Meniscus tear

Hospital Consultant at the Large Joint Clinic – Athens Medical Center Hospital. Director Dr Tsarouhas Ioannis

Menisci are fibrocartilageous C-shaped formations situated between femur and tibia in the knee joint. Their purpose is to absorb vibrations and to ensure a better contact between the bones of the joint, so that friction is minimized and the joint stabilized. There are two menisci (inner and outer) in each knee, connected to the upper part of the tibia and to the joint capsule.

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Meniscus injuries are among the commonest orthopaedic problems.
They happen in all ages, with various mechanisms and may be isolated or accompanied by injuries to other joint structures (eg rupture of the anterior cruciate).

They are quite frequent in athletes, while in elderly people meniscus tears are usually degenerative and can happen as a result of minor stress (for example, squatting).

Symptoms of meniscus tear are: pain, possibly with knee swelling or intraocular fluid collection, stiffness and restriction of joint mobility, a feeling of bouncing within the joint, and less often, a sense that the joint “locks” in a certain position.

A diagnosis of meniscus tear can be made by taking into account the manner in which the injury came about and the findings of clinical examination.

The most conclusive test is MRI of the knee. In case its findings are doubtful, a diagnostic arthroscopy sets a definitive diagnosis.

Therapy depends on type and degree of tear. Small tears in the periphery of the meniscus have a good prognosis with conservative treatment, because this area has a good blood supply and therefore, a high chance of healing.

Conservative treatment consists in resting, icing and physiotherapy combined with non-steroidal anti-inflammatory drugs. In contrast, large tears, tears away from the periphery or cases where there is a detached free-standing part of the meniscus within the joint are treated surgically.

Surgical treatment is adapted to the type of tear, age and activities of the patient. It is conducted by arthroscopy, under general or spinal anaesthesia and may consist in partial removal of the damaged meniscus or in sewing the parts together. Duration of the operation is about 30 minutes and the patient is released from hospital on the same or on the following day. After that, the patients follow a special rehabilitation program with or without the aid of a physiotherapist.