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Meniscus injury – Injury of the knee joint

The most famous part of the knee is definitely its smallest component, a little meniscus. Made from cartilage, looking like crescent moon or letter „C“, it serves its purpose as long as it can take all the pressure and stress we provide it with on a daily basis. When it finally gets damaged or broken, the knee gets blocked, often swells and becomes completely unusable. The only solution is operation.

The basic role of the meniscus is stabilizing the knee while moving. Considering that the ball of the knee joint is cylinder-shaped, and the socket very shallow (almost flat), there is always  a danger of sliding and slippage. This danger is lessened precisely by the meniscus, which is positioned on the edge of the socket, making it deeper. Simply put, this means that meniscus provides a deep plate. But things aren't that simple, so we have two different joint sockets in the knee, and thus two menisci (outer and inner).

Certain knee movements can damage the meniscus, usually those that are quick and sudden, when the muscles and tendons don't have the time to fixate all the segments, so ligaments and joint capsule are under a lot of pressure. Also, the ball of the joint pressures the meniscus itself. Damage can happen at once, but it's far more common to have a few smaller injuries which in the end result in rupture, with abovementioned swelling and knee blockage.  When this happens, no standard therapy has a result, only operational procedure, which is nowadays performed by arthroscope, leaving a slight two centimeter scar, each on the one side of the joint. After the procedure follows a speedy recovery, with the ability to walk already on the second day, and athletes go back to running after a week. You might wonder how is that possible if the meniscus is so important for knee function?

One of the reasons is the ability of the knee to compensate, seen in more tension in the tendons surrounding and stabilizing the joint. Second reason is the body trying to subtitute the removed meniscus, developing a similar formation made of tissue with weaker characteristics than the cartilage. So in a relatively short period of time the joint becomes capable to fully function after the operation.

Smaller menisci damage which cause pain and smaller knee blockages, but do not compromise movement, are a different story. Treating these conditions can be various, but it doesn't involve operation. Experience shows that classic physical therapy helps only with inflammation and pain, so ultrasound, laser, magnetic therapy and electrotherapy are used on a regular basis. But only regular exercising can lead to knee stabilization through strengthening leg muscles, which then effectively transfer the forces of movement in every direction. This means that the pressure on the meniscus is smaller, and so is the risk of its further damage. Other than pure strength and durability of the muscle, later we must improve the speed of reaction, balance, and explosiveness, all in order to prevent repeated or new injuries.

We must say that diagnosing meniscal lesions presents a special problem. Classic physicall exam (when the doctor spins the knee and tests it) can only establish a possibility of the injury. Very often the cartilage and meniscus damages have almost identical symptoms, and their treatment can be very different. Magnetic resonance is a very precise method of establishing this, but not quite completely correct. Only arthroscopy and direct visual examination can provide with certainty the cause of pain and blockage, followed by a decision on further treatment. But arthroscopy is an operational procedure and even though it is minimally invasive and is safe, we perform it only when there is a great risk of endangering the knee's mobility.

Long-term experience with patients that have in the past arthroscopically removed one or both menisci from one or both knees shows that they have more chance to develop osteoarthritis, the knee artrosis, much faster than those who didn't have their menisci removed or injured. That is why today orthopaedists try hard to save this small cartilage formation whenever possible, meaning that often instead of complete meniscectomy (removing the entire meniscus) we decide to do a partial one. With certain injuries we even opt for suturing the meniscus.

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