Meniscus, which is usually familiar to soccer players, is generally known for ending their sporting lives. Anterior cruciate ligament injuries are nowadays the fearful dream of not only athletes but also anyone who strains their knee for any reason. Fortunately, in today’s modern medicine, meniscus tear has taken its place among the easily treatable diseases.
What is Meniscus?
Although meniscus is popularly known as a disease, it is actually the name of a structure in the knee joint. The meniscus, which protects the cartilage, also facilitates the movement of the knee, one of the most used joints of the body. It roughly acts as a hinge between the femur and tibia and is present in sets of two in each knee.
The meniscus, a C and O-shaped structure in the knee joint, is located between the thigh and leg. There are 2 menisci in each knee, called the inner and outer meniscus. The function of the meniscus is to stabilize the knee and prevent cartilage injury by providing suspension. For this reason, it forms an important part of the anatomical structure of the knee.
The O-shaped meniscus is called the external meniscus and the C-shaped meniscus is called the internal meniscus. The meniscus allows the tibia and thigh bones to be in more contact with each other and also ensures a more balanced distribution of body weight.
Another task of the meniscus in the knee joint is to absorb sudden and violent impacts to the knee and to spread the intra-knee fluid to the articular cartilages. This task leads to meniscus diseases.
What are Meniscus Functions?
The meniscus is extremely important for the knee joint and fulfills 4 different tasks.
First Function
The primary function of the menisci is to absorb the load applied to the knee joints.
Second Function
Menisci increase the lubrication of the structures in the knee joint and protect the surfaces of the structures.
Third Function
The meniscus makes the knee joint more robust. This makes the knee joint more durable and flexible. It is located between the bone, ligament and capsule in the knee joint and contributes to the balance of the joint.
Fourth Function
It eliminates the incompatibilities that may occur between the thigh and tibia bones that increase the harmony of the structures in the knee joint with each other. In addition to these, the meniscus structures in the knee joints ensure that the cartilage in the knee is nourished and that the joint fluid is taken into the joint.
How Do Meniscus Injuries Occur?
Meniscus injuries, which athletes frequently encounter in their professional lives, are also seen in daily life. It is especially common in people who stand for long periods of time, carry heavy loads, the elderly and women who do a lot of housework. Meniscus injuries, which occur especially when body weight is placed in one direction, can sometimes occur when lifting heavy loads, squatting or kneeling. These injuries to the meniscus can be categorized under several main headings.
Direct Injuries
Meniscus injuries that occur as a result of direct blows to the knee joint. Kicks to the knee, traffic accidents or falling on the knee are the most common causes of these injuries.
Indirect Injuries
Injuries caused by the torso rotating on the knee when the knee joint is immobilized. These injuries, especially during soccer matches or skiing, occur as a result of uncontrolled rotation of the body on the knee as a result of loss of balance or tripping.
Degenerative Injuries
Degenerative injuries are injuries that occur at an advanced age. Degenerative injuries caused by deformations in the body due to advancing age can be seen even with a slight impact on the body.
Causes of Meniscus Tear
The menisci in the knee joint have a cartilage structure. The most common cause of meniscal tears, which are responsible for maintaining the harmony of the knee joint, is trauma, especially in young patients. The cause of meniscal tears in older age is usually due to a decrease in the quality of the meniscus. The reason for the decrease in meniscal quality at older ages is traumatic events.
Meniscus Symptoms
The first symptom of both meniscal injuries and meniscal tears is pain. The pain usually occurs when the knee breaks when going up or down stairs. For this reason, in the early stages of the disease, patients may not experience any pain when walking on a flat road.
Depending on the level of the meniscus tear, patients may also experience a locking, snapping or clicking sound in their knees.
The last symptom seen in meniscus patients is swelling in the knee area. Patients usually present to physicians with all three symptoms.
Diagnosis of Meniscus Injury & Tear
Patients who consult a physician with the above-mentioned symptoms are first physically examined. It is also important to take the patient’s history during the physical examination. The tests used in the physical examination are the Mc Murray test and the Apley test. In addition, during the physical examination, the orthopedist can also look for any deformity between the knee and the foot joint of the patient and have an idea about the condition of the disease. The presence of deformity in the patient affects the treatment plan. The valgus stress test and the varus stress test, which provide more information during the physical examination, can also be applied for a more detailed understanding of tears in the meniscus. Patients may then be asked for an MRI to determine whether there are other injuries besides the meniscus. This is because a meniscus tear can occur on its own, as well as injuries to the bone and muscle tissues to which it is connected. The degree and type of meniscal tear and the activity level of the patient are important in shaping the treatment.
Mc Murrey Test
It is a test to determine whether there is any problem in the medial or lateral meniscus. In this test, the patient is placed on his/her back and asked to bend the knee. After bending the knee joint at a 90-degree angle, the patient is asked to open it again. During these movements, one hand of the physician is positioned at the knee joint while the other hand is positioned at the patient’s ankle. With the hands in this position, it is much easier for the patient to move the leg more freely and to recognize possible problems. After checking whether there is a restriction of movement by bending the knee, the knee is bent outward without any change in the position of the hands. Finally, the patient’s knee is suddenly opened. The Mc Murrey test is interpreted as positive if there is any sound coming from the knee at this time. If the test is positive, a meniscus tear is suspected.
Apley Compression Test
Another test used to determine whether there is a problem with the medial or lateral meniscus is the Apley Compression test. To perform this test, the patient is first placed face down. The doctor then places one hand on the patient’s heel and the other on the patient’s toes. The test starts with the knee being pushed down by the doctor. In the meantime, the knee can be rotated inwards and outwards to identify the problem area. If the patient feels pain when the knee is rotated outwards, it is understood that the problem is in the internal meniscus structures. If the pain is experienced during inward rotation, external meniscus structures should be suspected.
Valgus Stress Test
In order to plan the meniscus treatment correctly, the inner and outer lateral ligaments must also be examined. For this, the valgus stress test is applied. During the administration of this test, the doctor has one hand on the ankle and the other hand on the outside of the patient’s knee. The knee is then bent 30 degrees and the patient is forced to open the knee. If there is an opening on the inside of the knee at this time, the Valgus Stress Test is interpreted as positive.
Varus Stress Test
The Varus Stress Test, which is the opposite of the Valgus Stress Test, is used to detect tears in the external lateral ligaments. In this test, doctors place one hand on the outside of the ankle and the other on the inside of the knee. In this test, the knee is forced to bend and it is checked to see if any loosening of the external lateral ligaments occurs.
Imaging Methods
In order to correctly determine the treatment of patients with any problems in the meniscus, imaging methods are used in addition to physical examination. Direct radiography, arthrography, magnetic resonance and computed tomography are used for this purpose.
Meniscus Classification
Meniscal tears are classified according to the cause of the disease. The type of tear and location of vascularization also play a role in classification.
Classification according to the Cause of the Disease
Acute tears that occur as a result of sudden trauma despite the absence of any degeneration in the meniscus are included in this class. Degenerative tears that normally occur as a result of knee loading can also be seen.
Classification by Shape
There is a classification according to the shape of the tear in the meniscus tissue. Within this class, vertical tears are called longitudinal and horizontal tears are called horizontal. There are also radial, flap and complex tears.
Classification According to Vascularization Characteristics
Meniscus tears are divided into three according to their vascularization. Patients with red-red areas have vascularization on both sides of the meniscal tears. There are usually no problems in the healing of these tears. In the red-white area, vascularization is seen only on one side of the meniscus tear. Healing rates are lower in these tears. Finally, in the white-white area, there is no vascularization on both sides of the meniscal tear and the likelihood of such tears responding to treatment is extremely low.
Meniscus Treatment
The degree and location of meniscal injuries are important in the planning of meniscal treatment. First aid in acute situations includes applying ice to the affected area and elevating the knee higher than the body. In case of chronic pain and hardening, intervention as soon as possible is of great importance for the quality of life of patients. For this reason, meniscus treatment should start as soon as complaints start to appear.
If the symptoms are ignored, it significantly affects the daily lives of patients, especially their sports activities. In addition, meniscus tears that are not treated in time cause wear on the bones and joints, leading to gonarthrosis, commonly known as arthritis. can cause disease.
Arthroscopy (Closed Method)
Today, arthroscopy is the most commonly used method in the treatment of meniscal tears. The full name of the operation is arthroscopic meniscectomy. In this method, the inside of the joint can be observed without making large incisions in patients with guide devices with a camera at the end. With the same medical device, the problematic meniscus parts are removed or repaired. After operations performed with the closed method, patients are discharged immediately. However, it may take 3 to 4 weeks for patients to return to their daily routines. However, surgery is not necessary for every meniscal tear. Especially in the treatment of meniscal tears in young patients, the rate of recovery with non-surgical methods is extremely high.
Some patients may have severe bleeding due to a meniscal tear. Since this is a situation that definitely requires intervention, operation is preferred. In some patients with no blood supply, it may be necessary to clean the meniscus due to the condition of the meniscus structure. In some patients, part of the meniscus structure may need to be removed, while in others the meniscus structure may need to be completely removed.
Exercise and Medication
In patients with low-grade meniscal tears, the meniscus can return to its former structure with medication and regular exercise. In addition to the exercise and medication recommended by the doctor, patients should also rest in order for the treatment to be successful. Failure to adhere to the physiotherapy plan recommended by the doctor causes the tear to progress. It is also recommended that the physical therapy applied in the treatment of low-grade meniscus should continue for 1.5 months. The aim of physical therapy in meniscal tears is to preserve the mobility of the knee and to restore the knee.
In the treatment of meniscus tears, medication and physical therapy are primarily applied. For this, it is important to apply ice to the area where the tear is located, while nonsteroidal medication is also used to reduce pain and swelling. This treatment also requires protection of the patient’s knee. Elastic bandages and rest are also included in these procedures to prevent the tear from recurring. If the patient has other problems in addition to the meniscus tear, then steroid injection therapy is also used.
Natural Treatment Methods
The meniscus is an extremely important structure for the knee joint. Vitamins and minerals can be used to support this structure. Drinking vinegar prepared at home helps to heal the meniscus structure. You can also add ginger, rose hips, lemon and salt to the vinegar.
