What is a meniscus?
The meniscus is a specialised piece of cartilage that sits between the top and bottom bones in your knee (femur and tibia). It has a tough rubbery consistency and is attached to the side walls of the joint.
The meniscus has several important functions in the knee joint:
- shock absorption
- distribution of load bearing over a larger surface area of the joint
- stability of the knee joint
- spread of lubricant fluid in the joint
- proprioception (contributes to allowing your brain to sense and control knee joint movement)
Obviously this structure plays a number of important protective functions in the knee joint, and it is worth preventing injuries to it or managing them appropriately
What symptoms does a meniscus tear cause ?
It is important to note that a meniscus tear can be present without too many symptoms. However, they may cause
- bleeding (internal) / swelling
- pain
- locking (where the knee joint sticks or jams)
- or a sense of instability
The location of the pain is often, but not always, located at the site of the meniscus tear.
Patients with chronic tears may have intermittent symptoms.
WHAT CAUSES A TEAR IN THE MENISCUS?
From the functions of the meniscus listed above, it is obvious that this structure does alot of work as the knee is functioning.
Meniscus tears can result from heavy impact on or around the knee, or from twisting injuries to the knee. Often there is rapid swelling but this does not always occur. Externally the knee may appear swollen, and the patient often experiences pain, instability, difficulty weight bearing, and the knee may be difficult to move (ie locking).
The structure of the meniscus often weakens with age, and the accompanying arthritis or other inflammatory disorders such as gout for example, and these will increase the risk of meniscal tears with knee trauma.
How is a meniscus tear Identified and managed surgically?
From the above information it can be seen that this structure is important to retain in the knee joint if possible.
As meniscal tears can cause pain and dysfunction they may require analgesia, activity modification, or surgery to alleviate the symptoms and allow a return to function.
Diagnosing a tear on the meniscus can be achieved with a clinical examination by Dr Ihsheish and if the diagnosis is suspected but further information is required (such as the location or type of tear), then adjuncive investigations may be undertaken, such as an MRI scan. Dr Ihsheish does not recommend ultrasound scans of the knee when looking for meniscal tears.
The decision to intervene surgically is usualy made if other treatment options have failed and the symptoms are still causing dysfunction.
Meniscal tears essentially result in the torn part becoming unstable and casuing pain and irritation, and therefor surgical management is aimed at transforming an unstable meniscal segment into a stable one. A successful repair is preferable, as this allows the retention of this importnant structure in the knee however not all meniscal tears are repairable, and some torn segments have to be removed (debridement) to alleviate of the symptoms. Dr Ihsheish can talk to you about your specific meniscal tear and the most suitable treatment option.
If the tear is repairable then sutures are placed through small incisions in the skin (see knee arthroscopy), and you will be required to wear a brace and use crutches for about six weeks generally to protect the repaired segment as it heals, thereafter you will be required to undergo some physiotherapy to regain movement and strength in the knee joint.
On the other hand, if the menical segment is simply debrided (cut out), you will be allowed to weight bear and function as tolerated, but one or two weeks rest is generally advised.
In general the knee will be swollen and stiff for 1-2 weeks after arthroscopic knee surgery.
Dr Ihsheish generally uses absorbable sutures (no suture remval required), but you will be seen for a wound check a 10-14 days after the operation, at which time the operations details will be discussed with you.