Meniscus

Fibroelastic cartilage structures in the shape of the letter C, located between the femur and tibia in the knee. Its content is 70% water and the most important of the remaining compounds is collagen (90% Type 1).

Function

1- Ensures even distribution of body weight on joint surfaces during daily activities, absorbs shocks

2- Contributes to index stability

3- Transmits information about the position of the knee into movement.

What is Discoid Meniscus in young individuals?

Sometimes congenitally, the external meniscus does not regress embryologically and covers more than 50% of the joint surface between the thigh and shin. This is called a discoid meniscus and often presents a disadvantage. This type of meniscus tends to tear with simple traumas. It causes locking, pain, fluid increase and swelling in the knee, especially during and after sports and activities. It is seen in up to 20% of the population, especially in adolescents (10-17 years old), but does not require intervention unless the above-mentioned findings are present.

What is the healing potential of the damaged meniscus?

The most important factor in the healing of a damaged tissue is adequate blood supply to the damaged tissue. Meniscus is an unlucky tissue in this sense and its blood supply varies according to anatomical regions.

Meniscus tissue is basically divided into 3 regions (outer - middle - inner) according to its blood supply and thus healing status. In the inner region (white-white zone/central region), where tears are more common and blood supply is low, the healing potential is very low, while in the outer region (red-red zone/peripheral region) the healing potential is high.

Mechanism of tear formation and accompanying injuries

• Abnormal knee movements at a young age, mostly during trauma and sports activities
• In middle aged individuals and older, the meniscus begins to degenerate and its elasticity and load-bearing capacity decreases. The meniscus may tear even with daily movements such as squatting, standing up, and descending stairs without any significant trauma.

Meniscal injuries may be isolated or may be accompanied by injuries to intra-articular and extra-articular tissues at different rates depending on the level of trauma energy and the mechanism of trauma to the knee. These structures include ligament, cartilage, tendon, bone and muscle tissue and must be evaluated and treated in patients with meniscal injury.

Symptoms of Meniscal Tear

• 1- Localized pain on the inside or outside of the knee at the joint line (mostly inside)
• 2- Swelling in the knee (occurring immediately or over time)
• 3- Mechanical symptoms (locking), especially when squatting, getting up and going up and down stairs.

Diagnosis of Meniscal Injury

• Physical examination
• Imaging methods: X-ray, Computed Tomography, Magnetic Resonance (MRI)

Menisküs Tedavi Yöntemleri

1- CERRAHİ DIŞI TEDAVİLER: – PRP, KÖK hücre uygulamaları, Fizik tedavi, ilaç tedavileri

2- CERRAHİ

Meniscus Treatment

The method and duration of treatment are influenced by various factors.Such as;

• 1- Localization, size, and pattern of the injury
• 2- Patient’s complaints
• 3- Duration of complaints
• 4- Patient's level of physical activity
• 5- Age

Meniscus Treatment Methods

1- NON-SURGICAL TREATMENTS: - PRP, stem cell applications, physical therapy, drug treatments

2- SURGICAL

ARTHROSCOPIC SURGERY (Closed Surgery): It is a method that provides simultaneous diagnosis and treatment of diseases and injuries occurring inside the joint by visual examination of the inside of the joints using fiber optic devices.

Which Joints Can Arthroscopic Surgery Be Performed On?

pToday it is effectively used in the knee, shoulder, ankle, elbow, wrist and hip joints.

Advantages

• The entire procedure is performed here using 2-3 small skin incisions of only 0.5 cm.
• Compared to open surgery, it is less painful as the tissues are minimally traumatized, the hospital stay and recovery time is significantly shorter and rehabilitation is easier
• Diseases that can be treated in the knee with arthroscopic surgery:
• Meniscus surgeries (symptomatic discoid meniscus, meniscus tears)
• Cartilage injuries (chondromalacia, osteochondral lesion, cartilage damage due to primary or secondary osteonecrosis)
• Ligament injuries around the knee (anterior cruciate ligament, posterior cruciate ligament, posteromedial and posterolateral corner injuries)
• Treatment of fractures involving the joint
• Intra-articular rheumatic and microbial conditions
• Treatment of intra-articular benign tumors

How is the meniscus treated with arthroscopic surgery?

1- Removal of only the torn part of the meniscus: in cases of tears that are not suitable for repair according to certain criteria, only the torn area is removed without disrupting the structure of the meniscus (since it is aimed to preserve the meniscus as much as possible, it is nowadays applied only in selected cases with decreasing rates)

2- Repair of the meniscus with special instruments and sutures: Under 55 years of age, traumatic, 1-4 cm, preferably less than 10 weeks, longitudinal-vertical, bucket handle and horizontal tears in the middle/outer region of the meniscus are suitable for repair.

3- Meniscus transplantation: It is preferred in young or active middle-aged patients with complete or near complete absence of the meniscus due to previous meniscal surgery.

Anesthesia, hospitalization and rehabilitation in arthroscopic meniscal surgery

• In most cases, general anesthesia is not required, only the lower back is numbed (spinal anesthesia).
• It is mostly a day procedure, only special cases require 1 night of hospitalization.
• In cases where only the torn part of the meniscus is removed, the patient can walk with full load on the operated side 4 hours after the operation and start knee exercises on the same day.
• In cases where the meniscus is repaired, gradual and controlled load is given for 5-6 weeks.

Arthroscopic meniscus surgery is a very comfortable treatment method for the patient in appropriate indications and cases, with a low complication rate and a high success rate in competent hands.