Meniscus surgery, meniscectomy
During meniscus surgery, the injured part of the meniscus is removed or re-fixed with minimally invasive arthroscopic intervention. In general, the injury indicating surgery is commonly referred to as cartilage detachment, but this is not entirely accurate, as we distinguish several types of rupture depending on the conditions of the injury. However, it is important to emphasize that in the absence of treatment, even the slightest tear can be further damaged and can lead to detached as a result of regular strain.
What is a meniscus and where is it located?
The meniscuses, or cricoid cartilages, are a formation of two crescent-shaped, fibrous cartilages. They are located inside the knee joint, where the femur and tibia meet.
They play an important role in knee function:
- improve insertion, reduce femoral and tibial shape differences
- distribute the pressure between the joint surfaces
- they absorb mechanical shock to joint surfaces
- promote knee stability
If any of these functions are impaired, the knee will be subjected to increased strain, which will sooner or later be accompanied by complaints.
Meniscus tear
The meniscus (cricoid cartilage) can become torn or injured as a result of trauma to the knee joint and can gradually wear out with age and with regular exercise. If the injury also involves cartilage ablation, it is recommended that the detached piece be removed as soon as possible to avoid damage to the hyaline cartilage at the end of the joints.
Injury to the medial meniscus is more common because it is better attached to the joint capsule, so it can dodge less and be more easily pressed between the articular surfaces. Tear of the meniscus can occur as a result of acute or chronic exertion. Traumatic (acute) rupture is most often caused by a sudden force on the knee joint. This type occurs more often in younger, active athletes, and is often associated with ligament injury. Regular, concentrated strain in one place (repetitive microtraumas) can also weaken the cartilage, the occurrence of this so-called degenerative rupture is more common in older age.
What are the symptoms of cricoid cartilage injury?
- the knee might swell
- sudden, severe pain, typically in the articular gap
- pain in the articular gap mainly due to rotational movements
- in case of meniscus tear, the knee cannot be fully extended or bent
- you keep the knee slightly bent due to pain as the torn part wedges between the articular surfaces, thus inhibiting its movement
- a snapping sensation may also occur when moving the knee.
How can meniscus injury be diagnosed?
If a knee injury is suspected, the traumatologist or orthopaedic specialist will first make a case history of past and present illnesses, possible knee injuries, surgeries, and then question the circumstances of the present injury.
Then the specialist examines the painful joint and, if necessary, compares it to the intact one. The physician checks the pressure sensitivity by touch, locates the exact location of the pain, checks the function of the patella. This is followed by an examination of the movements: examination of the extent of active and passive movement of the knee, and finally the stability of the knee joint to determine any ligament tear.
If meniscus injury is suspected, the specialist also performs specific tests (so-called meniscus tests) depending on whether there is a suspicion of rupture of the medial or lateral meniscus. In doing so, the doctor examines the direct pressure sensitivity and then performs rotation tests: in most cases, meniscus injury can be diagnosed on the basis of pain caused by leg rotation in the case of suspected medial meniscus injury and by rotation of the leg in case of suspected lateral meniscus injury.
There is a good chance that the cartilage damage can be diagnosed with a physical examination, but for accurate assessment or in case of uncertain symptoms or unclear physical examination, an MRI examination is recommended.
How can meniscus injury be cured?
Meniscus tear is treated with surgery, by re-fixing or removing the ruptured part, which is performed by a knee specialist orthopaedic surgeon. In our hospital, meniscus injuries are treated with an arthroscopic procedure. This precise, minimally invasive technique allows much faster healing. Without open exploration, cartilage can be healed with minimal tissue damage.
Meniscus surgery is performed under general anaesthesia or anaesthesia near the spine, during which the leg avascularised from the femur downwards with a tourniquet. The knee specialist makes several, approx. half a cm incisions next to the patellar tendon, through which the surgeon introduces the arthroscope and the special tools needed for surgery. The joint is filled with physiological saline so that the knee is clearly visible, as well as injuries and degenerative lesions. During meniscus surgery, the goal is to save the cartilage of the knee joint as much as possible, because its removal increases the instability and accelerates the wear of the cartilage surfaces.
The torn, pinched part is excised by the doctor, or in a favourable case, lesions in the so-called red zone are fixed back to the cartilage base. At the end of the surgery, the surgeon closes the wounds with small stitches.
After a day’s hospital stay, the patient can leave for home after learning the necessary gymnastics and walking exercises. After partial meniscus removal, the operated knee can be loaded the next day, but in the case of a sutured meniscus injury in the red zone, 4 weeks of relief/crutching and thrombosis prevention treatment are required.
If an early complication does not develop, the sutures will be removed after a week, and rehabilitation may begin if necessary. The patient may return to a lifestyle of average activity one week after partial meniscus removal, but exercise and strenuous physical work are recommended only gradually, 3 to 6 weeks after surgery. In the case of a sutured meniscus injury, gradual loading of the limb may begin on the 5th week after surgery.
