MENISCUS SURGERY

What is Meniscus? What it works for?

Creator of the knee joint, placed between the thigh and leg bones, placed as one externally and one internally, in crescent-shaped, fibrous cartilage structures such as auricle, is called ‘meniscus’.

The meniscus is located in the joint between the bones that make up the knee joint and are responsible for distributing the loads from the joint in a balanced manner. With their pressure-absorbing, shock-softening properties the meniscus act as a shock absorber in vehicles and play an extremely important role in the terms of joint health.

How does a meniscus tear occur?

The knee joint is the most frequently injured area in the human body and the most common cause of surgery is meniscus tears. Contrary to popular belief, meniscus is a health problem that can occur not only in athletes but also in every part of society and at any age.

Meniscus tears develop as a result of serious difficulties such as sports trauma and traffic accidents. As a result of rotation on the fixed foot, the meniscus is torn between the knee bones and rupture.
In the elderly, the already worn meniscus can be torn as a result of small movements.

In children, congenital abnormalities of the meniscus (such as discoid meniscus) may pave the way for early tears.

What are the signs of meniscus tear?

Meniscus rupture by force in youth causes to; pain, stinging or tearing sensation in the patient’s knee. Intra-knee haemorrhage may occur due to meniscus tear, in this situation swelling is occurred on the knee. In a period of about one month, all complaints are relieved and only the punctual tenderness remains in the torn area. If the torn meniscus stucks under the knee, the knee will lock. In this case, the patient cannot open or close its knee. If the knee is forced to move, sometimes the knee movements can become available with the feeling of jumping. In both cases, the tear is large and requires immediate surgery.

Ruptures in elderly patients cause milder complaints. Pain is not unbearable if cartilage wear has not occurred. Occasionally there is a feeling of stuck, but locking is rare. Swelling may occur due to fluid increase in the joint.

In children with discoid meniscus, a feeling of jumping is seen in the knee. When a rupture occurs pain increases, entanglement and locking may occur.

How is meniscus rupture diagnosed?

Diagnosis of meniscus rupture is made by the mechanism of event, complaints of the patient and knee examination. The location, shape and size of the meniscus tear can be determined with an accuracy of 95% by MRI. In addition, cartilage, anterior cruciate ligament and lateral ligament injuries associated with meniscus tear can be detected on knee MRI. It is possible to diagnose meniscus tears by arthroscopic examination which cannot be detected despite all examinations.

How is meniscus rupture treated?

In case of pain in the knee after trauma; ice and bandage are applied in the early period; pain medication is taken and being rested. Then you should consult your orthopaedic surgeon as soon as possible.
Early treatment is the ideal treatment, especially in young patients, because the torn meniscus usually does not heal itself. If the meniscus tear is not treated early, serious damage to the joint cartilage may occur over time. As a result of this, in early phase knee pain and limitation of movement and in late phases arthritis may develop in young ages due to permanent cartilage damage.
Elderly patients may require surgical treatment if they show signs of knee entangling and locking. If these findings do not exist, conservative treatments are applied.

In today, meniscus tear is treated with closed method (arthroscopic surgery).

Knee arthroscopy is performed through two 0.5 cm incisions. One of the two entrance holes is inserted into the joint by means of a thin tubular fibreoptic instrument called arthroscope and from the other the instruments to be used in surgical procedure are inserted. The arthroscope is connected to the screen through a camera. In addition, serum is injected into the joint to ensure that both the knee is washed and the image is clear. In this way, the surgeon can see the inside of the knee clearly from the screen and intervene in the knee structures.

Meniscus operations that can be performed with arthroscopic surgery can be grouped under three headings?

1- Arthroscopic Partial Menisectomy:

The problem is the removal of the torn meniscus. It is applied for internal tears where the meniscus is less blooded or damaged, torn and irreversible meniscus tears. Patients can walk on the same day after surgery and return to work within a few days.

2- Arthroscopic Meniscus Repair:

Since the blood vessels coming from the joint capsule adequately nourish the 1/3 outer edge of the meniscus, this region is suitable for tear repair. Postoperative patients may return to work and sports after 6 weeks to 6 months depending on the shape of the tear, the durability of the repair, and the work they perform.

3- Meniscus Transplantation:

These methods are used in young patients whose meniscus has to be removed. Synthetic (meniscus scaffolds) or meniscus from the cadaver are used for transplantation. Meniscus scaffolds are only used for partial meniscus losses and are sutured to the extracted part of the meniscus. The meniscus transplantation from the cadaver is performed in a limited number in our country and it is performed when the entire meniscus is removed. 10-year follow-up success is between 60-80%.