Synonyms in a broader sense
Meniscus lesion, meniscus tear, meniscus rupture, meniscus damage, arthroscopy, keyhole surgery, meniscus damage.
Definition
For the therapy of a meniscus lesion or meniscus tear, different options can be considered. Besides the type of damage and the location of the tear, individual circumstances such as age and professional and/or sporting ambitions are always decisive. In the past, the meniscus as such was only of little importance.
Therefore, it was widely spread to remove the meniscus completely in case of a tear. In medicine this is called meniscectomy. However, since the meniscus assumes important functions such as stabilization, cartilage nutrition and cartilage protection for the knee joint, it is now known that a meniscectomy is not always appropriate and increases the possibility of the development of knee joint arthrosis many times over.
Partly because of these important functions for the knee joint, efforts are now being made to preserve the meniscus in its original form as far as possible. The meniscus is therefore either sutured with a so-called meniscal suture or newly formed by a replacement product based on collagen. In the following, different forms of therapy are listed.
As already mentioned above, which form of therapy is suitable for you depends on the individual circumstances. The attending physician knows these individual circumstances and can – with your assistance – initiate the best form of therapy for you.
- Conservative therapyA conservative therapy in the form of immobilization is only possible in exceptional cases.
For this purpose, it must be ensured that the length of the longitudinal tear is not longer than 1 cm. Immobilization is usually carried out over a period of three to four weeks and often has little prospect of success without surgical therapy. (see: Duration of a meniscus tear)Conservative therapy is only possible in the case of a fresh tear in the outer zone, which is well supplied with vessels.
Best suited are splint positioning and decongestant measures for a period of a few days.
Arthroscopy can be used to detect damage to the meniscus.
- The Operative Therapy
- The advantage of arthroscopy is that if there is visible damage, surgery can be performed immediately. Arthroscopic surgery is often referred to as keyhole surgery, as large incisions (wounds) are avoided and in principle the procedure is performed in a very small space.
- Partial removal of the meniscus (partial resection)
If the meniscus tear is a so-called base near tear (see tear shapes of the meniscus) and/or if it is a young patient, it should first be decided whether a suture of the meniscus seems possible or whether parts of the meniscus have to be removed surgically.
As already mentioned above, the blood circulation of the meniscus is quite poor in some parts, so that a healing without any surgery seems to be impossible. The illustration on the left shows the blood flow ratio of the meniscus. It can be seen that only the parts near the capsule are well supplied with blood and therefore have a good healing potential and chance (red zone in the right figure).
It can therefore be said that healing is usually only possible in the red zone, and to a limited extent also in the red-white zone, and that tears in the white zone almost always have to be repaired by partial removal. The posterior part of the inner meniscus is relatively often affected by tears, partial meniscectomies are usually tolerated very well here. In addition, one should know that the outer meniscus is very decisive for the distribution of pressure and that preservation should always be the primary concern.
In case of a meniscus suture, two different options are available. These are:1. meniscal suturing, either with so-called absorbable (= self-dissolving) or non-absorbable sutures. 2. meniscal suturing with absorbable (= self-dissolving) arrows, the so-called arrows.
Parts of the meniscus far from the base are not supplied by blood vessels, but by the synovial fluid. If cracks appear in these far from the base areas, such as the crack of the basket handle, these parts can no longer grow.However, the joint function and stability should be preserved as far as possible, so that a so-called partial resection is performed. Such a partial resection (= partial meniscectomy) is also usually performed in the case of tears that occur as a result of the aging process and thus wear and tear (= meniscus degeneration).
During this procedure, the dead parts of the meniscus are removed. The aim of such an intervention is always the preservation of the remaining meniscus and the avoidance of new tears. This means that as much meniscus as necessary is removed so that no damaged, dead parts remain in the meniscus.
It also means that as little as possible of the meniscus is removed. Finally, as mentioned above, important functions are attributed to the meniscus. In case of a partial meniscus removal, the patient can usually be loaded immediately after the operation.
After the operation, physiotherapeutic follow-up treatment is usually prescribed. An exercise program for independent training is also intended to promote mobility and healing. Crutches are usually not necessary after the operation.
However, this depends on the patient and his individual safety while walking.
- The suture of the meniscus
In both procedures, the wound edges are first “refreshed”. This means that the edges of the meniscus tear are roughened in order to open up vessels and thus improve the supply of nutrients and allow growth factors to reach these areas.
A targeted bleeding is thus a basic requirement for a good healing! In the context of the meniscus suture, a thread is then passed through the meniscus and joint capsule (from the inside to the outside) in a U-shaped manner. In cases where the tear is located relatively far back, an injury cannot be ruled out due to the many nerves and vessels.
Under certain circumstances, even the meniscal suture thread could extend out of the hollow of the knee. In these cases the 2nd method described above, the so-called meniscal nailing, is preferred. Here, torn meniscus parts are fixed with absorbable arrows (Arrows, Biofix, etc.).
However, the post-treatment after meniscal suturing or nailing is much longer than with partial resection: A 6-week post-treatment must be expected. Depending on the individual circumstances and especially on the type of profession, an incapacity to work of about 2 to 8 weeks must be assumed. In this case, the possible strain within the scope of the profession has a prolonging effect on the incapacity to work.
