Meniscus Repair is a treatment method applied in the field of Orthopedics.
✓What is Meniscus?
The meniscus is a C-shaped cartilage located between the femur (thighbone) and tibia (shinbone) bones within the knee joint. There are two types: the inner and outer meniscus.
The meniscus acts as a shock absorber and load carrier between the bones that form the joint, and protects the joint cartilage from excessive loads.
✓Why and how does meniscus tear occur?
Meniscus tears occur due to trauma from impact or twisting during activities such as sports, wear and tear over time in advanced age, or due to certain congenital problems. Meniscus tear causes can be listed as follows:
Sudden movements performed in sports
In athletes, attempting to suddenly rotate or bend the knee to hit or catch a ball can cause cartilage tears
Knee calcification triggering meniscus injury
If there is calcification in the knees, the meniscus becomes prone to tearing. Thus, meniscus tears can develop more easily.
Knee collapse, squatting, or lifting something heavy
Knee collapse, squatting, or lifting something heavy can cause meniscus tears. Meniscus tears can occur from sudden stops, rotation, forced bending of the knee, or activities causing rotation.
Weakening of meniscus tissue due to aging
Meniscus injuries can occur at any age. In young people, since meniscus tissue is intact, it tears as a result of serious trauma, but with advancing age, degenerative changes in the knee can lead to meniscus tears. A simple bend while getting up from a chair can set the stage for meniscus tears. It is observed in more than 40% of people aged 65 and above.
Tearing due to loads exceeding the meniscus's load-bearing capacity is more common in young ages. While traumatic tears are generally seen between ages 10-40, meniscus tears resulting from degenerative deterioration that occurs over time are more commonly seen after age 40.
✓What are the symptoms of meniscus tear?
A sound from the knee following squatting, twisting, and impact, and the pain that follows, can be a sign of meniscus tear. Depending on the location of the tear, pain may develop on the inner or outer part of the knee. Additionally, with meniscus tear, there may be swelling in the knee and a feeling that something is catching inside when moving. Pain may cause a feeling of emptiness. Sometimes the knee locks and does not fully straighten.
✓How is meniscus tear treated?
Traumatic acute meniscus tears occurring in young patients are generally treated surgically. In small tears, the torn part is removed, while in larger tears, Meniscus Repair may be needed.
In degenerate knees in older ages, meniscus tears are generally treated with medication, exercise, injections, and other methods. However, if mechanical symptoms such as knee locking are significant or if there is a repairable tear at the meniscus root, surgery is recommended.
✓Imaging Methods in Meniscus Diagnosis
Magnetic Resonance (MR): MR, which is used for detailed imaging of hard and soft tissues in the knee, is the best imaging method for meniscus diagnosis.
X-ray: The meniscus, which has a cartilage structure, cannot be imaged with X-ray. However, X-ray imaging can be useful in eliminating conditions that cause similar knee problems such as osteoarthritis.
Arthroscopy: In some cases, an instrument known as an arthroscope can be used to examine inside the knee. The arthroscope, which also contains a light and small camera, is placed into the knee through a small incision and displays the interior of the knee magnified on a screen. However, its use for diagnostic purposes has been eliminated due to advances in imaging methods.
✓Surgical treatment of meniscus tears
If pain in the knee, locking, and other complaints resulting from non-surgical treatments continue to interfere with daily life, surgical treatment is considered.
In surgical treatments;
Total meniscectomy, which involves removal of the entire meniscus. In total meniscectomy surgery, removal of damaged meniscus tissue produces good results in the short term, but in the long term leads to arthritis development.
Partial meniscectomy, which involves removal of only the torn portion
Meniscus Repairs. In some meniscus tears, the torn pieces can be sutured together and repaired. Meniscus Repair depends on the type of tear and the overall condition of the meniscus. Meniscus Repair has good results, but has a longer recovery time than meniscectomy and is limited to suitable patients. Meniscus Repair is recommended in patients with quality meniscus tissue who lead an active life.
Meniscus transplantation, or meniscus grafting, can be performed.
✓Meniscus tear Arthroscopy surgery
In meniscus surgeries, closed surgical methods called Arthroscopic surgery are used instead of open surgical techniques. Arthroscopy is a procedure used to look inside the joint. A small camera, about the size of a pencil, is placed into the joint through a small incision (approximately 1 centimeter). Using one or more small incisions, the surgeon places other instruments inside the knee to remove or repair the torn cartilage.
The incisions made in the skin for Arthroscopy are very small, generally about 1 centimeter each. The incisions are closed with a suture that is on the outside or under the skin.
The torn meniscus can be removed using various instruments including small shavers and scissors. The arthroscope also allows the surgeon to examine the rest of the knee joint, see loose cartilage pieces in the knee, and observe other problems inside the knee.
Arthroscopy surgery can be performed under general anesthesia as well as using local, epidural, or spinal anesthesia.
Meniscus Shaving (Partial Meniscectomy): If the torn portion is cleaned, patients can usually get up on the same day or the next day. Return to daily activities takes 4–6 weeks, while return to controlled sports takes 2–3 months.
Meniscus Repair (Suturing): If the tear is sutured, recovery is slower because healing requires tissue fusion. Full recovery and return to normal activities takes 3–6 months, while athletes returning to the field takes approximately 6 months.
Mild pain and swelling in the knee during the first week are normal. Keeping the knee elevated and applying cold compress (ice) reduces swelling. While simple home exercises are sufficient for shaving procedures, regular physical therapy is mandatory after meniscus repair.
How long does a meniscus tear take to heal?
The recovery of the knee after Arthroscopy surgery depends on many factors, including how severe the meniscus tear is. Complete recovery after surgery may take 4 to 6 weeks depending on the type of procedure performed, among other procedures. However, it should not be forgotten that each person will recover at different rates. In most cases, physical therapy is used after surgery to minimize complications and accelerate healing.
How long does a patient stay in the hospital after meniscus surgery?
After arthroscopic surgery, the patient's leg is elevated on the day of surgery and discharged the next day. After the patient rests at home for 1-2 weeks, they should start knee-strengthening exercises. If the patient works in an office environment, they should stay away from work for 1-2 weeks; if they work in heavy jobs, they should stay away for 4-6 weeks.
Is meniscus Arthroscopy surgery painful?
Meniscus Arthroscopy surgery is a mildly painful procedure. Generally, mild pain experienced after surgery can be controlled with simple painkillers. The pain experienced may vary depending on the duration of surgery, the type of meniscus tear, and the surgical method applied. In addition to pain medication, ice therapy and simple exercises can also help in pain control.
How long does meniscus surgery take?
Arthroscopy surgery varies depending on the size and type of the tear, but it can take an average of 30-45 minutes.
Is meniscus a sports injury?
Meniscus tears are a condition we hear about more in athletes. However, a meniscus tear is not a sports injury. While it occurs more often in young people due to trauma and incorrect movements, it can occur in advanced ages as a result of degeneration of the joint and meniscus structure.
Does a meniscus tear recur?
There are two menisci in the knee. A second tear can occur in the intact portion of the meniscus whose torn portion was partially removed by arthroscopic surgery. Some meniscus tears can be treated by stitching. There is a risk of re-tearing in a meniscus that has been treated by stitching.
What happens if a meniscus tear is not treated?
If a meniscus tear is not treated for a long time, it can lead to cartilage wear and irreversible damage. In delayed treatments, pain and restricted movement in the knee may be experienced, while permanent cartilage damage and calcification problems may be seen in the long term.
