MENISCUS INJURIES: An Overview
by Dr. Mark Klion
Injuries to the knee are very common. As the baby boomer population tries to stay active and healthy, we are finding that our bodies are sometimes not up to the task. In this issue of bodyworksMD, we address some new techniques of both conservative (non-operative) and surgical treatments for common knee injuries. Meniscal injuries or torn cartilages are frequently seen in our practice. These semilunar fibrocartilage discs (one medial and one lateral) act as shock absorbers in the knee.
Figure 1.
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As we perform weight bearing activities these two structures together help cushion our knee. Twisting injuries, as well as repetitive forces like running can cause a meniscus to tear. In order to treat these injuries, it is helpful to understand our body's mechanism for healing. Vascularity or having a blood supply to the injured tissue is essential for healing to occur. New cells are sent to the area and start the process of healing. From birth through adolescence the menisci have a complete blood supply. By puberty the blood supply to the meniscus has receded to the peripheral 1/3 of the meniscus. Although the inner 2/3rd's is still a living structure, the cells in that area have no capacity to heal. Thus, much of our treatment protocols depend on the location of the tear. Most, if not all, meniscus tears should be given a chance to heal with conservative management. Tears that are centrally located or those that have a displaced fragment that cause locking or catching should be considered for arthroscopic excision (removal) or possible repair (placing sutures in it). Meniscal repairs are more successful with peripheral tears. Figures 2 and 3.
Figure 2.
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Figure 3.
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A common question is," If you take out a piece of my meniscus, what happens then?" At the present time, there is nothing to replace it. The good news is that long term results from a partial menisectomy (excision) including pain relief, and return to sports is good. We do know that if you take a piece out there is an increased chance of the development of degenerative arthritis. When and if that occurs is truly unknown. Can this cartilage be replaced? Transplantation of a meniscal allograft, tissue donated from a cadaver, is usually reserved for patients who have undergone a complete meniscal excision and have yet to develop an arthritic knee. Recent work on meniscal replacements or scaffolds has shown some promise in the animal models. Materials that can act as a scaffold for cell ingrowth have been sewn into the defect left by the menisectomy. Repopulation of cells and cartilage growth to replace the missing meniscal tissue hopefully occurs with this technique.
The Gold Standard treatment today of meniscal tears still relies on the principles of conservative management for healing and surgical intervention when all else fails. Application of ice to the knee and ingestion of oral anti-inflammatories help reduce the irritation and inflammation about the knee. Activity modification and the participation in low impact activities can be very helpful in the maintenance of muscular function around the knee. Telling someone today to stop an activity it if it hurts can be more of a psychological blow than ultimately a benefit. Finding some physical activity that doesn't cause discomfort can be of great benefit. Along those lines, a program of rehabilitation, including leg strengthening and flexibility exercises can help maintain muscle function and help build back weakened muscles from disuse. For most injuries, rest without proactive treatment rarely leads to healing. Six to 8 weeks is the average healing time for most meniscal injuries around the knee. If symptoms persist further orthopedic intervention is often required.
Dr. Mark Klion is a board certified Orthopedic Surgeon with a practice in Manhattan, New York. The creator of the BodyWorksMD series of Sports Medicine DVDs and professional reference to CoachTroy.com, Dr. Klion is also a multi-time IRONMAN FINISHER.
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