The two menisci are crescent-shaped wedges that fill the gap between femur & tibia and act as shock absorbers. Medial meniscus, located on the inner side of the knee, is more commonly injured because it is firmly attached. Lateral meniscus, on the outer side of the knee, is more mobile. Without menisci, contact pressures in the knee are increased which can eventually damage cartilage on the ends of bones.
Meniscal tears are often sports or accident related - twisting injury in the younger, active population. Acute symptoms are pain, swelling, and movement irregularities. The knee can "catch" or "lock" as it moves. Degenerative tears are more common in the older population. There may be repeated swelling, but patients often cannot recall any specific injury. Mechanical symptoms, such as the knee catching or locking, and pain on standing, walking and bending the knee are common.
The knee will be tender when pressed on the injured side where the femur and tibia meet (along the joint line). X-rays can rule out any fractures or arthritic conditions but MRI is the investigation of choice. It is 90- 95% accurate in revealing meniscal tears and can also show any ligament or cartilage damage.
When deciding treatment, following factors are considered;
Symptoms, age & activity level of patient
Timing, location & type of tear Partial, degenerative, and stable tears may be observed up to 6 weeks. If symptoms disappear, no surgery is needed. Bracing and activity restrictions may be suggested.
Operative Treatment: The surgical procedure is usually dependent on location and pattern of meniscal tear. All procedures are done arthroscopically (no open surgery).
For stable tears located on the periphery near the menisco-capsular junction, where there's a good blood supply. Multiple holes are made in the torn part of the meniscus to promote bleeding, which enhances the healing process.
For tears located in the inner 2/3 (rim) where there is no blood supply. Our goal is to stabilize the meniscal rim by removing as little of (torn) meniscus as possible. If most of the meniscus remains intact, patients do well and do not develop early arthritis.
For tears in the outer 1/3 of the meniscus where a good blood supply exists. The torn portion is repaired by using either sutures or absorbable fixation devices.
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