Meniscal Tears – Causes, Symptoms, Diagnosis, Treatment
The meniscus is a fibrocartilaginous structure in both knees at the periphery of the tibial articular fossa. Menisci combined occupy 70% of the area of contact in the joint. A long time the meniscus was considered a remnant muscle of the lower leg.
Causes of meniscal tears
Meniscal tears usually occur during the practice of sports like football, contact sports, skiing. In this case it is the traumatic rupture of vertical type, which usually occur in young, active individuals, athletes, and are frequently associated with articular cartilage tear.
Meniscal tears can also be degenerative. This type of meniscus tears are horizontal with a flap and are complex and occur in patients aged over 40 years without a history of traumatic episode.
Symptoms and signs of meniscal tears
Meniscal tear is felt as pain in the knee accompanied by joint effusion and / or a history of joint blocks. An important role in the diagnosis it is the patient history. The patient often reports the occurrence of a pain in the knee, accompanied by a feeling of escape, which occurs through a mechanism of joint rotation. The blockage which accompanies articular meniscus tear often consists in the inability to make full extension of the knee. Meniscus tear knee becomes swollen after a few hours after rupture, this swelling is due to joint effusion (accumulation of fluid in the joint). Accumulation of joint effusion in the knee can be palpated. On palpation a knee with meniscus tear the pain is most often felt in the center of the knee.
Meniscal tear can be accompanied by collateral ligament rupture on the same side or opposite side of the anterior cruciate ligament. In these cases the characteristic symptoms of meniscal tear are replaced by those caused by the rupture of the ligament.
A meniscus tear unrecognized or ignored can become chronic with the relief of acute symptoms. Instead of acute pain in this case will appear the feeling of knee escape, recurrent joint effusion, chronic joint pain, weakness of the quadriceps muscles.
The diagnosis of meniscus tear is on the basis of clinical examination and laboratory exams: radiography of the knee (only useful for evaluating associated bone lesions), CT (unused as routine), knee MRI and arthroscopy, the latter being the most used and with best results in the diagnosis of meniscus tear.
Meniscus tear treatment differs depending on the type, location and its extension, the patient’s age and length of rupture of the meniscus.
Small meniscus tears from the external portion of the meniscus often heal with rest and rehabilitation program.
If the lesion is small and the symptoms have a tendency to rapid improvement is recommended rest and reduced physical activity and wearing sling, with crutch support, application of ice compresses (ice wrapped in wet towel) for 20 minutes, 2-3 times per day in the first 2 days, NSAIDs (such as aspirin, ibuprofen) for pain and swelling. A meniscus tear red on red can heal spontaneously in 4-6 weeks.
Bigger meniscus lesions localized to the external portion of the meniscus need surgical repair. Surgical treatment of meniscal tear consists in removing the broken portion or even the entire meniscus. Surgical intervention is performed with loco-regional anesthesia (spinal) under arthroscopic control (the patient is awake, conscious and can watch on the screen the arthroscopy with resection of the meniscus). In the surgical intervention for meniscal tear the surgeon tries to preserve as much tissue as possible. Removal of meniscal tear portion is kept at minimum. The main concern is the removal of what was broken and damaged. It is necessary to remove any impediment of rotational movement of the knee which can cause tenderness, pain or joint lock.
Large meniscus tears, located towards the center of the meniscus may not heal well because the area is not well vascularized. Even if a successful surgical repair is unreliable in these ruptures, surgery is recommended for young people as it can restore joint functionality. Surgical repair may not bring any benefit to the elderly who have damaged meniscus.