A meniscal tear (meniscal damage) is a violation of the menisci - the "shock absorber" in the knee. Incorrect stress during exercise or age-related wear causes cracks in the annular fibrocartilages in the knee joint. Depending on how big the damage caused by the meniscal tear, there are various treatment options - not every meniscus damage, however, must be treated.
The menisci (gr. Mēnískos = moon-shaped body) are two ring-shaped cartilages located at the side of the knee between the bones of the upper and lower leg. They act as shock absorbers, that is, they increase the contact surface and reduce the friction between the bones. The menisci thus allow a sliding, painless movement in the knee joint. At least, as long as there are no cracks in the tissue, the so-called meniscal tear.
In particular, the inner and outer meniscus are distinguished in the knee joint. The medial meniscus is crescent-shaped and relatively immobile, because it is firmly attached to the inner ligament (collateral ligament). The result: he can not avoid acting forces so well and therefore tears easier. In contrast, the lateral meniscus has an approximately circular shape and is less fixed to the surrounding tissue. He therefore has a greater range of motion in force, a meniscal tear occurs less often in him.
Typically, a meniscus injury occurs especially in rotational fall injuries (traumatic), for example in sports such as skiing or football. A meniscal tear, however, also occurs with age-related wear or a chronic overloading of the knee joint, for example, in some occupational groups with predominantly squatting activity, such as tilers.
A meniscal tear can pull through the tissue in all directions. In addition to the shape of the tear, it is crucial for the choice of therapy at which point the tear in the meniscus is located. A seam is often possible in the well-perfused outer zone, while in the poorly perfused inner zone, the injured meniscal component often has to be removed.
A meniscal tear is relatively common, affecting about 160 out of every 10,000 people. Not every meniscal damage is accompanied by acute discomfort or pain. Depending on the size and extent of the tear, various symptoms may occur that impede the affected person differently. Treatment of the meniscal tear depends on this: In cases with no or limited restrictions, a meniscal tear is treated conservatively (without surgery). In severe cases, an operative therapy or an artificial meniscus may be necessary.
Typical meniscal tear symptoms are knee pain. In some cases, the joint is not as flexible as usual. Depending on the cause of the injury, symptoms of meniscal damage manifest differently. When an acute meniscal tear, the pain usually occurs suddenly, in degenerative knee changes they develop over a longer period of time and are getting worse. Read all important information about meniscal tear symptoms here.
The pain that comes with a meniscal tear is not triggered by the meniscus itself. Because the cartilage tissue has no own nerve fibers. The typical meniscal tear symptoms occur when small pieces of the menisci rupture and move freely in the capsule surrounding the joint. They can block the movement of the knee and irritate the surrounding tissue. In addition, symptoms of a meniscal tear can be seen when the tissue shifts only slightly through the tear and presses against the capsule surrounding the joint. It is rich with nerves. With every movement, the loose fiber parts can now irritate the nerves in the joint capsule. The result is sudden, stinging pains that cause pain even at the slightest movement, in severe cases even at rest.
A meniscal tear can be acute or creeping. The meniscal tear symptoms vary according to the extent of the injury. In general, symptoms are more pronounced in an acute meniscal tear than in an age- or wear-related meniscal tear. After a fall or a sports injury often occurs a sudden, stabbing pain. Sometimes you can not even walk anymore. In acute cases, you should try to treat the meniscal tear symptoms as well as possible yourself. Put your leg up and cool it with ice packs or damp compresses.
Depending on which meniscus is injured, the pain can be localized laterally (lateral) at the knee or inwards (medial).
Meniscal tear symptoms in damage to the external (lateral) meniscus:
Meniscal tear symptoms in damage to the inner (medial) meniscus:
It is particularly complicated when fiber parts of the menisci are torn off and move freely in the joint. They can completely block the joint and make the stretching of the leg impossible (stretch inhibition). The classic symptom of such a severe meniscal tear is symptoms such as a snap or click in the knee joint, which can be heard and felt during movement. If such a meniscal tear remains untreated, the joint can wear permanently and irreparably. It comes to knee joint arthrosis.
If the meniscus parts float freely in the knee joint, arthroscopy is used. An attempt is made to reduce the extent of the damage by removing the free-floating meniscus parts. Then the meniscal damage is sewn. This eliminates meniscal tear symptoms and prevents further damage to the knee joint.
A meniscal tear can have different causes. About half of all cases of meniscal injury are due to regression (degeneration) of the cartilage tissue. The other half is caused by acute injuries, often with an already damaged meniscus.
Meniscal degeneration is an increasing structural weakness of the fibrocartilage from which the cartilage discs are built. Due to wear, a meniscus is less resistant to force, so a meniscal tear can occur. Such a cartilage wear is normal after a certain age. However, certain occupational groups with increased knee strain are at greater risk of meniscal tear. These include athletes, construction workers, gardeners or tilers.
A strong vertical load (for example, when jumping from low altitude) can cushion the menisci well. However, if the force acts obliquely from the side on the fibrocartilage, it becomes overstretched and can tear. Typical triggers of a meniscal tear are rotational fall injuries, for example during skiing or football. In such accidents, the meniscus is fixed by body weight while at the same time the foot is twisted. This can lead to a meniscal tear, especially if the meniscus is damaged. Meniscus damage can also occur in everyday life, simply when "walking in a squat".
Even direct impact on the entire knee can lead to a meniscal tear. Physicians then speak of a primary traumatic meniscal tear. For example, knees, adjacent bones and menisci can be damaged together when falling from a great height.
Opinions differ widely about the benefits of meniscus surgery. Some doctors argue that any meniscal tear necessitates surgery or arthroscopy. Almost as often, however, it is held that most cases of meniscal injuries are not so pronounced and surgery is usually unnecessary.
It is clear that the method of treatment for a meniscal tear depends on various influencing factors and there is no universal recommendation for meniscal damage treatment. The choice of therapy depends on the severity of the pain, the age and the demands on the resilience of the menisci. The goal of meniscal surgery is always to maintain as much meniscal tissue as possible and to fully restore the ability to move.
Sometimes a meniscal tear can be treated without surgery. This is the case, for example, with rather small cracks. In particular, injuries in the well-ventilated outer zone of the meniscus (outer edge of the meniscus at the joint capsule) can sometimes heal on their own. Physicians speak in this case of a conservative (non-operative) meniscal tear therapy. The meniscal tear is treated with analgesics, cortisone injections and physiotherapy. The knee should be spared as much as possible during the first period after the meniscal injury. After a few weeks, light exercise exercises will begin. Your doctor or physiotherapist will show you exactly how to do this. Even with degenerative changes of the meniscus, a meniscal tear is treated without surgery. However, if pain occurs repeatedly on the meniscus, or if the examination reveals that parts of the meniscus have come loose at the tear and are now in the joint space, there is no alternative to meniscal surgery.
Before a meniscal tear operation, the affected knee must be thoroughly examined. As a rule, in addition to the physical examination, a magnetic resonance imaging (MRI) is made. In the pictures, the attending physician can determine where the meniscus is damaged. In addition, it can be ruled out that the pain in the knee of other structures such as ligaments or cartilage tissue originate. Depending on how the result of the MRI fails, we chose the appropriate treatment method. In many cases, however, only a joint mirroring (arthroscopy) can show how great the damage actually is. Then, during arthroscopy, the surgeon decides which method of meningeal surgery to use.
Two types of meniscal surgery are available with arthroscopic and open meniscal surgery. While in the past, surgery was mostly open, the arthroscopic meniscus surgery is the drug of choice today. The procedures are performed under regional anesthesia or sometimes under general anesthesia.
Arthroscopy is a so-called minimally invasive method. This means that in the meniscus surgery not a single large cut, but instead two to three smaller cuts are made. The first cut introduces a rod-shaped camera that transmits images from inside the knee joint live to a monitor. The other cuts introduce the surgeon's surgical instruments, which are used to remove ragged parts or create a meniscal suture. The advantage of arthroscopy is that the minor injuries to the skin heal faster and no major scar remains after meniscus surgery.
In some cases, open meniscal surgery is preferred over arthroscopy. The open method is used, for example, when not only meniscus tear treatment is to be done, but also additional damage to ligaments in the knee joint or on the joint capsule were found. In the open surgical procedure, the knee is opened with a cut approximately five centimeters long, which is re-sutured after meniscus surgery. As a rule, the threads can be removed about ten days after the meniscus surgery.
Whether operated arthroscopically or openly, the following surgical techniques are available for meniscal surgery:
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