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Torn Meniscus: Weight bearers

2 Jun 2021

Meniscus tear injuries often occur during athletic action, as in contact sports like football or hockey. But six of 10 patients older than 65 years also have a degenerative meniscus tear. While some may experience no pain at all, a few might need to fix these weight bearing tissues in knee joints.

Do you experience immense pain in your knee joints while climbing stairs or suddenly feel you are about to lose balance in the midst of your shopping in a supermarket? It could be due to a meniscus tear in your knee joint, and the treament options vary, depending on your symptoms and age.

Meniscus tear injuries often occur during athletic activities, especially in contact sports like football and hockey. Motions that require pivoting and sudden stops, in sports like tennis, basketball, and golf, can also cause meniscus damage.

The risk of developing a torn meniscus increases with age because cartilage begins to gradually wear out, losing its blood supply and its resilience. Increasing body weight also puts more stresson the meniscus. So, even routine daily activities, like walking and climbing stairs, increase the potential for wear and tear as well as degeneration.

It is estimated that six out of 10 patients older than 65 years have a degenerative meniscus tear. Many of these tears may never cause problems for most, but for some, it can seriously affect routine life and cause immense pain.

A torn meniscus is damage from a tear in the cartilage that is positioned on top of the tibia (the lower bone) to allows the femur (the upper bone) to glide when the knee joint moves. Tears are usually described by where they are located anatomically in the C shape and by their appearance.

While physical examination may predict whether it is the medial or lateral meniscus that is damaged, a diagnostic procedure, like an MRI or arthroscopic surgery, can locate the specific part of the cartilage anatomy that is torn and its appearance.

Because the blood supply is different to each part of the meniscus, knowing where the tear is located may help decide how easily an injury might heal (with or without surgery). The better the blood supply, the better the potential for recovery.

What is a torn meniscus?

There are 3 bones in the knee. These are the femur, tibia, and patella. The ends of those bones are covered with cartilage – a smooth material that cushions the bone and allows the joint to move easily without pain, acting as a shock absorber. Between the bones of the knees are two crescent-shaped disks of connective tissue, called menisci. These also act as shock absorbers to cushion the lower part of the leg from the weight of the rest of the body.

Meniscus tears can happen during a rotating movement while bearing weight, such as when twisting the upper leg while the foot stays in one place during sports and other activities. Tears can be minor, with the meniscus staying connected to the knee. Or they can be major, with the meniscus barely attached to the knee by a cartilage thread.

Symptoms

Each person may have different symptoms. But the most common symptoms are:

  • Pain, especially when holding the knee straight
  • Swelling and stiffness
  • Knee may catch, click, or lock
  • Knee may feel weak or unstable
  1. Diagnosis

Your healthcare provider will ask about your medical history and do a physical exam. You may also need:

X-ray. This test uses invisible electromagnetic energy beams to make images of internal tissues, bones, and organs onto film.

MRI. This test uses a combination of large magnets, radiofrequencies, and a computer to make detailed images of organs and structures within the body. It can often find damage or disease in a surrounding ligament, tendon, bone, or muscle.

Arthroscopy. This is a minimally-invasive procedure used for conditions of a joint. A small, lighted, optic tube (arthroscope) is inserted into the joint through a small incision in the joint. Images of the inside of the joint are projected onto a screen. They are used to evaluate any degenerative or arthritic changes in the joint.

Treatment options

Treatment will depend on the symptoms, age, and general health of the patient. It will also depend on how severe the condition is.

These include:

  • Icing
  • Medications to relieve pain/reduce inflammation (such as ibuprofen)
  • Muscle-strengthening exercises
  • Arthroscopic surgery
  • Possible complications

An untreated torn meniscus can result in instability of the knee and lasting pain. It can also increase the risk of osteoarthritis. Hence, immediate attention is necessary to stop the damage from increasing. If simple methods do not bear results, surgery might be necessary for some patients.

Surgical options

If the examination indicates that the meniscus tear is mild (Grade 1 or 2), sugery may not be necessary. However, if it’s Grade 3, surgical intervention will be needed. The following options are being used:

Arthroscopic repair – The doctor will make small cuts on the knee and insert an arthroscope to get a good look at the tear. Then they’ll place small devices that look like darts along the tear to stitch it up. Your body will absorb these over time.

Arthroscopic partial meniscectomy – Your doctor will remove a piece of the torn meniscus so that the knee can function normally. It usually takes about 4 to 8 weeks for patients to increase weight bearing and range of motion.

Arthroscopic total meniscectomy – During this procedure, the whole meniscus is surgically removed. Most patients are able to return to work within a few days or a week or two after arthroscopic total meniscectomy, provided work does not involve strenuous activity such as heavy lifting or climbing. 

 

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