Meniscus Tear

What is a meniscus and what does it do?
Before arthroscopic methods were available, menisci were thought to be useless remnants and every patient with knee pain was considered to have a meniscal tear and the menisci were removed during surgery. In recent years, however, it has become clear that the menisci have very important functions for the normal function of the knee.

Located between two bones (femur and tibia), the menisci act like a cushion, protecting the articular cartilage from abnormal loads. They are very important in carrying and transferring the loads on the knee. They also increase the compatibility of the joint surfaces and contribute to the intra-articular circulation of joint fluid. In the absence of menisci, loads on the knee joint are transferred directly to the articular cartilage, leading to premature wear and tear (osteoarthritis). Today, protecting the menisci has become a top priority.

How do meniscus tears occur?

The way meniscal tears occur in young and older people is different. In young people, trauma is required to tear the meniscus. This usually occurs during rotational movement on a stationary foot. Examples include tears that occur in sports such as soccer, basketball and skiing.

Over the years, the menisci lose their strength and flexibility and start to deteriorate. Deteriorated menisci can tear much more easily. In older people, meniscus tears can occur with a simple squat or tripping on a carpet.
The outer meniscus is more mobile than the inner meniscus, so tears of the inner meniscus are more common. Although rare, menisci may have congenital deformities. This type of meniscus is more susceptible to tears and can cause symptoms even at a young age.

What are the symptoms of meniscus tears?When meniscus tears occur, patients usually feel a sudden stinging pain or tearing. Depending on which meniscus is torn, the pain is more pronounced on the inside or outside of the knee. Within a few hours, swelling of the knee joint occurs due to fluid or blood pooling inside the knee. It is usually possible to step on the injured knee, but there is a limp and athletes often have to stop playing sports. If the injury is severe, meniscal tears may be accompanied by ruptures of the cruciate or lateral ligaments of the knee joint. In this case, symptoms such as insecurity and a feeling of emptiness in the knee may also occur. Sometimes the torn meniscus piece gets stuck between the bones that make up the knee joint and prevents knee movement. In this case, known as locked knee, surgical treatment should be performed at an early stage.

Over time, the diffuse pain in the knee decreases and becomes localized over the affected meniscus. The pain occurs especially during sudden turns and squatting. Torn meniscus fragments can get between the joint surfaces and cause symptoms such as sticking and locking of the knee. This can also lead to crunching noises that were previously absent in the knee.

How are meniscus tears diagnosed?

In order for your doctor to diagnose a meniscus tear, he or she will first ask you to describe how it happened. He or she will then examine your knee and look for signs of a meniscus tear. He will also examine your lateral and cruciate ligaments. After a good history and physical examination, the diagnosis of a meniscus tear is largely revealed. Your doctor may order X-rays to assess the amount of wear and tear on your knee and to see if there are any other problems with the bone structures. In recent years, the most reliable method to confirm the diagnosis of meniscal tears is magnetic resonance imaging (MRI) of the knee joint.

The accuracy rate of MRI in detecting meniscal tears is over 95% if performed properly and evaluated in experienced hands. However, MRI is not the only determinant in deciding on treatment. In some cases, a tear may appear as if there is a tear when there is no tear (false positive result) or, on the contrary, a tear may be present but not detected on MRI

Especially if previous surgical treatment of the meniscus has been performed, the margin of error increases significantly and further diagnostic methods may be required. Therefore, when deciding on your treatment, your doctor will take into account not only the MRI findings but also your history and physical examination findings. In some cases, all of these diagnostic methods may be insufficient. In this case, the diagnosis is confirmed by arthroscopy.

What are the treatment options for meniscal tears?
The treatment of meniscal tears in young people is mostly surgical. The menisci do not have the ability to heal spontaneously, except for some very rare small tears that are not full-thickness. In patients with significant complaints, surgical intervention is attempted to repair the meniscal tear, and if the tear is not suitable for repair, the torn part is removed.
In older patients, meniscal tears are usually accompanied by arthrosis (wear and tear, calcification) of the knee. In this case, intervening only in the meniscus tear may not completely solve the problem. In this case, your doctor will decide on medication to suppress the symptoms, intra-articular injections, arthroscopic surgery or arthroscopy and bone-correcting surgery.

Can the meniscus be sutured, how is meniscus repair done?
Repair is the first option for meniscal tears in order for them to fulfill their function, which is crucial for the long-term health of the knee. Due to the vascularization of the menisci, their healing ability is not very high and roughly one-fifth of meniscal tears are amenable to repair. Today, meniscal repair is performed with arthroscopic surgery. Depending on the strength of the repair and the presence of other interventions (e.g. cruciate ligament surgery), you may need to use crutches and avoid squatting for a few weeks in the postoperative period. Return to sports may take between 4 weeks and 4 months. The success rate of meniscal repair varies between 70 and 95% depending on the type of tear and the type of surgery performed. Despite the repair, the meniscus may not heal or may tear again. In other words, a second surgery may be necessary in 5-30% of patients who undergo meniscal repair. Although the failure rate seems high, this risk is acceptable considering the wear and tear that would occur in the knee without the meniscus. If the repair is unsuccessful, the torn meniscus can be removed with a simple surgery.

What is meniscus removal (meniscectomy)?

If your doctor decides that your meniscus tear is not suitable for repair, the torn meniscus is removed. This procedure is called meniscectomy. During this procedure, only the torn part is removed and the remaining intact part of the meniscus is preserved. This is called partial meniscectomy.
The more meniscal tissue that can be preserved, the better for the long-term health of the knee. This is because the remaining meniscus tissue continues to carry a partial load. The early results of partial meniscectomy are very good. There is no need for a serious rehabilitation program after surgery. It is often possible to return to normal life and sports within a few days or weeks after home exercises.
In more than 15 years of follow-up, about one fifth of patients who undergo partial meniscectomy may develop signs of knee wear. These symptoms are more severe in patients who have had the outer meniscus removed than in those who have had the inner meniscus removed.

What is a meniscus transplant, is there an artificial meniscus?

Studies on the production and transplantation of synthetic meniscus tissue instead of tissues taken from another person are ongoing. With today’s technology, synthetic meniscus tissues can only be used in partial meniscal losses.