Knee Deep In Pain? Understanding Meniscal Injuries & Repairs
The Meniscus is a C-shaped tissue on either side of the knee. This acts like a shock absorber of the Knee
The knee is one of the most important and large joints in the human body. The range of moments that this joint enjoys helps the humans to perform various activities of daily living, recreation, adventure and sports. Since it is a weight-bearing joint, it is vulnerable to various kinds of injuries and degeneration.
The Meniscus is a C-shaped tissue on either side of the knee. This acts like a shock absorber of the Knee. The meniscus is one of the common structures in the knee that gets damaged, apart from the ligaments. The injuries can happen with sports, road accidents, and due to age-related degeneration in the elderly. We will discuss the common causes and management of meniscal injuries in this article.
Functions of meniscus
The two Crescent-shaped Meniscus are located on either side of the knee: one on the inner aspect of the knee (medial Meniscus) and one on the outer side of the knee (lateral Meniscus).
The common functions of the Meniscus are they act as a shock absorber, help in weight distribution and increase the stability of the knee joint.
Risk factors and causes of meniscus injuries
Common causes of Meniscus injuries include sports-associated trauma in younger patients and degenerative arthritis in the elderly. Other causes include inflammatory arthritis.
Trauma is a common cause of Meniscal injury and may be associated with ligament injuries as well as fractures.
Degeneration in the knee is called osteoarthritis which happens due to aging. In a degenerated knee due to a reduction in the space between the bones due to wear and tear of the cartilage, the Meniscus, which is there in between is prone to injuries, even with a minor twisting of the knee.
Symptoms of Meniscus tear
The symptoms vary, depending on the type of injury and location of the injury on the Meniscus. However, common symptoms include pain, difficulty in moving the knee, difficulty in sitting down, squatting, and sitting cross-legged. The meniscus injuries can also cause significant pain, swelling, locking, and clicking in the Knee and are associated with knee stiffness.
Locking and clicking can happen because of the torn Meniscus coming in the way of the normal moment of the knee. In patients with arthritis, Meniscal tears can cause significant issues with mobility.
Diagnosis of the Meniscal tear
The meal tears can be diagnosed with the understanding of the history, mechanism of injury, clinical symptoms and signs, and also diagnostic imaging of the knee.
X-ray may not give us information about the Meniscus but help us to diagnose the fractures if any associated with injury. MRI is an excellent modality to accurately diagnose the meniscal tear with respect to the type and location of the tear. The MRI helps to diagnose meniscal injuries and also helps in planning the treatment.
Various types of meniscal tears can happen such as vertical tears, horizontal tears, and complex tears, which are the combination of horizontal and vertical tears. Bucket handle tears are a specific type of meniscal tears where a portion of the Meniscus is torn and flipped causes locking of the Knee.
Treatment of the meniscal tears
The management and treatment of the injury depend on various factors, including the duration of presentation since the time of injury, location of the tear, type of tear, age of the patient, activity levels and general health.
Two types of treatments are described for meniscal tears
1. Conservative treatment. (Non-surgical treatment)
2. Surgical treatment.
Conservative treatment involves local ice pack application, activity modification, and rest, bracing the part, medications. The main part of non-surgical management of meniscal tears involves physical therapy and rehabilitation. This is done by a qualified physical therapist or sports physiotherapist, who is well-versed in managing this.
Rehab involves gaining the range of movement, overcoming the stiffness and improving the muscle strength around the knee. This is of paramount importance for athletes to go back to their pre-injury activity level.
Surgical treatment involves
1. Meniscal balancing or trimming. This means trimming the torn portion of the Meniscus, which is coming in the way of the range of moments of the Knee using an arthroscopic minimally invasive technique.
2. Meniscal repair. This involves repairing the torn Meniscus to get the original anatomical structure. All meniscal tears may not be amenable to repair. This decision is based on the age of the patient, the type of tear location of the tear activity of the patient and the duration of the tear. Repairing and getting the Meniscus healed is the best way of restoring the biomechanics of the Knee, and more important in athletic individuals.
3. Meniscectomy
This involves the removal of the portion of the Meniscus, which is torn. The removal of the entire Meniscus is known to cause arthritis of the knee, hence it is not practised. In the present era, our aim should be to save the Meniscus. However, if the tear is bad and not repairable, a partial meniscectomy can give immediate relief of pain and return to activities.
Physical therapy plays an important and paramount role in restoring mobility function and gaining muscle strength post-surgery.
Latest advances in meniscal injury treatments
Recent advancements in meniscal injury treatments focus on improving surgical outcomes and enhancing healing.
Key developments include:
Regenerative Therapies: Techniques such as Platelet-Rich Plasma (PRP) therapy and mesenchymal stem cells (MSCs) are gaining popularity. PRP utilizes growth factors from the patient's blood to promote tissue repair, while MSCs show promise in enhancing meniscal regeneration post-surgery.
Surgical Innovations have aimed at getting a good clinical result. New surgical techniques, including the transtibial approach for meniscus root repairs, have demonstrated improved clinical outcomes.
Meniscal Implants: offer alternatives for total meniscal replacement, restoring knee function and pressure distribution similar to a healthy meniscus.
Biological Augmentation: Techniques such as trephination and the application of growth factors aim to increase vascularity at repair sites, potentially improving healing rates.
These advancements represent a shift toward more effective, less invasive treatments for meniscal injuries, enhancing recovery and long-term joint health.
Meniscal transplants from cadavers are evolving and showing initial promising results.
Prevention
It may not be entirely possible to prevent injuries to the Meniscus as this happens with our day-to-day activities, sports and in elderly individuals. Muscle Strengthening and conditioning help reduce the risk in athletes.
When these injuries occur, conservative or surgical treatment will help people to recover.
Though meniscal injuries are common, need not be a cause of despair. Conservative and surgical treatments with good rehabilitation and physical therapy can help the individuals return to their activities whether sports or activities of daily living.
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