Meniscal Tears of the Knee

Injuries to the knee menisci are one of the most common causes of knee pain and dysfunction. The knee contains two menisci. The medial meniscus is on the medial or “inner” aspect of the knee. The lateral meniscus is on the lateral or “outer” aspect of the knee. These structures are composed of tough fibrocartilage and function to deepen the tibial articulation for the femur thereby increasing contact area. The menisci also play a role in knee stability.

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Several decades ago the critical importance of the meniscus in the knee function was not appreciated by the medical community. Tears of the meniscus were treated with complete meniscectomy (open removal of the entire meniscus). Unfortunately, many of these patients went on to develop severe knee arthritis in later life. Surgeons now have a much improved understanding of the critical function the meniscus plays in knee function.

What is the Function of the Meniscus?

The meniscus has several crucial functions in the healthy knee. First, it functions to increased the contact surface area of the femoral condyle on the tibial plateau. This increased contact area allows for low and symmetric point stress on the knee articular cartilage which decreases the risk for cartilage wear and arthritis. Furthermore, the meniscus plays a key role, in conjunction with knee ligaments, in providing stability to the knee.

Symptoms and Treatment

Tears in the knee meniscus can occur due to trauma, athletic injury, or degenerative change. Patients can present with pain, swelling, or mechanical symptoms (catching and locking) of the knee. Clinical evaluation along with x-rays and magnetic resonance imaging (MRI) help establish the diagnosis. Symptomatic meniscal tears, especially those causing mechanical symptoms, are often treated surgically. Well trained surgeons can perform the vast majority of meniscal surgery arthroscopically with minimally invasive techniques.

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Arthroscopic image demonstrating a tear of the medial meniscus

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Treatment of the tear involves only removing the torn portion of the meniscus while leaving the remainder intact. Note that this type of meniscal tear was not repairable.

 

 

 

 

 

 

 

 

 

 

 

Arthroscopic surgery for meniscal tears can involve either repair of the meniscus or removal of the torn portion. The decision for repair versus removal is made based of the type of tear present, patient age, patient activity demands, and the presence of other cartilage wear. Most portions of the meniscus are avascular (no significant blood supply) and it is therefore quite difficult to promote healing in these areas. If the tear is not repairable then the torn portion of the meniscus is excised. Care is taken to only remove the injured areas and the majority of meniscus is left intact.  Some meniscal tears however do have a reasonable blood supply. In these cases repair is recommended. The meniscus can be repaired with various sutures using advanced arthroscopic techniques.

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Arthroscopic image of a meniscal repair utilizing two inside-out mattress sutures

Proven Experience

Dr. Wind has extensive experience with injury to the knee meniscus in athletes. He commonly performs both arthroscopic partial meniscal excision and arthroscopic meniscal repair. If at all possible attempt is made to repair and save as much meniscal tissue as possible for each patient. After surgery, all patients work closely with a physical therapist to minimize recovery time and maximize knee function.

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