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| New !! Lateral epicondylitis |
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Meniscus
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There are two menisci in the knee (medial meniscus and lateral meniscus). They are both triangular fibrocartilages, interposed between femur and tibia. Semicircular wedge shapes, they allow a good congruence between the femoral condyle and the tibial plateau. In response to axial loads, the menisci provide a protective load transmission and energy resorption: they can be considered to act like "shock absorbers". (more details...) |
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| What you have to know ... |
Total meniscectomy (surgical remove of the meniscus) lead in the long term to osteoarthritis of the knee, in particular if the anterior cruciate ligament is torn. It is therefore necessary to try to preserve as much of the meniscus as possible, performing “minimal” partial meniscectomy utilising arthroscopy. Meniscal repair must be always practised, if it is possible; in particular for peripheral injuries in young patients. (details) |
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Signs and sympto
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A meniscus tear can occur at any age: in young patients a torn meniscus is usually the result of twisting injuries to the knee, whereas in older patients, we find degenerative lesions. Twisting injuries to the knee can be the origins of other ligamentous injuries (MCL and anterior cruciate ligament tear). Another mechanism, often observed among more elderly patients "in later years", is a hyperflexion followed by a forced lifting: the meniscus overlapped by the internal condyle is crushed, rolled and tears. A meniscal portion may be luxated in the notch: it is a “true locking” (meniscal locking) (impossibe to fully extend the knee). The cause is a bucket handle meniscus tear. A cracking can be felt by the patient associated with a sharp pain. (details about the differents ruptures) |
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| Diagnosis |
A diagnosis may be easily obtained; investigation of the reason for consulting the doctor (history of present complaint) combined with a comparative clinical examination of the two knees. A fixed flexion deformity is always investigated with or without the presence of an effusion. The clinical examination looks for pain during direct palpation of the medial and lateral meniscus and other signs of meniscal lesions with specific tests ( Mc Murray, Grinding-test of Cooper-Appley etc.). |
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Radiographs
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Simple x-rays are necessary to eliminate a bone lesion or ostheochondral, even if they are generally normal. X-rays are very important (in particular using the "Rosemberg view") to detect an initial osteoarthritis, that may be associated with a meniscal tear. An arthrography visualizes the contours of the menisci: it is a reliable diagnostic method to visualize méniscal injuries. A ct-scan can also be used to evaluate the menisci. MRI (Magnetic Resonance) is a more reliable examination for the diagnosis of a meniscus tear. |
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Arthroscopic Surgery
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Surgical techniques used to remove or to repair the meniscus (meniscus repair) are performed in arthroscopy. With only a small skin incision it is possible to introduce a minute camera into the knee. Exploration of the articulation begins; the surgical procedure is practised using very small grips , which are introduced by a second small incision. The menisci are thus repaired - if the rupture allows it - or removed partially. |
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| Meniscus rehabilitation |
Arthroscopy considerably simplifies post-operative recovery. After medial meniscectomy, the patient can walk the day after surgical procedure and will recover his articular motion completely (complete flexion). Often meniscus rehabilitation is advised: electrostimulations, stretchings and proprioceptive rehabilitation can accelerate recovery. A lateral meniscectomy may be followed by some swelling during the first weeks. Meniscus repair requires, on the other hand, a different rehabilitation regime. To protect the suture flexion is limited for 4-6 weeks; complete weight bearing is generally allowed, but only when supported by two crutches. |
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Frequent questions
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How long is it necessary to wait before continuing sport sport after a meniscectomy in arthroscopy? Is it necessary to walk with two stamples after a arthroscopic partial meniscectomy ? How many days of hospitalization are likely to be necessary? Can I take a shower after the surgical procedure? How long is necessary it to stop work after an arthroscopy? How long after the intervention can I drive the car ? When is it necessary to remove the suture wires? And if I don’t want to undergo surgery? |
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