Written by Mr. Ioannis Vosinakis, Orthopedic Surgeon, Scientific Head of the Orthopedic Department of the ANASSA Clinic.
The menisci are crescent-shaped collagen structures between the femur and tibia and play an important role in knee stability, load distribution and the smooth fit of the articular surfaces. The meniscus acts like the shock absorber of the knee, it absorbs some of the loads carried by the thigh and distributes them over a larger area on the tibia.
Meniscal damage can be acute ruptures or chronic – degenerative ruptures.
Acute ruptures usually occur in young people due to sudden turning of the thigh on the tibia with the knee in flexion, on the load-bearing leg.
Chronic – Degenerative ruptures are common in older people. As the menisci age they become stiffer and less elastic. Degenerative-type tears can be completely asymptomatic or present with mild discomfort. Symptoms from the coexisting arthritis often dominate.
Lesions of the medial meniscus are more common because it is firmly attached to the medial collateral ligament and synovial bursa. The ruptures are differentiated according to their location (anterior, posterior horn, body) and type (elongated, bilateral bucket handle, oblique, radial, horizontal, degenerative). A rupture of a meniscus may be stable or unstable. A stable one does not move and may heal if it is in an area of good blood supply (periphery). An unstable one usually requires arthroscopic treatment.
How is a meniscus rupture treated?
The following must be taken into account when choosing the treatment:
The patient’s activity level, age, location and type of rupture, how recent it is, the patient’s complaints and any co-existing pathology.
Conservative treatment can be applied to stable, partial-thickness, degenerative or asymptomatic ruptures. Physiotherapy is recommended for 2-3 months and if there is no result, arthroscopic treatment follows.
Surgical arthroscopic treatment is recommended for ruptures that block the knee, in coexisting ACL ruptures, in athletes, and for ruptures that persist with symptoms after 2-3 months of conservative treatment.
The choice of partial meniscectomy or suturing depends on many factors. The patient can return home the same day or the next day at the least. In special cases, meniscal transplantation is also applied.
Recovery after meniscectomy is rapid without limitation of walking. Mobilization and gradual strengthening with physical therapy. Return to sports activities in 5-6 weeks.
After suturing, it is necessary to avoid tension for 1-6 weeks and gradually restore movement and muscle strength. Sports activities begin in the 3rd-4th month.