Meniscus tear
A small crack with big consequences
The menisci in the knee joint are essential for its normal functioning. The menisci are fibrocartilage discs between the bones that together form the knee joint. These bones are the femur and the tibia. The menisci's job is to balance the joint surfaces of the two bones so that they can interact optimally with each other. The menisci, together with other structures (especially ligaments), thus give the knee joint its all-important stability.
Because of this important function, any injuries to the menisci (meniscopathies) are not only painful but also extremely restrictive in terms of freedom of movement, as the joint can no longer function normally if the meniscus is torn. You can find out more details about the meniscus tear and the process of the best possible treatment in the following sections.
Definition
What exactly is a meniscus tear?
As already mentioned above, the menisci are cartilaginous structures of the knee joint. In the course of life, the menisci are subjected to a lot of stress. On the one hand, they enable the smooth movement of the knee joint. On the other hand, they are also stressed when standing, as they then fulfil a kind of cushioning function between the bones involved.
There are two menisci in the knee joint. One is on the outside of the knee joint and the other is on the inside. Both menisci are connected to the tibia bone by ligaments. However, the ligament attachment of the menisci differs in that it gives the outer meniscus more flexibility than the inner meniscus. This leads to the inner meniscus being very tight during certain movements (e.g. flexion and simultaneous external rotation). This anatomical condition is the reason why the medial meniscus is more susceptible to injury. Accordingly, a meniscus tear occurs three times as often on the inside as on the outside.
Different causes for a meniscus tear
The meniscus tear can have different causes. A distinction is made between forms that are caused by an acute injury (acute-traumatic meniscus tear) and those that have their origin in degenerative processes (chronic-degenerative meniscus tear).
Acute traumatic meniscopathies mainly occur in connection with sports activities. In these cases, however, it is usually not just an isolated meniscus tear, but injuries to the inner ligament or the cruciate ligaments also occur. Footballers and winter sportsmen and women are particularly at risk of this type of meniscopathy.
Chronic stress on the knee joints, for example from years of working on the knees, can lead to an accumulation of micro-injuries. If these exceed a critical limit, a meniscus tear can also occur as a result. These meniscopathies are then called secondary traumatic meniscus injuries.
Degenerative meniscus injuries tend to occur at an advanced age (around the 4th-5th decade of life) without an acute injury.
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Different symptoms of a meniscus tear
Depending on the cause of the meniscus tear, the symptoms also differ. In all forms, however, there is shooting pain in the knee joint space. In almost all cases, there is also swelling of the knee joint. Chronic degenerative meniscus tears occur recurrently. A typical feature of acute traumatic meniscopathies is joint blockage, which manifests itself mainly in the fact that the patients have inhibitions to stretch or bend the joint. Since, as mentioned above, ligaments are often affected in these cases, a feeling of instability of the knee joint can also occur.
As a result of recurrent effusions of the knee joint in chronic degenerative meniscus rupture, bulges of the joint capsule can develop, which become noticeable in the form of pain and swelling of the back of the knee.
The symptoms in summary:
- Shooting pain in the knee joint space
- Joint blockade (especially acute-traumatic)
- Feeling of instability (especially acute trauma)
- Swelling of the knee joint
- Swelling of the popliteal fossa (especially chronic degenerative)
- General limitation of movement of the knee joint
Therapy
How can a meniscus tear be treated?
Before a meniscus tear can be treated, it must first be confirmed beyond doubt that it is a meniscus tear. The diagnosis is usually made through a combination of physical examination by the practitioner and an imaging procedure. MRI is the standard procedure, as it can show the soft tissues (including the menisci). In addition, the diagnosis can also be made arthroscopically, i.e. with a camera inserted into the knee joint.
Once the meniscus tear has been diagnosed, therapy can be initiated. Generally, meniscus tears are an indication for surgery. The reason for this is that arthrosis of the knee joint can develop from a meniscus tear with unfavourable conservative treatment.
Conservative treatment methods in preparation for surgery
Nevertheless, a meniscus tear must always be treated conservatively at first . For this purpose, the joint must be cooled and relieved. In addition, anti-inflammatory medication is administered in most cases to reduce the swelling of the joint. Basically, the initial conservative therapy aims to stabilise the joint in order to prepare it for meniscus surgery. Meniscus surgery can only be performed when the joint is sufficiently swollen.
Specifically, various surgical procedures are available for the treatment of a meniscus injury, depending on the type and location of the damage as well as the age of the person or persons affected.
Different surgical procedures for a meniscus tear
In younger patients, a meniscus suture can be considered if the tear has not been present for long. This has the advantage that the entire meniscus can be preserved.
However, if the meniscopathy has existed for a long time or has its origin in chronic degenerative processes, part of the affected structure is removed during meniscus surgery. This surgical technique is called meniscus resection. This is necessary because in these cases the affected tissue can no longer be reconstructed. During meniscus resection, only as much cartilage is removed as is necessary.
The optimal procedure for treating most meniscus injuries is arthroscopic partial meniscus removal. A small camera and the necessary instruments are inserted into the joint through small openings. This allows an optimal overview of the surgical area and precise work. This ensures that not too much meniscus tissue is removed unnecessarily. In some cases, however, it is unavoidable that the entire meniscus cartilage has to be removed from the joint.
If the lateral ligaments or the cruciate ligaments are affected in addition to the menisci, these are also reconstructed in the course of the meniscus operation.
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Opportunities & Risks
What are the chances and risks of treating a meniscus tear?
If no meniscal tissue needs to be removed at all, there is a favourable prognosis at a younger age that the full functionality of the knee joint can be restored. In general, the prognosis is improved by age under 35 years, normal weight and a stable ligamentous apparatus. However, the further course of healing also depends on the blood supply to the affected area. The better the blood circulation, the better the chances of healing.
The treatment of the meniscus tear by means of arthroscopic partial resection significantly reduces the postoperative complaints. However, in some cases, arthrosis develops in the course of the following years. This is particularly due to the fact that the affected side is exposed to additional stress even after meniscus surgery.
In addition, meniscus resection is a surgical procedure. Risks such as iatrogenic (caused by medical intervention) injuries to the knee joint as well as inflammation or bleeding cannot be ruled out.
However, as treatment by arthroscopy is a minimally invasive and precise procedure, these risks are low. Meniscus surgery has long been integrated into routine treatment and is a safe procedure. In order to influence the course of treatment favourably, patients also have a number of options that they can influence themselves.
Preparation & Follow-up
What should be considered before and after the treatment of a meniscus tear?
In the run-up to the operation, care should be taken to reduce the swelling of the joint as quickly as possible. Cooling and relieving the joint are essential factors that can be influenced by the patients themselves.
The operation itself is a minimally invasive procedure that usually takes about 30-60 minutes. In order for the treatment to be carried out optimally, an anaesthetic is necessary. A partial or general anaesthetic can be used. In most cases, the operation can be performed on an outpatient basis. Only major meniscus resections may require a stay in hospital, but this is usually limited to a few days. If you are treated as an outpatient, please make sure that someone picks you up after the operation, as driving a motor vehicle is not allowed after such an operation due to the anaesthesia.
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Schedule after meniscus surgery
The load on the affected meniscus should only be increased slowly after the operation and should be discussed with the surgeon. However, it is possible to put weight on the operated knee immediately after the operation. Forearm crutches are suitable for relieving the meniscus during the first few days. Outpatient physiotherapy or lymphatic drainage can also be used to support the healing process.
The downtime after such an operation depends greatly on the type of meniscus tear and the condition of the person affected. As a rule, however, a return to work can be expected within one to two weeks. Only if the activity is particularly stressful for the knees or if complications have arisen is a longer period of sick leave advisable.
