The meniscus is a C-shaped fibrocartilage which is located at the peripheral aspect of the joint. The majority of the meniscus has no blood supply. For that reason, when damaged, the meniscus is unable to undergo the normal healing process that occurs in most of the rest of the body. In addition, with age, the meniscus begins to deteriorate, often developing degenerative tears. Typically, when the meniscus is damaged, the torn piece begins to move in an abnormal fashion inside the joint. Because the space between the bones of the joint is very small, as the abnormally mobile piece of meniscal tissue moves, it may become caught between the bones of the joint (femur and tibia). When this happens, the knee becomes painful, swollen, and difficult to move (locking) and damages the articular cartilage.
The Role Of Meniscus
The meniscus has several functions
- Stability of joint
- Lubrication and nutrition of joint
- Stiffness Maintenance of the integrity of the articular cartilage is critical to preventing the development
of post- traumatic or degenerative arthritis.
- Shock absorptiones the articular cartilage.
Physician takes a history is to determine the specific problems that a patient is having with the knee.Physical examination of the area will be performed to determine the site of the pain, the presence or absence of physical findings that are known to be associated with a torn meniscus. X-rays are performed to identify other abnormalities that may give associated problems to those of a torn meniscus.Additional diagnostic tests such as an MRI may be ordered. If the history and physical findings indicate that a tear is present, arthroscopic surgery may be indicated for treatment.
Partial meniscectomy and Meniscal repair
Depending on the type of tear, the piece of meniscus that is torn may be removed from the knee (partial meniscectomy) or repaired (sewn back in place). If a tear occurs in the outer one-third of the meniscus (peripheral tear), there is usually adequate blood supply for the tear to heal and it is fixed. However, tears in the inner two-thirds of the meniscus (where most tears occur) have no blood supply, and will not heal with repair. Therefore, the torn piece needs to be removed. Every effort is made to try and repair a tear that may heal. If the tear is repaired, it may require a small incision on the inside or outside of the knee to tie down the stitches and protect the nerves and arteries for the repair. If the meniscus does not heal after repair the patient might require repeat surgery to remove the unhealed tear.
Post operative rehabilitation
The rehabilitation is based on several goals: 1) allowing the tissue to heal; 2) regaining motion; 3) regaining strength; and 4) return to sports. After partial meniscectomy, the rehabilitation generally occurs very rapidly. Most patients can return to strenuous work in two to six weeks. Following meniscus repair, you will be restricted from bending beyond 90 degrees or squatting for the first 4 - 6 weeks. The specific rehabilitation protocol will be reviewed after surgery.