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Meniscus Lesions - Cartilage Tear
Medical Conditions last reviewed October 2000
What are Meniscus Lesions ?
The cartilages of the knee are thin pads of gristle, each the shape of a crescent. There are two in each knee, lying side by side. The so-called medial cartilage lies in the inside compartment, while the lateral cartilage is in the outside compartment of the knee joint. The lower surface of each cartilage is flat, and lies on the upper surface of the shin bone (or tibia). The upper surface is concave and rests against the lower end of the thigh bone (or femur). As the knee bends and straightens, the cartilages glide very slightly forwards and backwards. The cartilages carry much of the load across the joint, from thigh bone to shin bone. They also act as shock absorbers. Damage to these cartilages result in tears. A so-called bucket-handle tear occurs near the outer edge of the cartilage and extends most of the way around the rim. This type of tear, which tends to affect the medial cartilage, often gets trapped in the centre of the joint. This causes locking of the knee. This means that the patient is unable to fully straighten the knee. A so-called parrot-beak tear goes from the edge into the substance of the cartilage. This can cause locking if large enough, or simply pain and swelling. Such a tear is more common in the lateral cartilage. A torn cartilage can also cause the knee to give way. A tear of the parrot-beak type in the lateral cartilage stimulates fluid to develop in the knee joint. It is forced through the tear to the outside of the cartilage, where it may form a noticeable cyst. These increase in size with physical activity, are painful and often quite obvious when the knee is bent.
How do Meniscus Lesions occur ?
Tears occur when there is a sudden rotation of the knee while it is bent. It can also occur with sudden straightening of the knee. In general the tibia is fixed due to the foot being on the ground. Getting up from a squatting position may also tear a cartilage. Sometimes it is due to a more complex ligament injury following a major accident.
Why do Meniscus Lesions occur ?
In a few people, the lateral cartilage may be in the shape of a complete disc (discoid). Rather than a crescent, this discoid cartilage is more likely to tear than a normal one. Usually, tears occur in normal cartilages that are subjected to abnormal strains.
Treatment Involved for Meniscus Lesions
When the knee remains locked following an injury, surgical treatment needs to be carried out as soon as possible. If there is pain and swelling only after an injury, then non-operative treatment is usually followed. This consists of rest and anti-inflammation drugs to start with, followed by exercises to strengthen the thigh muscles. A physiotherapist will usually supervise the treatment. Repeated episodes of pain and swelling, locking or giving way require surgical treatment if symptoms interfere regularly with daily activities or sports. A particular type of scan (called magnetic resonance imaging) may be carried out by a specialist. This usually allows the tear to be seen accurately before treatment. Surgical treatment is usually carried out using an instrument called an arthroscope. This is a very slim telescope with a light at the end. It can be inserted into the knee through a very small incision under general anaesthetic (arthroscopy). All the structures inside the knee can be clearly seen. By inserting instruments into the knee through other small incisions, cartilage tears can be quite readily removed. Only the abnormal loose parts of the cartilage are generally removed. An abnormal discoid cartilage can also be trimmed back to a normal crescent shape. When there is a cyst present, its fluid can be released into the knee joint at the same time.
During Treatment for Meniscus Lesions
Arthroscopic surgery is usually carried out as a day case procedure and there can be surprisingly little pain, even immediately afterwards. You will be told what exercises to do by a physiotherapist before discharge from hospital, and may require a crutch. Often no stitches are used, but the knee is checked between 1 and 2 weeks after surgery. Any undue pain or swelling may be due to blood or fluid collecting in the knee, or more rarely, infection. Therefore contact your doctor if pain worsens in the first 7 10 days after operation. Normally full weight bearing will be both possible and comfortable in a few days. Full bending of the knee usually returns between 1 and 2 weeks. Occasionally inflammation of the knee with soreness and swelling is a problem after surgery. This is due to irritation of the lining of the joint. It usually settles with rest and anti-inflammation drugs. Return to a less active job is normally possible by two weeks. Four to six weeks are necessary before return to a more manual job or to sporting activities. Occasionally, a tear at the very outer margin of the cartilage may be treated by actually repairing it. Immobilization in a plaster cast or a brace is then necessary.
After Treatment for Meniscus Lesions
If only a small tear has been removed then a further injury can tear the remaining cartilage rim. There is also an increased risk of wear-and-tear arthritis following removal of the cartilages. This risk is greater on the lateral than on the medial side. It depends on the amount of the cartilage that has to be removed. If the cartilage tear is associated with a more major ligament injury, then repair of this may be necessary.
If Meniscus Lesions are Left Untreated
Small cartilage tears may not be harmful if ignored. The need for surgical treatment depends on how bad the symptoms are. An initially locked knee may gradually straighten, but full straightening may never be possible. Muscle wasting and giving way are then likely to be serious problems. Sometimes partial tears can worsen without treatment. This is particularly true if damage to ligaments is also present, taking away stability from the knee. Damage to the joint surfaces from a large fragment can also occur, sometimes as a result of repeated locking.
Amélie Mauresmo, 2009 GDF Suez, 2007 Proximus Diamond Games, 2006 World No. 1 ,Wimbledon Champion, Proximus Diamond Games, Gaz, Australian Open, 2005 YEC, Advanta Chamionships, Italian Open, Proximus Diamond Games, 2004 World No. 1, Advanta Championships, Generali Linz, Rogers Cup, Italian Open, German Open, 2003 J&S Cup, Advanta Championships, 2002 Rogers AT&T Cup, Dubai Open, 2001 Gaz, Nice, Amelia Island, and Eurocard Ladies German Open, 2000 Adidas International, and 1999 Bratislava Champion
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