Meniscus tear: Difference between revisions
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==External Links== |
==External Links== |
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* [http://www.kneeguru.co.uk/KNEEnotes/node/855 The KNEEguru - educational site packed with knee content with sections on meniscus injuries] |
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Revision as of 15:00, 28 March 2008
| Meniscus tear | |
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| Specialty | Orthopedic surgery  |
In sports and orthopedics, people will sometimes speak of "torn cartilage" and actually be referring to an injury to one of the menisci. Menisci can be torn during innocuous activities such as walking or squatting. They can also be torn due to traumatic forces encountered in sports. Tears can lead to pain and/or effusion in the knee joint. Especially acute injuries (typically in younger, more active patients) can lead to displaced tears which can cause mechanical symptoms such as clicking, catching, or locking during motion of the knee joint.[1] The joint will be in pain when in use, but when there is no load, the pain goes away.
A tear of the medial meniscus occurs as part of the unhappy triad, which includes the anterior cruciate and medial cruciate ligaments.
Diagnosis
Following a painful knee injury, one should consult a doctor. After noting symptoms, a physician can perform clinical tests to determine if the pain is caused by compression and impingement of a torn meniscus. MRI and knee arthroscopy can yield a more accurate diagnosis.
Treatment
The treatment course is dependent on the needs and status of the patient. A conservative course of treatment involving just physical therapy is possible. The patient will probably have to take a small break from his or her normal activities, allowing the knee to heal. A victim of a torn meniscus should try strengthening exercises for the knee muscle (stronger and bigger muscles will protect the meniscus cartilage by absorbing a part of the weight) and may be given some anti-inflammatory medications.
If this does not resolve the symptoms or in cases of a locked knee, then surgical intervention may be required. Depending on the location of the tear, a repair may be possible. In the outer third of the meniscus, an adequate blood supply exists and a repair will likely heal.[2] Usually younger patients are more resilient and react well to this treatment, while older, more sedentary patients do not have such rejuvenating ability. If the tear is far away from the meniscus' blood supply (the meniscus becomes avascular towards the unattached, thin interior edge), then a repair is unlikely to heal. In these cases (the majority) arthroscopic surgery allows for a partial meniscectomy, removing the torn tissue and allowing the knee to function with some of the meniscus missing. In situations where the meniscus is damaged beyond repair or partial removal, a total menisectomy is performed. This option is avoided at all costs as total menisectomy leads to an increased risk of osteoarthritis and eventual total knee replacement. In some cases, a meniscus replacement is done to prevent this.
Rehab after Meniscus Surgery
After a successful surgery for treating the destroyed part of the meniscus patients must follow a rehabilitation program to have the best result. The rehabilitation following a meniscus surgery depends on whether the entire meniscus was removed or repaired.
If the destroyed part of the meniscus was removed, patients can usually start walking a day or two after surgery and return normal activities after a few weeks (2 or 3). However, each case is different and patients must consult the surgeon.
If the meniscus was repaired the rehabilitation program that follows is a lot more intensive. After the surgery a hinged knee brace is placed on the patient. This brace allows controlled movement of the knee. The patient is encouraged to walk using crutches from the first day, and most of the times can put weight on the knee. After four weeks the patient can start walking using the hinged knee brace only. Starting from the second month the patient can walk freely and can also do various "light" exercises (static bicycle, swimming, etc.). If the rehabilitation was done properly the patient can gradually return back to "heavier" activities (like running). However each case is different and the patient must consult the doctor and physiotherapist regarding a proper rehabilitation program.