Meniscus tear

Definition: What is a meniscus and a meniscus tear?

The menisci are initially two crescent-shaped cartilages that are located between the lower and femur bones. The medial meniscus is located on the inner side of the femur bone and the outer meniscus is on the outer side of the femur bone.

The menisci are used to stabilize the movement of the knee joint when walking. Here, the menisci function in a similar way to shock absorbers, because the pressure is evenly distributed over the musculoskeletal system.

How the Meniscus Works

The meniscus works in a similar way to a shock absorber: it is responsible for the healthy balance and biomechanics in the knee joint. The connective cartilage consists primarily of elastic building blocks, which consist of one third of collagen and two thirds of hydrogen.

This is different from medial meniscus Due to its significantly firmer structure, which is more firmly connected to the joint capsule of the knee joint. The disadvantage is that rotational movements from outside cannot be optimally compensated for. The result is frequent injuries, which can happen more often.

The external meniscus Is much more flexible in comparison, although the structure is the same. The thicker edge of the menisci is firmly attached to the joint capsule, which additionally stabilizes the knee joint. Both menisci strengthen the movement of the knee joint, distribute pressure and absorb shocks. At the same time, they oil the joint cartilage and supply it with important nutrients.‍

Which age group is often affected by a meniscus tear?

The rupture of the meniscus is common in young adults who play ball sports, such as soccer. As a result of the increasing load, the probability of a knee injury occurring may increase.

However, older people with reduced meniscal function are also plagued by mechanical blockages of the knee joint, which are caused by cartilage wear and knee osteoarthritis Be caused. Depending on the length and position of the meniscus, mechanical blockage of the knee joint can be caused.

Symptoms: Detect a meniscus tear 

The symptoms of a meniscus tear vary depending on the size and shape of the meniscus damage. Small meniscus cracks are not always immediately noticeable. It is therefore quite possible that you will not experience the pain until a few hours, days or even weeks after the injury. If a meniscus injury occurs, you should experience the following symptoms:

• First and foremost, you should check and assess the pain in your knees and especially during rotational movements.
• You may also hear a popping or cracking sound when the meniscus ruptures.
• Visually, you can determine the meniscus tear due to knee swelling.
• It may also be true that you hear a popping or cracking sound when the meniscus ruptures.
• A common symptom of meniscus rupture is impaired motor function and knee blockage.
• Furthermore, many are plagued by knee joint instability

The Causes: This Is How Meniscus Damage Occurs

Not all meniscus ruptures are the same, because there are different types of ways in which the meniscus can rupture. A distinction is made here between longitudinal, basket handle, flap, transverse, radial and horizontal cracks. The inner meniscus is affected by injuries about five times more often than the outer meniscus, which is looser on the femur bone.

Traumatic or degenerative meniscus damage

A meniscus tear is often the result of a violent knee twisting, twisting or simply overloading the affected area. The causes of the sudden crack are not only due to sporting activities, but also to everyday situations.

Basically, a distinction is made between traumatic (accident-related) and degenerative (wear-related) meniscus lesions. A typical cause of traumatic meniscus injuries is the twisting of the knee joint under stress. Here, patients usually immediately feel a shooting and shooting pain or even a feeling of blockage. In fact, younger patients are primarily affected by this meniscus damage.

A degenerative Meniscus damage mainly plagues elderly patients. The symptoms here are usually gradual, but there can also be acute pain events and blockages.

The Meniscus Tear During Sports Activities

Sport involves a lot of exercise, so the probability of getting injured while doing it is quite high. Especially in contact sports such as soccer, for example, the meniscus tear results when the ball is shot at full speed. Due to the dynamism, impact with the ball and the shot, the knee joint is no longer able to react. Depending on the impact and position, the extent of the crack may be larger or smaller.

The meniscus tear when working

Meniscus tears often occur during everyday activities, such as working. Because here too, the knee joints can be confronted with heavy loads. Frequent bending, such as by kindergarten teachers, who mostly bend over to toddlers, can have a negative effect on the knee joint. Factors such as body weight put additional stress on the knee. Other conditions, such as carrying heavy objects, constantly climbing stairs or being very overweight, i.e. lead to an unfavorable development of the meniscus. As a result, you are unable to work after the meniscus tear.

Treatment: Treatments for torn meniscus

For treatment against acute meniscus injury There are a few options that depend on the degree of networking. If the meniscus tear is large, a surgical treatment approach is often recommended. Minor damage can ideally be remedied by conservative treatments.

This is the first thing you should do if you notice a meniscus tear

The first signs of a meniscus rupture are pain and significant swelling of the knee. Therefore, you should consider the following steps:

• Ideally, put your leg up to protect it.
• Cool the knee area by placing a cool bag on the affected area at regular intervals. This allows you to reduce swelling.
• Avoid jerky movements and pressure on the knee. You should immediately avoid kneeling, squatting and activities such as climbing stairs.
• Anti-inflammatory pain relievers should be taken when the pain is too severe.

Conservative meniscus tear exercises and therapies

After the Doctor diagnoses the meniscus tear, treatment can begin. Depending on the degree of cross-linking, the damage can be treated surgically or conservatively. There are the following treatment options for conservative treatment of torn meniscus:

• The through Physiotherapy Guided exercise therapy.
• That's what anti-inflammatory painkillers consume.
• Traditional knee braces or braces
• Reducing weight if excess weight is the cause of the disease.

The conservative method has the great advantage that the function of the meniscus can be better preserved. In addition, the risk of developing knee arthrosis is significantly lower than after partial removal of the meniscus.

Operative meniscus tear treatment: meniscus smoothing, meniscus repair or meniscus transplant

In addition to conservative treatment of meniscus rupture, there is the option of surgical treatment. Here is the option of suturing or removing the damaged parts of the previously torn meniscus. The position of the crack is decisive for the treatment process, which is ultimately carried out:

• When removing the damaged parts of the torn meniscus, it is first frayed and cut away. The surface of the meniscus can then be smoothed out. In technical terminology, this process is referred to as Meniscus smoothing or partial resection Referred to.
• If the meniscus is only slightly torn, can the Meniscus repair, including meniscus suture Called, take place. Here, the meniscus is stitched together using smaller instruments.
• In a few cases, the meniscus is not only removed but also replaced immediately. This methodology is only used when the meniscus is too damaged. So if the entire meniscus is affected, it can be caused by a Meniscus transplant Be replaced using a donor meniscus. In addition to this transplant, surgery can also be performed with biological tissue replacement. The meniscus replacement is sutured into the cleansed deficit and consists of either collagen or polyurethane, which are gradually replaced by the body's own tissue.

• The well-circulated areas (red markings) heal better. Therefore, the treatment method of meniscus repair can be used here.
• The situation is different in the part of the menisci that is not supplied with blood (the white area). If this region of the meniscus is torn, the treatment step is meniscus smoothing.
• In the case of areas with only partial blood flow (the white-red areas), the attending physician will usually decide which method is appropriate.

Surgical treatment of a torn meniscus has the disadvantage that you will probably need a longer recovery period to fully recover. The risk of developing knee osteoarthritis is more likely in subsequent years than with conservative treatment.

How does a knee brace work

If the attending physician opts for surgical treatment, surgery is always performed as part of a knee mirror (arthroscopy). This requires two to three small incisions on the knee. As a result, a special endoscope (arthroscopy) can be inserted.

It contains a camera with light and cannula. With the help of this technique, an assessment of the degree of injury and Surgical methods Be determined.

Through the further incisions, surgical instruments for cutting, gripping and suturing are inserted, which are required to perform the operation.

Follow-up Treatment and Rehabilitation: The Three Phases of Healing

Preoperative: Operative knee arthroscopy rarely involves complications. The length of the operation is decided on the basis of the degree of injury. To prevent blood clots, venous thrombosis and pulmonary embolism, anti-thrombosis injections and thrombosis stockings are usually administered before the procedure.

Post-operative: The rehabilitation phase after surgical treatment of the meniscus tear also depends on the treatment method: meniscus repair or meniscus smoothing. Once the meniscus has been sutured, it could rip open again if the grace period is not respected. After knee arthroscopy, you should therefore protect yourself first and cool down as much as possible.

Rehabilitation after meniscus smoothing

Rehabilitation of meniscus smoothing of the meniscus is carried out in three phases after consultation with your attending physician:

1. Stage: Just three weeks after the surgical procedure, the body weight can be applied to the leg. In order to minimize pain or possible damage as much as possible, a walking aid is recommended.
2. Stage: Four to six weeks after partial meniscus removal, the leg is stabilized by sporting sessions on an ergometer or bicycle. Knee training movements should be avoided as much as possible during this phase.
3. Stage: Six Most sporting activities should be possible again weeks after the surgical procedure. However, consultation with the attending physician or physiotherapist should be made in advance.

Rehabilitation after meniscal suturing

After consultation with your attending physician, the rehabilitation of the meniscal suture is also carried out in three phases, but these start much later:

1. Stage: Six weeks after surgery, you should only use a walker to strain your leg. First, gentle physiotherapy is introduced for rehabilitation, in which the knee should be moved passively. The aim of this therapy is that the leg can be fully extended and bent again at a 90-degree angle.
2. Stage: In the seventh to fourteenth week, the knee can already be loaded with the entire body weight. The goal in this phase is to gently strain the knee, which then brings you back to your everyday life.
3. Stage: Sports exercises and light sports can be restarted after the fourteenth week, after consultation with your doctor.

The rather less common meniscus tear treatment through a transplant is similar to the rehabilitation process with the meniscal suture. Since this procedure also includes further surgical steps to create biological tissue replacement, rehabilitation could take a significantly longer period of time. You should therefore definitely discuss further steps with your treating doctor.