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HSS Presents: Meniscal Injury - An Overview

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HSS Presents: Meniscal Injury - An Overview

Travis G. Maak

2011 Fellow, Sports Medicine and Shoulder Service

Hospital for Special Surgery

Attending Orthopaedic Surgeon, Hospital for Special Surgery
Professor of Orthopaedic Surgery, Weill Cornell Medical College

Attending Orthopaedic Surgeon, Hospital for Special Surgery
Professor of Orthopaedic Surgery, Weill Cornell Medical College

Meniscus Overview

The meniscus is a special structure in the knee that spans the space between the thigh bone (or femur) and the shin bone (or tibia). There are two menisci in each knee – one on the inside (medial meniscus) and one on the outside (lateral meniscus). They are made of strong fibrocartilage and are shaped like the letter "C". These menisci look like suction cups that are carefully molded to the shape of the thigh and shin bones.

The Function of the Meniscus

The specific shape and size of the meniscus allows it to serve several functions. When you stand up, your weight is placed through your legs and, as a result, your knees. The stress is even higher during walking, running, and jumping. As a result, the body needs a cushion to keep the bones from grinding against each other and causing harm. The meniscus helps to cushion this weight and transmits the load across the knee joint.

Also, because the meniscus is carefully molded to the shape of the thigh and shin bone, it helps to evenly share the weight throughout the knee. This sharing also helps to avoid knee injury and is extremely important to the health of the knee. An injury to the meniscus can affect its ability to function normally.

Another important part of the meniscus is its ability to get oxygen from its blood supply in the form of small blood vessels. These vessels are only present in the outer one-third of the meniscus (known as the "red zone");  the inner two-thirds (also known as the "white zone") are "avascular" - without a blood supply. Thus, most meniscus injuries affecting the inner two-thirds will not heal, as oxygen is required in the area of injury for proper healing.

Meniscus Injury & Symptoms

The most common meniscus injury is a meniscal tear, which most often happens when an athlete quickly turns the body while the foot is held in place. This motion results in a twisting within the knee that can tear the meniscus. This may occur in sporting events including football, basketball, and soccer, but can happen in any activity where this twisting motion takes place.

If a meniscus is torn, the knee often becomes painful when the knee is bent. The knee may swell after the injury occurs. Ascending or descending stairs may also cause pain and swelling of the knee. Locking or catching sensations can be experienced following a meniscal tear as well. The leg may feel some weakness, since the knee swelling can affect the function of the thigh muscles that straighten the knee.

How is a Meniscus Tear Treated?

There are many options that are available for treatment of a torn meniscus. These options range from anti-inflammatory medications and rehabilitation with a physical therapist to surgery. The treating orthopedic surgeon will discuss these options and help decide the ideal option based on the patient history, physical examination and the type of tear seen on imaging studies including plain x-ray and magnetic resonance imaging (MRI).

A non-operative physical therapy treatment program will often focus first on reducing pain and maintaining the full motion of the knee. Oral non-steroidal anti-inflammatory medications (i.e., Ibuprofen) may also be prescribed. After the initial injury pain has decreased and the knee motion is good, treatment may move to muscle strengthening.

If surgery is required for treatment of the meniscal tear, this will likely be performed arthroscopically with very small incisions and a small camera. These instruments allow careful removal of the torn sections or repair of the meniscal tear with sutures or "tacks."

Since the meniscus has an important role in the health of the knee, the surgeon will always attempt to keep or repair any part of the meniscus that could heal. Some meniscal tears occur in the "avascular" part of the meniscus and cannot be repaired. In this case, the torn portion of the meniscus is removed. If the tear is large and occurs in a part of the meniscus with a good blood supply, then a repair may be performed.

In addition, the patient age is important for healing, as patients in their 40s to 50s will often have a degenerative tear with poor quality tissue that cannot be repaired.

Rehabilitation

The surgical recovery from a meniscal tear is extremely important and will change according to the type of meniscal surgery that is selected.

If a meniscus tear is repaired, then crutches may be required for approximately 4-6 weeks. On the other hand, if the torn meniscal portion is removed, then they may only be required for a few days.

The early rehabilitation will focus on achieving full knee motion and reducing the swelling from surgery. After this has been achieved, the focus will move to muscle strengthening.

The time that may be required to achieve a complete recovery will depend on the specific type of meniscal surgery. The treating physician and physical therapist or athletic trainer will carefully guide the rehabilitation after surgery. A well-directed rehabilitation plan is important to achieve an excellent result.

For more articles, videos, podcasts, and the latest news about bone and joint health, visit the comprehensive Hospital for Special Surgery website at *www.hss.edu.  *

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