MENISCUS TEARS/ MENISCAL ROOT INJURIES
What is a meniscus?
Your knee meniscus is a C-shaped piece of cartilage that acts as a cushion between your femur (thigh bone) and your tibia (shin bone). Each knee joint has a medial meniscus and a lateral meniscus. A meniscus acts as a shock absorber, preventing damage to bone surfaces, and assisting with rotational stability.
What is a meniscus tear?
A torn meniscus is one of the most common knee injuries. Any activity that causes you to forcefully twist or rotate your knee, especially when putting your full weight on it, can lead to a torn meniscus. Older age and obesity can also lead to meniscus tears as well. There are two main causes of meniscal injuries:
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Traumatic – In the younger population, meniscus tears are typically the result of traumatic sports injuries, by twisting on a slightly flexed knee
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Degenerative – In the older adult, a meniscus tear may be due to natural age-related degeneration of the meniscus or from the wear-and-tear of arthritis
What are the symptoms of a torn meniscus?
If you've torn your meniscus, you may experience the following symptoms:
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Joint swelling or stiffness
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Pain, especially when twisting or rotating your knee
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A clicking or popping sensation
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Feeling as though your knee is locked in place when you try to move it
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Difficulty straightening your knee fully
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Feeling of your knee giving way
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Pain and difficulty with squatting
How is a meniscus tear diagnosed?
Clinical examination may reveal pain and tenderness along the joint lines of the inside or outside of your knee. Your doctor may perform a McMurray's test and other clinical assessments to help confirm the diagnosis. Dr. Wusu will commonly perform x-rays to evaluate the bony structure of your knee, and may order an MRI scan to confirm the diagnosis and rule out other additional injuries.
What is the treatment?
Treatment of a meniscus tear varies based on the type of tear and the location within the knee joint. Dr. Wusu will carefully consider the patient’s age, activity level and other associated knee injuries when determining the best treatment plan. A small meniscus tear, or a tear in the red zone (with good blood supply for healing), will usually respond well with conservative management.
In some cases, a torn meniscus may require surgical intervention with minimally invasive knee arthroscopy. Dr. Wusu strives to preserve as much healthy meniscus as possible due to its protective effect on the knee.
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Meniscus Repair – When possible, Dr. Wusu will utilize surgery sutures to sew the meniscus tear back together, in order to facilitate healing and preserve meniscal function
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Partial Meniscectomy – If the tear is degenerative, complex, and non-repairable, a procedure called a partial meniscectomy will remove the damaged portion of the meniscus.
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Meniscus Transplant – In younger patients with little to no meniscus left, a perfectly size-matched meniscus from a cadaver donor is transplanted into the patient’s knee
What is a meniscal root tear?
The meniscus is a C-shaped piece of cartilage that acts as a shock absorber between your femur (thigh bone) and your tibia (shin bone). There is a meniscus in both the medial and lateral compartments of the knee, and both have very strong attachments at their most posterior aspects, called the root attachments. These attachments are crucial to the function of the meniscus because they hold it in place, provide stability to the circumferential fibers of the meniscus, and prevent meniscal extrusion.
Once the meniscus has been pushed out, or extruded, the underlying cartilage can start to rapidly deteriorate. The surrounding bone can frequently become inflamed, causing significant pain. In fact, it has been shown that a tear of the meniscal root is actually comparable to removing the entire meniscus itself, and exposes the cartilage to extremely large stresses. Thus, a tear of the meniscal root is considered a very serious condition.
What causes a meniscal root tear?
There are two different patient populations who commonly suffer meniscal root tears:
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Young athletes with trauma-related injuries – This could include an injury to the ACL, PCL, and other associated ligament combinations. In these circumstances, the meniscal root is commonly torn along with the ligament, and it is recommended to perform a concurrent meniscal root repair. Failure to repair the meniscal root tear in these circumstances can lead to the development of osteoarthritis, failure of a ligament reconstruction, or other joint problems in the future.
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Middle-age adults with everyday injuries – The consequences of a meniscal root tear appear to be much more severe in this age group. A meniscal root tear, which can occur with minor or seemingly trivial trauma, with a pop in the back of their knee with deep flexion, squatting and lifting, and other activities, can be quite severe. In this population, the rapid development of osteoarthritis or insufficiency fractures can occur.
What is the treatment for a meniscal root tear?
Meniscal root tears are repaired whenever possible based on their importance in limiting future knee arthritis. The repair is performed with minimally invasive knee arthroscopy, and involves passing stitches into the meniscus remnant, and re-anchoring it to the bone. Surgical repair of the meniscus root has been shown to have incredibly successful outcomes by restoring the protective function of the meniscus.
