Dr. DeLee Talks About Torn Meniscus of the Knee
The meniscus is the most commonly injured structure in the knee. The
injury can occur in any age group. In younger people, the meniscus is
fairly tough, and tears usually occur as a result of a fairly forceful
twisting injury. The meniscus grows
weaker with age, hence, in older people meniscus tears occur as a
result of fairly minor injury, such as the up and down motion of
squatting.
There is a meniscus on either side of the knee joint. The
meniscus acts like a gasket between the femur and the tibia. The
meniscus can be torn in several ways. The entire inner rim of the
meniscus can be torn in what is called a bucket handle tear. The
meniscus can also have a flap torn from the inner rim, or the tear can
be a degenerative type tear where a portion of the meniscus is frayed
and torn in multiple directions.
SYMPTOMS
The most common problem caused by a torn meniscus is pain. The
pain may be felt along the joint line where the meniscus is located or
may be more vague and involve the whole knee. If the torn portion or
the meniscus is large enough, "locking" may occur. Locking occurs when
the fragment of meniscus gets caught in the hinge mechanism of the knee
and will not allow the knee to straighten completely.
There are long-term effects of a torn meniscus. The constant rubbing of
the torn meniscus on the articular cartilage may cause wear and tear on
the surface, leading to arthritis of the joint.
DIAGNOSIS
Diagnosis begins with a history and physical examination. The
examination will try to determine where the pain is located, whether or
not locking has occurred, and if there are any clicks or pops as the
knee is moved. Routine X-rays will not show the torn meniscus. They are
mainly useful to determine if other conditions are present. An MRI is ordered if the clinical history and
exam are not absolutely diagnostic of a meniscus tear or if the
integrity of the articular cartilage is in question.
An MRI scan
is very good at showing the meniscus. If the history and physical
examination strongly suggest that a torn meniscus is present, then
arthroscopy may be suggested to confirm the diagnosis and treat the
problem at the same time.
TREATMENT
Initial treatment for a torn meniscus is directed towards reducing the
pain and swelling in the knee. This includes rest from painful
activities, exercise programs and possibly medicaion.
If the symptoms continue, surgery will be required to either
remove the torn potion of the meniscus or to repair the tear. Most
meniscus surgery today is done using the arthroscope. Small incisions
are made in the knee to allow the insertion of a small TV camera into
the joint. Through another small incision, special instruments are used
to remove the torn portion of meniscus while the arthroscope is used to
view the inside of the joint.
In some cases, the meniscus tear can be repaired. The
arthroscope is used to view the torn meniscus. Sutures are then placed
into the torn meniscus. The placement of sutures continues until the
tear is repaired. Repair of the meniscus is not possible in most cases.
Young people with relatively recent meniscal tears are the most likely
candidates for repair. Degenerative type tears in older people are not
repairable.
|
|
home |
location |
privacy policy