Therapy of an inner meniscus lesion

In most cases, a knee joint endoscopy (arthroscopy) is performed as part of a meniscus lesion. This not only serves the exact diagnosis of the tear, but also the therapy. Arthroscopy offers various options.

In young patients and tears in the peripheral third, an attempt is made to perform a meniscus suture. In some cases, this is not possible because the inner meniscus tear does not grow together sufficiently. In this case, the meniscus can be completely or partially removed (meniscectomy).

If the meniscus has to be partially removed, the procedure should be as gentle as possible, since the meniscus does not grow back. This worsens the shock absorbing properties in the knee and can lead to knee joint arthrosis. In some cases it is necessary to remove the meniscus completely.

In this case the removed meniscus is replaced by a transplant (artificial meniscus). The graft (artificial meniscus) can be made of an artificial material or be used in the context of a direct donation from a corpse. Both materials have advantages and disadvantages, which are still being investigated in studies.

The exact surgical treatment of a lesion of the inner meniscus naturally depends on the exact pattern of injury. Nowadays, however, almost all operations are performed in the form of knee arthroscopy. This procedure requires only two small accesses to the knee joint.

The damage can then be repaired with the help of inserted instruments. In most cases, the damaged parts of the meniscus are simply removed during arthroscopy. On the one hand, it is important that as large a part of the meniscus as possible remains, but on the other hand, not too little should be removed to avoid continuous damage.

Since damage to the inner meniscus is often accompanied by injury to the cruciate ligament or the inner ligament, it may also be necessary to treat these structures. Depending on how exactly the pattern of damage to the inner meniscus is and on the intensity of stress that is still required after the operation, the tear in the meniscus can also be reattached with the help of a suture. This is especially possible if the tear runs close to the base of the meniscus.

In most cases, fixation systems are now used for this purpose, which do not need to be removed again after healing. Especially for children, it is recommended to use sutures, as otherwise the risk of further knee damage increases in the long run. However, the post-treatment period for meniscus suturing is considerably longer.

A third possibility is the use of meniscus implants. Suturing is not possible if there is a tear in the marginal area of the meniscus that is not supplied with blood.However, if the impairment of the meniscus is so severe that simple removal of the destroyed parts is not possible, an implant may be an option. This can then take over the support and buffering function that the destroyed meniscus can no longer fulfill.

The implants can also be inserted arthroscopically in most cases. The latest generation of implants, mostly consists of collagen fibers, which are resorbable. Through these, the body’s own cells should then grow in and in the long term, allow meniscus-like tissue to develop.

These newly grown tissues can then take over the meniscus function. Overall, the results of the operations are usually good. However, in the case of slight meniscus lesions, conservative therapy is approximately equivalent with a lower risk.