The knee is the largest joint in the human body, and appropriate knee function and health are necessary for most daily tasks. The lower end of the femur (thighbone), the patella (kneecap), and the upper end of the tibia comprise the knee (shinbone). Articular cartilage, a smooth layer that protects and allows the bones to move easily, covers the ends of the three bones and serves as the primary shock absorber. The menisci are two C-shaped cushioning wedges that act as additional shock absorbers between the femur and the tibia. Large ligaments (tough bands of tissue) help hold the femur and tibia together, preventing excessive movement and thereby stabilizing the joint. The synovial membrane, a thin lining that produces fluid that lubricates the cartilage, reduces friction within the knee joint, and provides nutrients to the cartilage, covers the lining joint. All of these components work together to provide healthy knee function.
The menisci are strong, rubbery bits of cartilage that cover the gap between the tibia and the femur, cushioning and stabilizing the joint. The menisci's exterior borders are rather thick, while the interior surfaces are narrow to adapt to the bone wedges that surround them. Given that it is tightly connected to the medial collateral ligament and joint capsule, the medial meniscus is more frequently torn than the lateral meniscus. Once believed to be of little benefit, the medial and lateral meniscus were frequently removed when torn. Their significance in joint stability, lubrication, and force transmission, however, has only lately come to light.
Among the most frequent knee injuries are meniscal tears, especially among athletes who participate in contact sports. Meniscal tears frequently happen during sports when a player is squatting and twisting their knee, or when they are hit by another player. Acute tears are those that are diagnosed quickly after the injury and come from sports-related activities. However, a meniscus can be torn by anyone at any age. Adults are most frequently affected by chronic, degenerative tears brought on by frequent use.
Individuals who experience a meniscal injury generally have the following signs and symptoms:
Without medical attention, a meniscus fragment may come loose and travel into the joint, which could result in the knee slipping, popping, or locking. Therefore, if someone exhibits the aforementioned symptoms, they should see a doctor immediately.
A meniscus injury is usually diagnosed using a combination of patient history, physical examination, and imaging investigations. The doctor will check the knee to see how it compares to the uninjured knee in terms of range of motion, stability, edema, soreness, and general strength. The McMurry test, in which the knee is bent and rotated repeatedly to see if the tension on the meniscus generates pain, may be performed by the doctor. Because other knee disorders can cause similar symptoms, the doctor may conduct X-rays to assess bone damage or osteoarthritis. An MRI scan may be required to evaluate the amount of the injury as well as the location and kind of tear.
The meniscus can tear in a variety of ways, depending on the form and location of the rip. A tear can occur in the anterior horn, body, or posterior horn. The meniscus is divided into three sections: the outer, middle, and inner thirds. The third location of the tear will affect its capacity to heal, as blood circulation in that area is crucial to the healing process. Tears in the outside third have the best likelihood of healing due to a substantially higher blood supply than in the middle and inner thirds.
Treatment for a meniscal injury or tear will differ depending on the severity of the damage, age, the level of activity desired, and the location/kind of tear. If the tear is tiny and on the outer margin of the meniscus, surgical treatment may not be necessary if the symptoms improve over time and the knee is stable.
The self-care RICE technique is used for immediate treatment of a meniscal injury:
Rest: Walking will be unpleasant, so avoid putting pressure on the injured knee and minimize activities while the inflammation is present.
Ice: Ice should be applied for the first 48 to 72 hours or until the swelling subsides for 10 to 20 minutes no more than once per hour. It is extremely recommended that you use a barrier, such as a towel, to protect your skin. Heat should be avoided while the inflammation is active; once the swelling has subsided, heat can assist relieve pain.
Compression: Using a compression wrap can help reduce swelling dramatically. Make sure the wrap is snug; however, if there is numbness, tingling, or swelling above or below the wrap, it is definitely too tight and should be loosened.
Elevation: Raising the knee above the heart level for a few hours every day can significantly help to reduce swelling.
Medication: OTC anti-inflammatory medications like ibuprofen and naproxen can help relieve pain and swelling.
Operative Treatment: Once the initial swelling has subsided as a result of the RICE technique, the patient and physician must decide on the best course of action. Consider whether a misplaced tear is causing the joint to lock, particularly if the anterior cruciate ligament (ACL) is torn or damaged. The treatment used to treat a meniscal tear is mainly determined by its location and nature.
Small incisions are made around the joint to introduce surgical equipment and the arthroscope (a small camera), and the image is transmitted to a video monitor, allowing the doctor to look within the joint. The damaged ACL is entirely removed using surgical instruments. The following phase is graft preparation and insertion:
A meniscectomy (partial) This operation is utilized for tears that have a minimal healing potential, such as those in the inner two-thirds of the meniscus, where there is no blood supply. The goal of this surgery is to stabilize the meniscus rim by removing as little meniscus as possible. The surgical instruments are put into the knee via an incision around the joint and used to trim the torn meniscus fragment.
Meniscus Repair: This operation is performed to repair clean tears in the outer one-third of the meniscus, where there is an adequate blood supply. The surgical instruments are placed through an incision around the joint and utilized to repair the injured meniscus using various devices as determined by the surgeon.
Patients undergo a rehabilitation regimen that includes physical therapy exercises that are essential to strengthening their leg muscles and regaining knee strength and motion, regardless of the treatment strategy used. Because every patient is different, the therapy plan will change depending on the patient's level of discomfort, the severity of the injury, and the desired level of activity. Recovery may take up to six weeks for those who had partial meniscectomies. On the other hand, restoration from a meniscal repair can take three to six months.
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