meniscus surgery

Knee Meniscus

The meniscus is a type of cartilage in the knee joint. It acts like a cushion between the femur and the tibia. There is one present on both the inside (medial) and outside (lateral) part of the knee. Injuries to the meniscus are common. The injury can occur in almost any age group. Younger people have a stronger meniscus and tears usually occur as a result of a forceful twisting injury. As people age, the meniscus loses strength and is more easily injured. Simple activities such as squatting can result in meniscus tears in the elderly.

Meniscus injuries are very common. The injury can occur in any age group. In younger people, the meniscus is fairly tough, and tears usually occur as a result of a fairly forceful twisting injury. In older people, the meniscus grows weaker with age, and meniscus tears can occur as a result of a minor injury. Simple activities such as the up and down motion of squatting can result in tears.

SYMPTOMS

The most common problem caused by a torn meniscus is pain. The pain may be felt along the joint line where the meniscus is torn or may be more vague and involve the whole knee. An effusion or swelling in the knee may also develop. There may be intermittent clicking or popping in the knee. If the torn portion or the meniscus is large enough, the knee may actually lock. Locking occurs when the torn fragment of the meniscus gets caught out of its normal position in the knee, preventing the knee from straightening completely. Long-term, a torn meniscus may cause abrasion of the articular cartilage in the knee leading to arthritis.

DIAGNOSIS

Diagnosis begins with a history and physical examination. The examination will try to determine where the pain is located, whether or not locking has occurred, and if there are any clicks or pops as the knee is moved. X-rays will be taken to see if there is any obvious pathology such as a loose body, arthritis, fracture or other lesion. A torn meniscus is not visible on an X-ray. MRI scans are very good at showing the meniscus. If the history and physical examination strongly suggest that a torn meniscus is present, an MRI may be ordered to confirm the diagnosis. An MRI may also be ordered if there is a suspicion of an injury to the articular cartilage.

Initial treatment for a torn meniscus is directed towards reducing the pain and swelling in the knee. This includes rest from painful activities, low impact exercise programs, and possibly medication or knee injection. Often the symptoms continue and a recommendation is made to proceed with arthroscopic evaluation and treatment.

Almost all meniscus surgery is done using an arthroscope, a small camera. Small incisions or punctures are made on the knee to allow the insertion of the arthroscope and instruments to treat the injury. The meniscus and other structures in the knee are carefully evaluated by the surgeon looking at a monitor connected to the arthroscope, and gently probing with a small instrument. In some instances, typically in younger people, the meniscus can be repaired using special sutures or anchors. Most other tears require removal of the damaged portion of the meniscus using special instruments. With rare exceptions, patients are sent home the same day as their surgery.