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The knee joint is one of the largest and the most complex joint in the body. The joint is made up of the femur (thigh bone), the tibia (shin bone), and patella (kneecap). Between the femur and the tibia lie two wedge-shaped pads of cartilaginous tissue called menisci, which serve to reduce friction in the joint as well as act as shock absorbers. The two menisci present in the knee are the lateral meniscus on the outside and medial meniscus on the inside of the knee.

The meniscus helps in even distribution of the body weight across the knee joint. As the substance is tough and rubbery it cushions the joint and keeps it stable. It also protects the articular surface of the tibia and assists in rotation of the knee. As secondary stabilizers, the intact menisci interact with the stabilizing function of the ligaments and are most effective when the surrounding ligaments are intact.

Meniscal tears are one of the most frequently reported injuries to the knee joint. Meniscal injuries occur when upper leg is rotated or twisted without moving the foot. Sudden meniscal tear occurs among athletes, especially those involved in contact sports. During sports activities, an athlete may suddenly bend or twist the knee causing the meniscus to tear. This is a traumatic meniscus tear. Elderly people are more prone to degenerative meniscal tears as the cartilage wears out and weakens with age.

Most parts of the meniscus have no blood supply and because of this reason the damaged meniscus is unable to undergo the normal healing process that occurs in the rest of the body. Typically, when the meniscus is damaged, the torn pieces begin to move in an abnormal fashion inside the joint. The symptoms of a meniscal tear include pain over the inner or outer side of the knee where the tear occurred, swelling, stiffness, tightness, and reduced range of motion. The source of knee pain should be evaluated to determine the treatment options for pain relief. Depending on the medical history and physical examination, your doctor may order diagnostic tests such as X-ray and MRI fully diagnose the condition.

Immediately following a knee injury, you should initiate RICE method of treatment. Rest the knee as more damage could result from putting pressure on the injury. Ice packs can be applied to the affected area for 15-20 minutes four times a day for several days. This helps to reduce swelling and pain. Compress the knee with an elastic bandage or compression stocking to minimize swelling and to provide support. Keep your leg in an elevated position at orabove the heart level to reduce swelling. Anti-inflammatory medications may be prescribed to reduce pain and swelling. You may need crutches temporarily to assist in limiting weight bearing. Physical therapy may be recommended for muscle and joint strengthening. Immobilizers such as a soft brace may be applied to the knee to keep the joint stable.

Often, non surgical treatment can be provided which might include corticosteroid injections and or physical therapy. Many patients with meniscus tears also have arthritis and surgical outcomes can be less predictable. Your surgeon may recommend surgery, however if the conservative treatment options fail to relieve your knee pain or if your knee continues to lock and is not healing. The timing an surgical treatment recommended will depend on the type of tear, location and extent of the tear.

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Surgical procedures

Meniscus Repair

Meniscal repair depends on the extent of the tear and the blood supply to the region. A torn meniscus will be evaluated for the possibility of repair. When indicated, meniscal repair may decrease the chance for osteoarthritic change and the impact on sports activity in the long-term as compared to partial meniscectomy. Meniscal repair involves the use of sutures or implants to reduce and fix the meniscal tear through an arthroscopic procedure. The goal is to repair any meniscal tear if appropriate. If the tear is not repairable then partial meniscectomy will be recommended. A thorough discussion with your surgeon will help determine the best course of action.

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Post operative care

Rehab protocol

Meniscectomy

Meniscectomy is a surgical procedure to remove the torn portion of the meniscus from the knee joint. This procedure is done arthroscopically, and the torn meniscus is removed and the remaining edges of the meniscus are smoothed so that there are no sharp ends. Any unstable fragments which are causing locking and catching sensation will also be removed.

Dr. Cole’s related publications

Post operative care

Rehab protocol