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Removing a damaged meniscus relieves pain, but over time leads to degeneration of the knee joint. Therefore, it is saved at all costs. If it fails, it is replaced with an implant.
It is believed that injurymeniscusonly happens to athletes. Meanwhile, it is not true. It can even happen in people who avoid sports. Sometimes the meniscus breaks during everyday activities. There are actually two menisci in the knee: medial and lateral. They are flexible cartilaginous-fibrous structures made mainly of collagen, resembling a crescent moon. Its ends are the front and rear horns, and the center is the shank. Only 1/3 of the meniscus, adjacent to thejoint capsule , is well supplied with blood and therefore also well nourished. Later in it, nutrition becomes weaker, and so does the chance that the meniscus will heal when it breaks. It was once believed that its removal did not entail serious consequences. Later, this view was revised as meniscuses appeared to have important functions. They are a shock absorber because they take over a significant part of the load on the knee joint during movement. They protect the articular cartilages of the tibia and femur from abrasion. They stabilizeknee , because they are a kind of a movement limiter.
Cartilage wears out over time
In young people, the meniscus is damaged as a result of very severe trauma, most often while skiing or playing football. But in your forties, it can break when you squat or slip on an icy pavement. Over time, the meniscus wears out, especially when we practice sports related to running and jumping. Degenerative changes appear in it. In addition, it loses its elasticity because the amount of collagen and water in it decreases (just like in the skin).
Meniscus - symptoms of damage
- Knee pain isn't the only symptom of meniscus problems. It may be accompanied by other ailments that suggest the nature of its damage. If it takes the form of the so-called bucket handle, leg cannot be straightened. In this case, the meniscus breaks right next to the joint capsule and is held only by its horns. It then slides forward, blocking the knee joint.
- Temporary blocking is characteristic for the damage called the tabjoint, crunch and a feeling of jumping in the knee accompanied by pain. These ailments are related to the displacement of the severed fragment of the meniscus.
- In the most common lesions caused by degenerative changes, there is pain in the joint space, felt on the sides of the knee. It also happens that the meniscus breaks horizontally. The synovial fluid then pushes into this gap and presses on the nerve endings in the joint capsule, which causes severe pain. All types of damage are usually accompanied by knee swelling and exudation.
- To confirm a meniscal injury, the doctor performs a so-calledmeniscal tests . Later, he orders ultrasound and magnetic resonance imaging. But the results of these studies only in conjunction with clinical symptoms allow for a diagnosis.
For an experienced orthopedist, they have a considerable diagnostic value, as they can allow for an initial diagnosis. The doctor performs various movements with the patient's leg (e.g. twist of the shin, flexion in the knee and hip joint, extension up to 90 degrees), and depending on the movement of the pain, he can determine which meniscus is defective and what kind of damage it is.
A cracked meniscus requires stitching
A ruptured meniscus irritates the synovium, hence pain and exudate in the knee. However, it also irritates the articular cartilages, which accelerates their wear, so damaged menisci must be treated, in 90%. operative cases. Conservative treatment, which may lead to spontaneous growth of the meniscus, works only in young children and very young people.
In other cases, it must be sewn. Currently, such surgery uses arthroscopy (endoscopy), a relatively minimally invasive surgical method. The effects depend on the zone in which the fracture occurred. If the meniscus is well vascularized, the procedure is usually successful. In the intermediate zone, which is slightly less nourished, the probability of the formation of union is 50%. On the other hand, in the non-vascularized part, the chance of healing is low, so the damaged fragment of the meniscus is removed. Removal of it completely is avoided, as it leads to degenerative changes in the knee joint. Such a procedure is performed as a last resort, when the damage is so large that there is no need to sew.
How to save a knee
- The removed meniscus can be replaced with a natural one from a donor. There is no guarantee that it will serve the new owner for a long time, because in order to be completely safe, it must be sterilized with gamma rays, which reduce its strength (they destroy the fiberscollagen).
- Frozen menisci are of much better quality, but in their case there is - admittedly little - risk of transmission of infection from a deceased donor to the transplant recipient.
- Another solution are sponge-like collagen implants. The recipient's cells grow into the holes in them over time.
- After a few months (up to a year), the natural tissue replaces the implant (the collagen it is made of is absorbed). However, such a reconstruction of this part of the knee joint is very expensive, and since it has been used for a short time, there is no evidence of its long-term effectiveness. But research into new solutions is still ongoing.
- We also work on implants that will perfectly fit a specific knee and will withstand loads in the joint for years. Also advanced are the research on the collagen membrane soaked in growth factors obtained from the patient's own blood or with stem cells derived from the patient's bone marrow, which will enable regeneration of the damaged meniscus.
How To Avoid A Meniscus Injury
- Avoid crouching work when you are mature, e.g. weeding your garden or washing kitchen cabinets.
- Keep in good physical condition to reduce the risk of injury.
- If you lead a sedentary lifestyle on a daily basis, do not suddenly start practicing sports intensively on vacation, because you risk injuring the meniscus. It can be easily overloaded because the muscles are too weak.
- Do not underestimate the knee instability (caused, for example, by rupture of the cruciate ligaments), although the related ailments do not bother us every day. Due to the instability of the knee, the menisci rupture even without acute trauma.