Meniscus lesion & Its Treatment

a meniscus tear can be painful and debilitating. Unfortunately, it's quite common. In fact, a meniscal tear is one of the most frequently occurring cartilage injuries.

So what is the meniscus?

It's a piece of cartilage in that cushions and stabilizes the joint. It protects the bones from wear and tear. But all it takes is a good twist to tear the meniscus. In some cases, a piece of the shredded cartilage breaks loose and catches in the knee joint, causing it to lock up.

Meniscus tears are common in contact sports like football as well as noncontact sports requiring jumping and cutting such as volleyball and soccer. They can happen when a person changes direction suddenly while running, and often occur at the same time as other knee injuries.

Meniscus tears are a special risk for older athletes since the meniscus weakens with age. More than 40% of people 65 or older have them.

Different types of meniscus ruptures:

• Radial rupture
• Oblique rupture
• Longitudinal rupture
• Bucket handle
• Horizontal rupture
• Complex rupture

Once the diagnosis of injury lesion confirmed, a decision of therapeutic choice must be taken. Two fundamental questions must be systematically asked:

? is it necessary to treat this lesion surgically?

? If yes, is it possible to treat this lesion with a repair (meniscus suture) rather than a meniscectomie (resection resection)?

Several particularly chronic meniscales lesions can be treated without surgery. Non-Surgical treatment may include:

- Physiotherapy and rehabilitation

please check: https://youtu.be/5Hf4_1VMzLk

- Anti-inflammatory

- Local infiltration

- we prefer Visco-supplementation today. It consists of injecting a solution called hyaluronic acid which restores viscosity to the synovial liquid present inside the knee, Example: CuraVisc which one of the best (in my opinion) in the market to date.

However, surgical treatment is necessary in some cases.

What is the meniscus surgery?

Until the 80s, the torn meniscus was systematically and completely removed when the knee became symptomatic. Patients feel much better and resume normal life after surgery.

Unfortunately, problems begin a few years after surgery. It is now admitted that the resection of the meniscus accelerated the wear of the knee cartilage, which favours the appearance of osteoarthritis.

Since the advent of arthroscopic surgery and its democratization, there are more and more orthopaedic surgeons who control meniscale repair and partial resection of the meniscus, called partial meniscectomie.

Suture or resection?

The meniscus ensure a primary role in the knee, namely the transmission of the load and the absorption of shocks. Therefore, the ideal would certainly be the suture of the meniscus, because as we mentioned earlier, the resection of the meniscus promotes the wear of cartilage and the installation of osteoarthritis.

Depending on the seat of the lesion, a meniscal tear can be treated in several ways according to its healing potential. It should be known that the meniscus is divided into three areas, from outside the knee to the inside:

- a peripheral zone known as "Red Zone", the best vascular, it has an important healing potential and must be sutured as far as possible.

- an intermediate zone called "Red-White", a méniscale suture still has a chance to heal.

- in the internal (Central) area called "White" or avascular, the lesion must be surgically because there is no potential for healing.

In Case of failure to repair, the surgeon performs partial resection of the meniscus (partial méniscectomie), less arthrogène than total resection.

Surgical abstention applies to asymptomatic stable méniscales lesions (not painful, without blocking).

Who are the candidates for meniscale surgery?

The choice of treatment depends on several factors such as the history of the disease, the length of the injury, the age of the patient, the level of activity, the associated lesions (especially those of the anterior cross-ligament and cartilage), the meniscus , the type of lesion, location and extension.

Young patients with meniscale lesions usually have cartilage in good condition. Hence the possibility of "fixing" the meniscus.

For older patients, the meniscus operation is less frequent. Due to the chronic wear of the meniscus, its repair and healing is more difficult from 50 years. Removing a meniscus would cause an acceleration of cartilage wear and osteoarthritis.

Other Non-surgical treatments are then preferred (cited above). On the other hand, surgery is recommended to remove a possible méniscal fragment that has detached and remains free inside the knee.

Arthroscopy Surgery:

Great progress has been made in recent years in the suture techniques of of and méniscectomie. Interventions are carried out under arthroscopy, which avoids opening the knee as we did before.

Two or three small incisions of less than one inch are made to allow one or two instruments and a camera (Arthroscope) to suture the meniscus.

The intervention is carried out in ambulatory and partial méniscectomie. Depending on the patient's wish, anaesthesia is locorégionale (half or all of the spine or nerves of the femoral-femoral block) or general.

In the event of an associated rupture of the anterior knee ligament, the isolated surgical treatment of the méniscale lesion is not justified. At the plasma of a ligament reconstruction, the surgeon must be as conservative as possible (Suture, minimum resection).

these information is for educational & entertainment purposes only, please consult a qualified Arthroscopic Surgeon whenever required.