Meniscal injuries

Most Meniscus injuries (meniscus lesions) happen during sports, through an accident or an uncontrolled movement in which the knee is twisted too much. The meniscus often tears, which leads to instability of the complicated knee apparatus and the lesion of the meniscus has to be operated on. But there are also degenerative changes in the menisci when cartilage mass shrinks.

What are meniscus injuries?

Damage to the cartilage disc located in the knee joint Meniscus injuries (meniscus lesions) In the knee joint area of ​​all mammals there are two larger menisci.

There is a lot of weight on a person's knee and it is used more than any other part of the body in the course of a person's life. The knee joint is a complex structure made up of bones, muscles, tendons, vessels and cartilage.

The menisci are two supporting, large cartilaginous ligaments of the knee, which run around the bony kneecap. They contribute significantly to the hold of the whole structure and enable people to walk and flex and stretch movements. If the cartilage of the meniscus tears due to incorrect movement, excessive rotation or a hard impact, the stability of the entire knee joint is impaired.

Many athletes and especially soccer players therefore suffer one or more meniscus tears in the course of their athletic lives. The degenerative changes in a meniscus manifest as osteoarthritis.

Meniscus injuries can result primarily from the effects of force (e.g. in an accident) or cartilage wear, as well as from a combination of both factors. In addition, congenital malformations of the meniscus trigger a meniscus injury. Meniscus injuries are differentiated according to the location of the lesion (back, center, or front) and the shape of the damage.

Menisci represent a wedge-shaped and crescent-shaped cartilage disc. Each of the knee joints has an outer and an inner meniscus, which are located between the head of the shinbone (tibia) and the thighbone (femur). The meniscus ensures that these two bones, which have differently shaped surfaces, work together smoothly.

The two knee joint menisci absorb about 30% of the weight loads and ensure an even distribution over the joint. Meniscus injuries endanger the stabilizing, shock-absorbing, braking and load-distributing effect of the menisci.

causes

Meniscal injuries are, as already indicated, often triggered by abrupt movements. These include a sudden turning or a violent stopping, as happens particularly often in some sports (e.g. football, tennis or alpine skiing).

The combination of high pressure and rotary motion often causes both ligament and meniscus tears. Movement sequences that are carried out regularly over long periods of time (e.g. long-distance running) put stress on the cartilage and can cause meniscus injuries.

Since menisci only renew themselves to a limited extent, they lose part of their efficiency with increasing age. Over the years, they begin to become brittle and develop cracks, so that even moderate use of a meniscus can lead to a crack.

There is also the possibility that misalignments of the legs cause meniscus injuries (meniscus lesions). With "bow legs" the inner meniscus is more likely to be injured, while with "knock knees" the outer meniscus is more at risk.

Symptoms, ailments & signs

Meniscus injuries (especially the meniscus tear) are noticeable through typical pain characteristics, which in most cases occur as a function of certain movements. The pain conditions differ depending on whether the inner or outer meniscus is affected.

The outer meniscus is particularly painful when the knee is rotated inward or when the patient crouches, i.e. brings the knee joint into strong flexion. Even if the inner meniscus is injured, the knee hurts in a bent position, but also often when the patient gets up from a crouch. In the case of meniscus injuries on the inside of the knee, external rotation of the knee is also associated with pain.

Both meniscus injuries are felt with a sharp, light pain during the movements mentioned. In addition, there is pressure pain. if the patient or doctor is at the cleft of the knee joint where the upper and lower legs meet. With a little practice, this gap can also be felt by the layperson.

In the case of injuries to the outer meniscus, the pressure pain is felt at the lateral knee joint space, and in the case of damage to the inner meniscus, the medial knee joint space. Problems with walking combined with sharp knee pain also indicate meniscus injuries. This is especially the case if there was a fall or confrontation while doing sports. A palpable effusion can indicate inflammation.

Diagnosis & course

The patient usually notices immediately that the meniscus is torn or torn. Affected patients report that the tear in the meniscus could be heard with a bang.

The doctor can often detect a meniscus tear through a physical examination. The kneecap has slipped or is at least very easy to move and no longer has a hold. The diagnosis is confirmed by arthroscopy, in which a probe with a small miniature camera is inserted into the knee area.

Now the doctor can identify the tear or several tears in the cartilage of the meniscus. If an arthroscopy device is not immediately available, an ultrasound examination can also serve as an initial diagnosis. More detailed examinations must be carried out as soon as possible in the hospital or in an orthopedic practice.

Basis of a diagnosis Meniscal injuries In addition to the acute symptoms, they also provide information from the patient about long-term stress and accidents in the past. The doctor can usually diagnose meniscus damage as well as possible further knee joint injuries with just a few movements and tests.

If an effusion has formed in the knee joint, fluid can be removed by puncturing the joint and analyzed to aid the diagnosis. An X-ray provides information about possible bone injuries and cartilage wear. If there are still doubts, as already noted, an arthroscopy (knee joint mirroring) or magnetic resonance imaging (MRI) usually leads to a clear diagnosis.

If meniscus damage is not treated in good time, joint effusions can expand and further cartilage damage can develop, which can cause osteoarthritis. Occurring tears can expand and even tear off the meniscus.

If the meniscus damage is located in an area of ​​the cartilage with sufficient blood supply, meniscal lesions have a good chance of recovery.

In some people, a meniscus tear is almost painless, while others complain of pain in the knee area. Normal walking is no longer possible after a meniscus tear and the patient has to undergo an operation.

The meniscus tear is usually not treated as an emergency, but surgery is also not waited longer than absolutely necessary, otherwise the cartilage could suffer further damage from stress. The knee is supported by a bandage until the operation, the plastering of the knee that was previously used is now controversial both before and after an operation.

Complications

Depending on the severity of the meniscus injury, the injury is treated either surgically or, in lighter cases, locally. If, as a result of a serious injury, an operation finally occurs, this, like all other operations, is associated with certain risks. One possible complication - especially with the open surgical method - is secondary bleeding.

Another risk are infections caused by certain germs in the wound. An infection in the knee joint is a very unfavorable disorder in connection with a meniscus injury, as the inflammation can lead to severe damage to the knee joint cartilage. Infection after meniscus surgery is rare, however, as the surgical procedure is always performed under sterile conditions.

In some cases the pain can persist even after meniscus surgery or reappear after a certain period of time. If the meniscus is replaced, there is a risk that the implant will tear as well. Another complication after a meniscus replacement is an effusion in the knee. This would make a puncture of the knee a necessity. These aftereffects can show up, but in reality they are very rare. After a meniscus operation, you should always be aware of the risk that the meniscus could tear again later.

When should you go to the doctor?

If the person concerned suddenly experiences musculoskeletal problems, there is a health impairment that must be examined and treated. Medical care is required if mobility is restricted. If you experience pain in a resting position, experience pain when touching or exerting pressure on the knee or while moving, a doctor should be consulted. A meniscus injury is characterized by pain while the person concerned is straightening up from a crouching position or is in a bent posture. A loss of the usual physical performance as well as disturbances in normal movement sequences are signs of an existing disturbance. A doctor should be consulted if the symptoms do not improve.

If the knee swells, the skin is discolored or the knee becomes warm, a doctor should be consulted. If the symptoms set in immediately after a sudden movement, an accident, or while exercising, a visit to a doctor is recommended. If an effusion can be felt on the knee joint or if the optical shape of the knee has changed, a doctor is required. If turning the knee inward is associated with discomfort, a doctor should be consulted. In the case of a meniscus injury, cooling the knee joint is felt to be pleasant and pain-relieving. It should be carried out until the examination.

Treatment & Therapy

The actual operation of the Meniscus lesion takes place either under partial or general anesthesia. The knee is tied off and a small incision is necessary near the area to be operated on. Large surgical incisions are no longer necessary with today's invasive technology.

The surgeon uses arthroscopic surgical equipment to remove dislocated cartilage, put the torn off parts of the meniscus back together and sutured them. In some patients, the meniscus is torn in two, three, or even more pieces. Then the wound is sutured and the leg is bandaged.

A patient who has operated on the meniscus therefore needs a lot of patience to get the knee back to work. Physiotherapy for the operated knee is usually started a few days after the operation. If the movement of the knee is not trained, it threatens to stiffen. The appointments with the physiotherapist or the orthopedist must therefore be kept by the patient.

Physiotherapy is painful and the treatment can drag on for months, or even years for older people. In the first weeks and months after the operation, the doctor will again perform arthroscopies in order to be able to observe the healing process. He will also remove wound water through puncture, which can repeatedly accumulate in the knee.

There is no guarantee that the meniscus will not tear again. To support the actual operation and also in the case of osteoarthritis, an attempt can be made to build up cartilage by injecting hyaluronic acid into the aftercare.

The aim of treatment for meniscus injuries is on the one hand to bring about freedom from pain or at least pain relief and on the other hand to restore the functionality of the joint. Conservative, non-surgical therapy, but possibly also an operation, can be considered. If there are only minor injuries to the meniscus, treatment is conservative with medication and exercise therapy.

Often, however, an operative intervention is necessary, in which one tries to preserve the cartilage as much as possible. Before starting conservative therapy, the patient is informed about the natural course of the disease. The doctor also gives advice on everyday behavior that is gentle on the knee joints. In the future, sports should not be practiced that require too many abrupt changes in movement. The patient should also avoid squatting postures that are too low.

The muscles of the thighs in particular are strengthened with specially designed physiotherapy. Electrotherapy can also be used as a supplement. Crutches largely relieve the convalescent's knee joints. If there is also inflammation, cooling has a pain-relieving effect. Cortisone-free medication is preferred for painful inflammation.

As noted above, operations are now performed using a knee joint specimen under general or partial anesthesia. Depending on the extent of the damage, operations are carried out on an outpatient or inpatient basis, usually only requiring a one-week hospital stay. A non-arthroscopic, but open operation is usually only necessary if there are ligaments and bone damage in addition to the meniscus injuries (meniscus lesions).

Outlook & forecast

A prognosis depends primarily on the extent of the damage. Age and general health are also decisive for the chances of recovery. The worst way is not to treat it. This usually makes the meniscus injury even bigger. Other areas of the knee such as the ligaments are also damaged in this way.

A meniscus injury is considered a male disease. About twice as many male patients as women appear in doctors' offices. Above all, athletes and employees in physically demanding jobs are considered risk groups. Small damage can usually be treated successfully with conservative methods. After a good two weeks of rest, a gradual exercise can be resumed. Severe damage must be treated surgically. The chances of success are considered good here. Complications only play a minor role. Gradual exercise is possible again after about eight weeks.

Statistically speaking, there is an increased risk of re-injury after a single illness. Before resuming body-intensive activities, the attending physician should be consulted. Depending on the outcome of the therapy, patients may have to accept restrictions. Certain sports are no longer allowed to be practiced, a professional reorientation may be indicated.

prevention

Against Meniscal injuries it helps preventively to avoid deep squatting as much as possible. Sports that put a lot of strain on the knee joints (such as skiing, handball, soccer, and tennis) should be avoided. In any case, there should be a sufficient warm-up phase before sport and the wearing of protectors should not be avoided. Alternative sports such as swimming or cycling as well as gymnastics ensure the mobility of the knee joints in the long term and are therefore a good prophylaxis against meniscus lesions.

Aftercare

In most cases, meniscus injuries are associated with severe pain, which has a very negative effect on the quality of life of the person affected and also significantly reduces it. The person affected should slowly pick up the usual rhythm so that there are no further complaints. Sports activities should be avoided until the attending physician no longer sees any concerns. Sometimes those affected are dependent on help and support from friends or relatives in everyday life in order to cope with this. Adequate rest and a positive attitude promote a quick recovery.

You can do that yourself

If you have a meniscus injury, it is necessary to seek the assistance of a doctor. Despite all efforts, the injury cannot heal completely free of symptoms on its own without medical care. In addition, there are a number of ways that the person concerned can use to improve his or her well-being and ease the symptoms more quickly.

It is particularly important to protect the knee. The joint should be loaded carefully and only according to individual possibilities. If the knee is stressed too much, the symptoms increase. Physiotherapy exercises help with healthy and optimal movement. These can be carried out daily and independently. In order to cope with everyday life, it is advisable to restructure some processes and seek help from relatives or friends. Wearing healthy footwear is also beneficial. High heels should be avoided. Comfortable, closed and breathable shoes in the right size help to prevent incorrect loads or misalignment.

Exercising should be stopped until the end of the healing process. Even afterwards, sports that put a lot of strain on the knee should be avoided or reduced.Sports that are gentle on the joints are more helpful. They include swimming or walking.