The meniscus, a C-shaped piece of tough, rubbery cartilage, resides within the knee joint, acting as a cushion between the shinbone and the thighbone. Each knee contains two menisci, which are important for evenly distributing weight and absorbing shock during movement. They also contribute to knee stability and assist in joint lubrication.
Understanding Meniscus Damage
A meniscus tear commonly results from activities that involve forceful twisting or rotation of the knee, especially when weight-bearing. This can occur during sports with sudden pivoting movements, such as soccer or basketball, or from direct impact. Age-related degeneration also makes the meniscus more susceptible to tears, even from simple movements like squatting or standing up quickly.
Meniscus tears vary in type and configuration, including radial, horizontal, flap, and bucket-handle tears. The location of the tear significantly influences its healing potential, primarily due to blood supply. The outer third of the meniscus, known as the “red zone,” has a relatively rich blood supply, which allows some tears in this area to heal naturally. Conversely, the inner two-thirds, or “white zone,” has minimal to no direct blood supply, making self-healing unlikely for tears in this region.
Surgical Procedures
When a meniscus tear requires intervention, arthroscopic surgery is a common approach, utilizing small incisions and a camera to visualize the joint. Two primary procedures are performed: partial meniscectomy and meniscus repair. A partial meniscectomy involves removing only the damaged or torn portion of the meniscus, preserving as much healthy tissue as possible. This procedure aims to alleviate pain and restore function by eliminating unstable fragments.
Meniscus repair, on the other hand, involves stitching the torn pieces of the meniscus back together. This option is considered for tears located in the vascular “red zone” and for younger, active patients. The decision between these procedures depends on factors like the tear’s location, type, and the patient’s age and activity level. Both procedures are minimally invasive, allowing for quicker recovery compared to traditional open surgery.
What to Expect After Surgery
Following meniscus surgery, patients can generally expect pain relief and improved knee function. Many individuals regain the ability to return to daily activities and sports. Success rates for meniscus repair range from 70% to 90%.
Despite successful immediate outcomes, long-term considerations exist, particularly regarding the risk of developing osteoarthritis. While surgery can resolve immediate symptoms, removing meniscal tissue, even partially, reduces the knee’s natural shock absorption. Studies indicate that partial meniscectomy can increase the risk of osteoarthritis development, with some research suggesting a significantly higher incidence in operated knees compared to unoperated ones over several years. Meniscus repair may offer a lower risk of osteoarthritis compared to partial meniscectomy, though the risk remains higher than in the general population.
The Role of Rehabilitation
Physical therapy and rehabilitation play an important role in achieving a successful recovery after meniscus surgery. Rehabilitation progresses through several phases, beginning with managing swelling and pain immediately after surgery. The initial focus is on regaining full knee extension and gradually restoring range of motion.
Subsequent phases involve strengthening the muscles surrounding the knee, including quadriceps and hamstrings, and improving balance. Patients then gradually progress to more demanding exercises, ultimately working towards a safe return to sports or other physical activities. Adherence to the prescribed rehabilitation program is important for healing and preventing re-injury.
Non-Surgical Approaches
For certain meniscus injuries, non-surgical management is the initial course of action. Conservative strategies include rest, ice, compression, and elevation (RICE) to reduce pain and swelling. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen may also be used to manage discomfort and inflammation.
Physical therapy is a key component of non-surgical treatment, focusing on strengthening the muscles around the knee and improving flexibility and stability. Older patients with degenerative tears may also find sufficient relief through conservative care without the need for surgery.