This article gives you a brief overview on meniscus injuries in the knee. In case you or your loved ones are diagnosed with meniscal injury we would like to throw some light on how your Sports surgeon or Orthopedic surgeon would approach this problem .

Meniscus tear are diagnosed by the Orthopedic surgeon based on your history , symptoms, clinical findings and investigations such as MRI .

Meniscus injury is very common amongst sportsmen but can occur routinely to anyone at any age.

Anatomy

The knee joint is formed by the upper end of tibia (shin bone) , lower end of femur (thigh bone) and patella (knee cap).

Two wedge shaped pieces of fibrocartilage act as shock absorbers between the thigh bone and shinbone. The help in transmitting the load evenly , provide stability and nutrition.

Clinical presentation

Those suffering from meniscus injury may present with (traumatic) , such as while playing sports or due to a fall ; or without a history of injury (degenerative). As people age degenerative meniscus tears are more likely.

Patients may have pain in the knee joint with activity such as walking, running , pivoting activities , knee bending or in the Indian setting while squatting or sitting cross legged.

If the meniscus is tear is displaced it way cause locking or popping.

Your orthopedic doctor will examine clinically looking for joint tenderness and some special tests such as McMurray or Apley’s grinding test.

Your doctor will advise MRI of the affected joint to find out the pattern of injury .

Types of tear

Tears are classified into various types based on their shape such as

• Longitudinal tear
• Horizontal tear
• Radial tear
• Bucket handle tear
• Complex tear
• Root tears

Based on the degree of tear they may be classified as grade 1, 2 or 3 (complete tear)

Treatment

The treatment for meniscal tear will depend on number of factors such as

• Age
• Symptoms
• Activity level
• Type , size and location of injury

Partial tears and asymptomatic tears can be treated with Rest, Ice and Physiotherapy. Non operative treatment may also be given to see if certain tear types heal with time and any surgery if possible may be avoided.

Some medications may be prescribed based on your doctors discretion to relieve pain and decrease swelling.

Symptomatic tears

Complete tears which are in the red – red zone (good blood supply ) or red white zone (fair blood supply) may be amenable to various types of repair using key hole surgery (Arthroscopy)

• All inside repair

• Inside out repair

• Outside in repair

Some meniscus tears can be repaired by suturing (stitching) the torn pieces together. Whether a tear can be successfully repaired depends upon the type of tear, as well as the overall condition of the injured meniscus. Because the meniscus must heal back together, recovery time for a repair is longer than for a meniscectomy.

Some tears if not likely to heal may need to be excised partially or completely especially in the white white zone.

Partial meniscectomy – In this procedure, the damaged meniscus tissue is trimmed away. This procedure typically allows for immediate weight bearing, and full range of motion soon after surgery.

Rehabilitation

You will be prescribed supervised or home based physiotherapy after surgery . Menisectomized (balancing) patients have earlier return to function . But they may face earlier degeneration of the knee joint.

Those who have undergone repair will be given crutches and advised non weight bearing for a certain duration mostly from 6 weeks to 3 months. Gradual return to function is advised with phase wise exercises to improve range of motion , strength and stability.

Complications

These surgeries are mostly uneventful but there are chances of complications such as persistent pain , re-tear , Neuro vascular injury and rarely infection .

Please consult your local orthopedic surgeon for further advise.

Dr. Vishal Kasliwal is a consultant orthopedic, sports and joint replacement surgeon based at Kasliwal Superspeciality Hospital , Nashik ,Maharashtra( India) . His expertise includes arthroscopic Treatment of meniscal tears amongst elite athletes.