Particularly in sports, such as soccer, skiing and even athletics, the knee joints are subjected to a lot of stress. Sharp twists and turns can result in the meniscus, the cartilaginous buffer between the joint surfaces in the knee joint, tearing or ripping off. Although such an injury is one of the most common sports accidents, it can be prevented by proper behavior. This article will explain when a meniscus tear can occur and how to prevent such an injury.
What is a meniscus tear?
Schematic diagram showing the anatomy and structure of the meniscus. Click to enlarge. One hears talk of meniscus injuries or meniscus tears particularly often when a well-known soccer player, track and field athlete or skier has to stay in bed in the hospital because of such a sports accident. Now not every injured meniscus is operated on immediately. In the case of a first-time injury, there is a chance of healing without surgery, especially in young patients up to the age of 25. Only if the conservative healing measures have not been successful or if no reliable scar has formed after the first accident and the meniscus has been injured again, surgery is necessary. In this case, the damaged meniscus is removed either partially or completely. Are menisci so superfluous that they can be removed without any danger? This question has been investigated very thoroughly by the medical community, especially since the number of knee injuries in work and sports accidents has increased and meniscus surgery is now a routine operation at almost all hospitals. It is absolutely clear that the menisci are by no means superfluous structures, but are necessary and important components for the undisturbed function of the knee joint. They increase the contact area of the joint between the thigh and the tibia, compensate for the different shapes of the joint surfaces of the upper and lower leg, which move against each other, and, like elastic buffers, absorb the compressions acting on the joint and distribute them over a larger area. However, only the healthy meniscus fulfills these important and diverse functions. It consists of a fibrocartilaginous material. Seen from above, it has a crescent shape and is wedge-shaped in cross-section. It is located between the outer and inner joint ends of the femur and tibia. Its length depends on age and is about seven centimeters, and its width averages ten to thirteen millimeters. The possibility of injury is greater at the inner meniscus than at the outer because it is particularly firmly attached to the joint capsule and thus can be moved only slightly. Damage to the inner meniscus therefore occurs ten times more frequently than to the outer meniscus. The forms of injury are extremely varied. Tears or lacerations can be found. The meniscus can also tear off completely. There is always a danger that the detached part of the meniscus will get between the two joint cartilages during movement and quite suddenly block mobility, causing a sharp pain.
Complications and causes
But even worse than joint lock and pain is the severe damage that the torn part of the meniscus causes to the joint cartilage. It is pressed onto the cartilage surface under such high pressure that it can be destroyed at the site. The resulting cartilage ulcer develops into arthrosis over time, which is the term used for premature wear of the joint, if no intervention is made now. It can limit the movement and load capacity of the knee joint forever. Another factor in favor of timely removal of the damaged meniscus is the fortunate circumstance that a new meniscus forms in the resulting tissue gap after a short time, which is usually somewhat narrower, but otherwise hardly differs from the original meniscus. It can even happen that this “replacement meniscus” is also damaged in a new accident. We have observed this especially in high-performance athletes who became fully competitive again even after this second meniscus was removed. The meniscus can also tear during insignificant events in daily life, when tripping, slipping or missing a step, but most often it is injured in accidents. Eighty-nine percent of all meniscus injuries are due to a sports accident, but only 11 percent are due to an accident at work.Not every sport has the same number of injuries, which means that it is not the sport itself that should be blamed for the injuries, but the particular conditions under which it is practiced and, in many cases, one’s own incorrect behavior. Since, fortunately, more and more people participate in sports, an important task arises for sports medicine with the prophylaxis (prevention) of sports accidents.
Prevention in sports
Thus, the analysis of meniscus injuries has already shown that most of the damage occurs in those sports where unnatural and therefore dangerous leverage forces act on the knee joint. This is particularly the case in soccer, but also occurs in skiing and some athletic disciplines. Friends of the round leather are familiar, for example, with the blow with the “instep”. It fulfills exactly the conditions for a meniscus injury, because when striking with the ball of the big toe, the lower leg is turned outward with such force while the thigh is stationary that the meniscus can tear. The risk of injury increases if the ball is not hit in a free strike, but at the same moment an opponent blocks the ball. Soccer fans know that this action of the opponent is not allowed, but it happens frequently. A preventive measure is the blow with the small toe side, but it is difficult for players to change to it. Another cause of meniscus injuries is recognized to be the cleats on the soccer boots. They are approved by the International Federation up to a length of 1.9 cm and prevent slipping in unfavorable ground conditions. However, the arrangement and number of studs fix the foot not only against slipping, but also against turning. This could be remedied by a more practical arrangement of the studs, which would prevent the risk of slipping, but at least still allow rotation to a certain extent. If possible, young soccer players should dispense with cleats altogether and wear shoes with treaded soles instead. In the accident statistics of meniscus injuries, alpine skiing is in second place. Fortunately, only minor injuries occur in most cases. Seventy-five percent of all skiing accidents occur among beginners. To reduce the risk of injury, beginners are advised to use short skis (carving skis) whose leverage is less than that of earlier boards. Modern safety bindings have also proved to be good. As soon as a certain torque is exceeded, as in the case of an unforeseen turning of the body or a spinning fall, the brackets that fix the ski boot to the ski loosen and release the foot. Beginners would also do well not only to adapt to the snow conditions by waxing their boards, but also to adjust their skiing style accordingly. Deep snow is ideal for a hike, but if you get into a deep snowfield on a downhill run, the sudden braking action can cause a nasty fall. This is something to keep in mind when skiing in fresh snow. When descending in wet snow, people like to use the track of previous runners or skiers. However, if the track is very steep, and the speed becomes faster and faster, the skier who is not able to cope with these conditions, often has to abandon the correct downhill position with knees advanced and a good lean when trying to get out of the track. In doing so, he falls, usually getting caught with the ski torn backward and outward, and the body falls forward in the direction of travel. Here, too, the meniscus can tear. Finally, many injuries are caused by the skier overdoing it. On a downhill run, for example, the skier is no longer able to adapt his speed to the distance of the descent and exposes himself to an increased risk of accident due to his unrestrained speed. The winter sportsman should therefore correctly assess his own ability and then select the degree of difficulty of “his” slope or ski run. But also the advanced skier should first get reacquainted with the boards in a less difficult terrain at the beginning of the winter vacation and remember that the joy of a successful dashing descent depends not only on the mastery of a good technique, but also requires a trained body. Therefore, preparations for the winter sports vacation should begin a few weeks before with gymnastic exercises, especially stretching exercises of the calf muscles.By behaving correctly during sports, we can therefore do a lot ourselves to prevent injuries to the meniscus as far as possible.
