturing techniques, each technique having its own indications and advantages, depending on the location and type of meniscal tear:
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