Synonyms
Meniscus lesion, meniscus tear, meniscus tear, meniscus rupture, meniscus damage
Conservative or surgical therapy?
There are several ways to treat a torn meniscus. Which of the treatment options is used depends on a variety of factors. The most decisive factors that influence the choice of treatment are the patient’s age, general condition and the level of suffering caused by the meniscus tear.
In addition, the individual wishes of the patient are always of great importance, which is why the physician should always inform his patient about all possibilities before the start of the therapy and then decide together with the patient which way will yield the best result under the specific circumstances under minimal stress of the therapy. In principle, a torn meniscus can be treated either conservatively (i.e. without surgery) or surgically. The aim of all treatment is to eliminate or at least alleviate pain and to restore or maintain unrestricted mobility in the knee joint.
If there is only slight wear and tear of a meniscus or minimal tears (so-called micro-traumas), which do not cause the patient any discomfort either, treatment can be postponed, as these often recover completely by themselves and the knee is restored to full mobility relatively quickly, even without the intervention of a physician. However, the leg should be immobilized in any case, preferably in a bent position, as the knee joint must not be loaded. Consequently, crutches must also be used when walking.
This relief is usually for 3 to 4 weeks, but if the complaints have not improved over this period, one should consider taking other measures. Another important component of conservative therapy is patient training. Patients should be educated about the natural course of their injury and how best to counteract it.
This includes, among other things, avoiding joint-burdening movements such as any kind of sport that involves rapid changes of direction (e.g. soccer or skiing) or remaining in a deep squat. In addition, it makes sense for the doctor or a physiotherapist to show the patient some exercises that serve to strengthen the muscles (especially those of the thigh) and which the patient can ideally perform alone at home. Electrotherapy can be used to support this physiotherapy.
In this form of treatment, electrical stimuli are used specifically to stimulate blood circulation in the irritated area, relax muscles and thus ultimately improve pain. Cooling the knee joint can also have a pain-relieving effect. In addition, various drugs can be used as part of a conservative therapy.
These fulfil two main tasks, namely reducing pain and curbing an inflammatory reaction. First of all, anti-inflammatory painkillers from the anti-rheumatic group (non-steroidal anti-rheumatic drugs = NSAIDs) such as ibuprofen should be used. If the desired effect cannot be achieved by this, the doctor will next either use preparations containing cortisone (also an anti-inflammatory drug, which is more effective but also has more side effects) or even local anaesthetics which can be injected directly into the affected knee joint.
Conservative therapy is particularly suitable for elderly people or those who do not need to quickly regain a properly functioning knee joint and for whom major stress on the knee joint is unlikely. If the joint is subjected to heavy loads, there is a high risk that the meniscus will tear further and free parts of the joint can form, which then lie in the knee joint and lead to a complete restriction of movement. Therefore, persons who are active in sports should always undergo an operation to avoid consequential damage.
Overall, the surgical procedure is used more frequently, since the menisci have an extremely important function as a buffer in the knee joint, and a good quality of life in the long term can usually only be achieved with surgery. There are various surgical options, but all of them aim to preserve as much healthy meniscal tissue as possible.Thus, a meniscus refixation (also: meniscus suture) can be performed, in which the meniscus remains in the knee joint and is only “repaired”, or a partial or complete resection of the meniscus can be performed. In rare cases, a meniscus replacement with a transplant may also be necessary.
The follow-up treatment after the operation depends on the original extent of the damage, but of course also on the chosen surgical procedure. With the most common procedure, the arthroscopic removal of the torn parts, loading is in principle possible directly after the operation. However, as long as pain persists, movement should be started with the help of crutches.
Only partial weight-bearing of the knee should be performed for about 5-7 days. Especially if mobility is still limited at the beginning, thrombosis prophylaxis should be carried out with stockings or medication. If the other condition permits, physiotherapy can be started directly.
This is particularly important because the damaged meniscus can no longer perform its support and buffer function properly. Therefore, muscle building is a prerequisite for maintaining the stability of the knee joint after the operation. In addition, strengthening the muscles prevents further knee damage.
In addition, the movement exercises restore the mobility of the knee. Particularly if you have waited some time before the operation, a relieving posture may have already developed, which must be broken. Also own exercises and sports can be started depending on the pain situation.
Cycling on a home trainer is best suited for this. Running should only be resumed after about 6 weeks. If the meniscus has been sutured, the healing process is longer.
Here, physiotherapy should be started more slowly. Sports should only be resumed after 4-6 months. In this case, the knee is initially fitted with splints after the operation to prevent excessive movement.
A functional splint, which only allows certain degrees of movement, can be used afterwards. This prevents too much bending or stretching from damaging the fresh meniscus suture. In addition to the muscle build-up, there are different measures after both operation methods, which can improve the healing process.
This includes cooling the knee several times a day. In addition, the taking of anti-inflammatory drugs such as ibuprofen, Voltaren® or others. Lymph drainage can also accelerate the healing process.
Painkillers not only help to relieve the pain itself, but also by moving the knee faster. In this case, this makes sense because it does not allow for a relieving posture. After operations, one should never want to simply endure pain without medication.