Patient's Guide To Meniscus Injuries
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A Patient's Guide
to
Meniscus Injuries
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Introduction
The meniscus is a commonly injured structure in the knee. The
injury can occur in any age group. In younger people, the meniscus is
fairly tough and rubbery, and tears usually occur as a result of a
forceful twisting injury. In older people, the meniscus grows weaker with
age, and meniscal tears can occur as the result of fairly minor injuries,
even from the up and down motion of squatting.
This guide will help you understand
- where the menisci are located in the knee
- how an injured meniscus causes problems
- what can be done for an injured meniscus
Anatomy
What is the meniscus and what does it do?
 If you have not reviewed
the section on
knee anatomy, you may want to look at this page now. Remember, there
is a meniscus on either side of the
knee joint. The meniscus acts like a gasket between the femur and the
tibia to spread out the weight being transferred from the femur above to
the tibia below. The knee anatomy section points out that
articular cartilage covers the ends
of the bones that make up the joint. The articular cartilage surface is a
tough, very slick material that allows the surfaces to slide against one
another without damage to either surface. This ability of the meniscus to
spread out the force on the joint surfaces as we walk is important because
it protects the articular cartilage from excessive forces occurring in any
one area on the joint surface. Without the meniscus, the concentration of
force into a small area on the articular cartilage can damage the surface,
leading to degeneration over time.
Remember also that the meniscus helps with the stability of the knee
joint. The meniscus converts the tibial surface into a shallow socket.
A socket configuration is more
stable than a flat surface. Without the meniscus, the round femur would
be
free to slide on top of the flat tibial surface.
The meniscus can be torn in several ways. The entire inner rim of the
medial meniscus can be torn in what is called a
buckethandle tear. The meniscus
can also have a flap torn from the
inner rim, or the tear can be a
degenerative type tear where a portion of the meniscus is frayed and
torn in multiple directions.
Causes
How does the meniscus cause problems in the knee?
Meniscus injuries can occur in any age group, but the causes are
somewhat different for each age group. In younger people, the meniscus is
a fairly tough and rubbery structure. Tears in the meniscus in patients
under the age of thirty usually occur as a result of a fairly forceful
twisting injury. In the younger age group, meniscal tears are more likely
to be caused by a sport activity.
In older people, the meniscus grows weaker with age. The tissue that
makes up the meniscus becomes
degenerative and is much easier to tear. Meniscal tears in the older
age group occur as a result of a fairly minor injury, even from the up and
down motion of squatting. Degenerative tears of the meniscus are commonly
seen as a part of the overall condition of
osteoarthritis of the knee in the
older population. In many cases, there is no one associated injury to the
knee that leads to the meniscal tear.
Symptoms
What does a torn meniscus feel like?
The most common problem caused by a torn meniscus is pain . The pain
may be felt along the joint line where the meniscus is located or may be
more vague and involve the whole knee. If the torn portion of the
meniscus is large enough,
locking may occur. Locking simply refers to the inability to
completely straighten out the knee. Occurs when the fragment of torn
meniscus gets caught in the hinge mechanism of the knee and will not allow
the leg to straighten completely. (Imagine sticking a pencil between the
hinges in a door and trying to close it.)
There are long term effects of a
torn meniscus as well. The constant rubbing of the torn meniscus on the
articular cartilage may cause wear and tear on the surface, leading to
degeneration of the joint. The knee may swell with use and become
stiff and tight. This is usually because of fluid accumulating inside the
knee joint - sometimes called water on the knee. This is
not unique to meniscus tears, but occurs whenever the knee becomes
inflamed.
Diagnosis
How do we look into this problem?
Diagnosis begins with a history and physical. The examination
will try to determine where the pain is located, whether or not locking
has occurred, and if you have any clicks or pops as the knee is moved.
X-rays will not show the torn meniscus. X-rays are mainly useful to
determine if other conditions are present. The MRI scan is very good at
showing the meniscus. The MRI (Magnetic Resonance Imaging) machine uses
magnetic waves rather than x-rays, to show the soft tissues of the body.
With this machine, we are able to "slice" through the area we are
interested in very clearly. Usually, this test is done to look for
injuries, such as tears in the menisci or ligaments of the knee. This
test does not require any needles or special dye, and is painless. Here
the MRI scan shows a tear in the
meniscus. If there is a uncertainty in the diagnosis following the
history and physical examination, or if other injuries in addition to the
meniscal tear are suspected, the MRI scan may be suggested.
If the history and physical examination strongly suggest that a torn
meniscus is present, then arthroscopy
may be suggested to confirm the diagnosis and treat the problem at the
same time. Arthroscopy is a type of an operation where a small fiberoptic
TV camera is placed into the knee joint, allowing the orthopedic surgeon
to look at the structures inside the knee joint directly. The arthroscope
allows your doctor to actually look into the knee joint and see the
condition of the articular cartilage, the ligaments and the menisci .
Treatment
How do we treat this problem?
Initial treatment for a torn meniscus
usually is directed towards reducing the pain and swelling in the knee.
Your physician may recommend crutches for resting the knee for several
days and suggest ice to reduce the pain and swelling. If the knee is
locked and cannot be straightened out, surgery may be recommended as soon
as reasonably possible to remove the torn portion that is caught in the
knee joint. Once a meniscus is torn, it will most likely not heal on its
own.
If the symptoms
continue, surgery will be required to either remove the torn portion of
the meniscus or to repair the tear. Most meniscus surgery today is done
using the arthroscope. Small incisions are made in the knee to allow the
insertion of a small TV camera into the joint. Through another small
incision, special instruments are used to
remove the
torn portion of meniscus while the arthroscope is used to see what is
happening. In some cases, the meniscus tear can be
repaired. The arthroscope is used to view the
torn meniscus. Sutures are then placed into the torn meniscus until the
tear is repaired. Repair of the meniscus is not possible in all cases.
Young people with relatively recent meniscal tears are the most likely
candidates for repair. Degenerative type tears in older people are not
usually repairable.
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Last updated on Saturday, February 01, 2003.
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