Small crack with big consequences

There are many different possible causes of pain in the knee joint. A common cause of such pain, which considerably limits the quality of life and mobility of those affected, is a so-called meniscopathy. This article tells you everything you need to know about meniscus lesions. We will inform you about how such an injury occurs, why an inner meniscus lesion is more common than other forms and what you should bear in mind about treatment. If you have any further questions, simply contact us at our orthopaedic specialist practice in Kronberg, we will be happy to advise you!

What exactly is meniscopathy?

Due to anatomical conditions, the bones of the thigh and the lower leg do not fit together exactly, which makes their smooth interaction difficult. For this reason, nature has found a way to compensate for the so-called incongruities of the bones. This function is fulfilled in the knee joint by the menisci. These consist of fibrocartilage and lie between the bones involved in the knee joint. If there is a tear in this fibrocartilage, severe stabbing pain occurs, which can restrict the freedom of movement of affected persons.

Differentiation between acute and chronic meniscopathies

A distinction is made between acute meniscopathies caused by direct trauma (such as a wrong movement during sport) and meniscus lesions caused by chronic degeneration processes. The knee joint consists of a large number of ligaments and cartilages. There are two menisci in each knee, one medial (lying towards the centre of the body) and one lateral (lying towards the outside of the body). The medial meniscus is strongly fixed by ligaments, whereas the lateral meniscus is less strongly fixed and is therefore more able to withstand sudden loads. For this reason, the inner meniscus is much more susceptible to both acute and chronic degenerative meniscus lesions.

Risk factors for (medial) meniscopathies

Risk factors for such meniscopathy are advanced age, certain professions (e.g. tiler) or a pronounced sporting activity that puts permanent strain on the knee joint. Men, meanwhile, are about twice as likely to be affected by meniscopathy as women.

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How is meniscopathy diagnosed?

As a rule, the basis of medical diagnostics is the medical history interview, in which doctors can already deduce indications of whether it is actually a meniscopathy from the description of the symptoms as well as from descriptions of life circumstances. If you put a lot of strain on your knee because of your job or a sporting activity, then this is information that you should always communicate in the medical history interview. The consultation is usually followed by a physical examination, during which the causes of the pain can be narrowed down further. The main focus is on whether the knee is swollen, whether a cyst has developed in the area of the back of the knee due to the increased pressure caused by a joint effusion and whether there is significant pain during certain movements.

Meniscus testing and imaging

For example, if meniscopathy is suspected, the so-called meniscus test is used. The knee is stretched and light pressure is applied to the outside and inside of the knee joint. Pain on the inside then logically indicates a lesion of the medial meniscus and pain on the outside indicates a myosicopathy of the lateral meniscus. Furthermore, the examiner rotates the knee joint either outwards or inwards. If pain occurs on the medial part of the joint during external rotation, this again indicates a medial meniscopathy. Pain during internal rotation is more indicative of a lateral meniscus lesion.

In addition to the clinical physical examination, in which other forms of movement can be checked for pain sensitivity, an imaging procedure is usually used to make an exact diagnosis and to be able to make a more accurate prognosis, as this allows the condition of the menisci to be better assessed. The method of choice in this case is magnetic resonance imaging (MRI) because, unlike X-rays or computer tomography, it can show soft tissues particularly well. The cartilaginous menisci are counted among these soft tissues.

How is meniscopathy treated?

At the beginning of the treatment of a meniscopathy, conservative therapy approaches are usually resorted to. This is the case for both chronic degenerative meniscal lesions and acute meniscopathies. First, it is important to immobilise the affected joint and cool it to prevent an excessive inflammatory reaction. The administration of anti-inflammatory drugs also serves this purpose. The inflammatory reaction after an injury is natural and has its physiological purpose, as it helps the healing process to take place. However, if this reaction is too strong, massive fluid accumulation occurs inside the joint, which is also called joint effusion. This increases the pressure in the joint and intensifies the pain.

The further procedure strongly depends on how severe the meniscus lesion is classified on the basis of the MRI results. If the symptoms already improve with conservative therapy and the MRI results show that there is only a minor injury, then conservative therapy can be continued without having to resort to surgery. For example, surgery is not always necessary if there are only partial tears in the meniscus that do not completely sever the meniscus.

When does surgery make sense?

However, if the symptoms do not improve with conservative measures, an operation is advisable. Exactly which operation is performed depends on the severity of the injury and the age of the person affected.

In younger patients with a fresh, i.e. acute, meniscus tear, the injured tissue can be sutured. Especially if the tear is at the base of the meniscus, as this region is particularly well supplied with blood. If a meniscus lesion has existed for a long time or is caused by chronic degeneration processes, then part of the cartilage tissue is often surgically removed. It is important that as much healthy tissue as possible is preserved.

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Opportunities & Risks

What are the chances and risks of treating meniscopathies?

The prognosis for a meniscus lesion depends very much on the type of injury and the age of the person affected. In general, it can be said that smaller tears in younger patients can usually be treated well with conservative treatment methods. For example, an age below 35 years, low body weight and a stable ligamentous apparatus are considered positive prognostic signs. Chronic courses can also be treated well without surgery in some cases. However, if the meniscus tear is too large, there is a clear indication for surgery. This is mainly due to the fact that untreated meniscopathy increases the risk of developing gonarthrosis (knee osteoarthritis). However, it must also be mentioned that this risk cannot be excluded by a partial resection.

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Preparation & Follow-up

What do I need to know about the treatment of meniscopathy?

As already mentioned, it is important to give your knee the rest it needs if you have meniscopathy. Therefore, do not put too much stress on your knee if you know that you might have such an injury. The length of treatment also depends on the injury. With conservative treatment, a period of a few weeks to months can be expected. In the case of chronic meniscopathies, however, complete freedom from pain is usually not achieved in this way.

If an operation is unavoidable, then in most cases surgery is not performed immediately. Especially in the case of acute meniscus lesions, the joint is given time to recover and reduce the inflammation. This is important for the success of the operation, as it allows the anatomical structures to be better classified and assessed. Not every meniscus operation has to be performed in hospital. Especially for smaller operations, outpatient therapy is also possible, so that in these cases an overnight stay in hospital is not necessary.

Inpatient stay after the operation

For more complicated procedures, however, a hospital stay of several days may be necessary. Please find out in advance of an operation whether your health insurance will cover the costs incurred. In most cases this is the case, but not all health insurance companies pay for minimally invasive meniscus surgery. If your health insurance does not cover the costs, you have to expect an amount of several hundred euros, which can vary due to different services such as anaesthesia, dressing material and intensity of the aftercare.

After an operation, it is often advisable to use crutches so that the knee is not immediately overloaded again. The period of sick leave is very variable and ranges from a few days to up to six weeks depending on the severity of the injury and the age of the person affected.

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