Meniscal Repair

Meniscal Repair

WHAT IS MENISCUS?
There are 3 bones that make up the knee joint. They are thigh (femur), leg (tibia) bone and knee cap (patella) bone in front. Since the joint faces are not very suitable for each other, the knee joint is strengthened by joint ligaments and cartilaginous menisci.

Each knee has two menisci, one internal and one external. "C" shaped menisci are elastic structures with dense tightly knitted collagen fibers to resist compression. The menisci act as shock absorbers between the knee pads and the joint, distributing the load over a wider area and protecting the articular cartilages from high pressure.

WHAT ARE THE SYMPTOMS OF MENISCUS TEARS?
Knee pain The discomfort may be mild at first following a meniscus tear. People who participate in sports can even continue to participate in the sport that initially piqued their interest. However, as joint fluid and edema develop as a result of the mechanical problem in the knee, the discomfort begins to worsen.
Sounds coming from inside the knee
Swelling and stiffness.
Locking or sticking at one point in the knee.
Limitation of movement (inability to bend the knee completely)
WHAT ARE THE CAUSES OF MENISCUS INJURIES?
Depending on the frequency of occurrence, meniscal tears can be traumatic, caused by deterioration over time or as a result of congenital problems. Meniscal tears can occur in all segments of society and at any time.

Meniscus tears can be injured in activities that cause sudden stopping, turning, forcibly bending or rotating the knee.
Kneeling, squatting or lifting something heavy can cause meniscus tears.
Meniscus injuries can occur frequently in sports that require double contact such as football, basketball, and even in sports that involve sudden maneuvers such as volleyball and tennis.
Meniscus injuries can be seen at any age. In young people, the meniscus tissue is intact and tears as a result of serious trauma, but with age, degenerative changes in the knee can lead to meniscal tears. Even a simple twist when getting up from a chair can predispose to meniscal tears.  It occurs in more than 40% of people aged 65 and over.
Tearing of the meniscus as a result of loads exceeding its endurance limit is mostly seen at a young age. While traumatic tears are usually seen between the ages of 10-40, degenerative meniscal tears, that is, meniscal tears caused by deterioration over time, are mostly seen after the age of 40.

How is the meniscus diagnosed?

A doctor's examination plays an important role in the diagnosis of meniscus tears. The Orthopedics and Traumatology doctor checks for tenderness along the joint line where the meniscus sits. In young patients, there is usually a history of pain and locking in the knee as a result of spraining or twisting. In middle-aged and older patients, degenerative tears due to the wear and tear of the meniscus may occur with a feeling of locking and sticking after simple movements such as squatting and bending. The doctor evaluates the area of pain, its relation to movement and its intensity during the examination.

Your doctor will perform tests such as McMurray, Apley, Steinman during the examination. He/she will evaluate the presence and severity of the meniscus by bending, straightening and rotating the knee.

Imaging methods in meniscus diagnosis

Since different problems in the knee can cause similar symptoms, the diagnosis can be confirmed with imaging methods.

Magnetic Resonance (MRI): Used to visualize the hard and soft tissues in the knee in detail, MRI is the best imaging method for meniscus diagnosis.
X-ray: The cartilaginous meniscus cannot be visualized by X-ray. However, X-ray imaging can be useful to rule out conditions that cause similar problems in the knee, such as osteoarthritis.
Arthroscopy: In some cases, an instrument known as an arthroscope can be used to examine the inside of the knee. The arthroscope, which is lightweight and includes a small camera, is inserted into the knee through a small incision and projects a magnified image of the inside of the knee onto a screen.  However, its use for diagnostic purposes has disappeared due to the development of imaging methods.
MENISCUS TREATMENT
In the treatment of meniscal tears, total meniscectomy operations were previously performed in which the entire meniscus was removed. It has been scientifically proven that patients who underwent this method developed destruction on the cartilage surface within 10-15 years and the knee-protective feature of the meniscus was understood.

 Before deciding on treatment;

Age of the patient
Physical activity status
Patient's expectations from work and social life
Structure of a meniscus tear
Type and length of meniscus tear
Localization of the meniscus tear
The treatment method is determined by looking at the presence of different injuries in addition to the meniscus tear.
Non-Surgical Treatments of Meniscus Tears

If the area where the meniscus tear is located is red, that is, if the tear is in an area with blood supply, there is a possibility that it will heal on its own. Non-surgical methods can be used to accelerate the healing of meniscal tears in this area.

Rest: Activities that aggravate knee pain, especially those that cause bending or rotating the knee, should be avoided. In cases where the pain is very severe, the load on the knee can be alleviated by avoiding even walking or using crutches.
Ice treatment: Ice therapy can reduce knee pain and swelling. This therapy can be applied to the knee for 20-25 minutes at a time, several times a day. Care should be taken to avoid direct contact of the ice with the skin.
Bandage: Wrapping the knee with a suitable bandage can give positive results for pain and swelling.
Elevation: To reduce swelling during rest, placing a pillow under the leg and lifting it above the heart level gives positive results.
Medication or injections into the knee (hyaluronic acid): Non-steroidal anti-inflammatory drugs such as aspirin can reduce pain and swelling. In addition, drugs used as supplementary vitamins can also be used in treatment, although their effectiveness is still not scientifically proven. It is an undeniable fact that such medications have a "placebo effect". Although the drugs do not have a curative effect, it has been proven in studies that the majority of patients experience a reduction or disappearance of pain. Products such as shark cartilage, hyaluronic acid, chondroitin sulfate preparations reduce the frequency and severity of complaints, even though they are not medically proven to be beneficial. This effect is explained by the so-called placebo effect, which is the psychological effect of the patient believing in the treatment and thinking that it will improve.
Physical therapy: Stretching and strengthening exercises can reduce stress on the knee. It may be necessary to seek help from a physiotherapist for such movements.
PRP and stem cells: The effectiveness of treatments with names such as PRP and stem cells has not been established when evidence-based medicine data are taken into account.
These treatments may not always be sufficient. Surgical treatment may be necessary if the meniscus tear is large, unstable or causes locking symptoms.

Surgical Treatment of Meniscal Tears

If complaints such as knee pain and locking continue to interfere with daily life as a result of non-surgical treatments, surgical treatment is considered.

Surgical treatments include

Total meniscectomy, which involves the removal of the entire meniscus. Removing the damaged meniscus tissue in total meniscectomy surgery gives good results in the short term but leads to the development of arthritis in the long term.
Partial meniscectomy, which involves removing only the torn part Meniscus repairs. Some meniscal tears can be repaired by sewing the torn pieces together. Meniscal repair depends on the type of tear and the general condition of the meniscus. Meniscal repair has good results, but there is a longer recovery time than meniscectomy and meniscal repair is limited to suitable patients. Meniscal repair is recommended in patients with good quality meniscal tissue who lead an active life.