MENISCUS REPAIR

Meniscus is a fibro-cartilage structure that fits in the knee joint between the femur and the tibia bone.

There are 2 meniscus in side the joint 1 medial and 1 lateral meniscus

Medial meniscus is a C shaped structure and lateral meniscus is more circular ion shape.

Medial meniscus covers almost 50% of the medial tibial plateau where as lateral meniscus covers almost 70% of the lateral tibial plateau

Function of Meniscus

1. It provides cushioning to the knee. It provide load sharing across the knee by increasing the contact area and decreasing the contact stress. So if a meniscus is removed the contact stress increases several times and the stress increases incrementally with the increased loss of meniscus tissue and the patient develops arthritis of the knee joint.

2. It also acts as stabiliser of the knee joint in association with ligaments of the knee.

Blood Supply

The blood Suppy of the meniscus determines the healing potential of meniscus. On the basis of blood supply meniscus has three zones

The peripheral one third of the meniscus is vascular and is called Red-Red Zone and has good healing potential The middle third has some blood supply and is called red-white zone and has some healing potential. The inner third of the meniscus has no blood Suppy and has very low healing potential.

The swelling in case of meniscus tear is usually gradual and not immediate like in ACL tears.

Confusion with Treatment

Many times I see patients getting confused about whether meniscus needs to be repaired or not.

The confusion ends once patients know the importance of meniscus in the knee.

So a meniscus once thought to be a vestigial structure inside the joint is now considered the one of the most important structure because of the functions mentioned above So a meniscus for me is the life line of the knee - no meniscus no life of knee.

So now you know the answer - Meniscus injury need to be treated well.

How did I tear my Meniscus

Meniscus injury can happen during twisting or jumping in any sports related activities

Changing direction quickly or cutting around an obstacle or another player with one foot solidly planted on the ground. (This can happen in sports that put high demand on the ACL, such as basketball, football, soccer, skiing, and gymnastics.)

Landing after a jump with a sudden slowing down, especially if the leg is straight or slightly bent (such as in basketball).

Falling off a ladder, stepping off a curb, jumping from a moderate or extreme height, stepping into a hole, or missing a step when walking down a staircase. Injuries like these tend to be caused by stopping suddenly, with the leg straight or slightly bent.

Tears of the medial meniscus is 3 times more common that lateral meniscus because medial meniscus is less mobile as compared to lateral meniscus The other common pathology apart from tears are Discoid meniscus and meniscal cyst. Both these pathology are more common in lateral meniscus.

Grading and Treatment of meniscus tear

Treatment options for meniscus tear It depends on the grade of the tear, Location of the tear and the pattern of the tear.

Grade 1 and 2 tear not communicating with the joint surface and peripheral location of the tear usually heal with rest and extensive rehab following rest can get you back to sports in 2-3 months time.

Grade 2 tears communicating with the joint and grade 3 tear or complex tear usually require surgery

Root tears of meniscus lead to extrusion of the body of the meniscus from the joint and need to be replaced back to its position and repaired.

Surgical option for the treatment of meniscus tear

In past the techniques of meniscus tear repair were evolving and the results were not very promising so the only option left with the surgeon was to shave off/ remove the torn part and smoothen the edges of the meniscus. Enormous studies now confirm that meniscus needs to be saved as best as possible because removing it has led to accelerated degenerative arthritis of the knee. After partial meniscus removal the pain relief is only temporary and the ultimately patient might land up into Total Knee Replacement.

So now Meniscus is repaired surgically as best as possible

Techniques of Meniscus Repair

There are 3 techniques for an excellent Meniscus repair -

1. All-Inside

2. Inside-out and

3. Outside-in techniques.

All-Inside technique of meniscus repair is used to repair mainly the porterio Horn and the body of the meniscus. All inside implants are ready to use implants which are very reliable and safe in terms of usage and repair strength and results are excellent.

Inside-in technique is used mainly to repair the body of the meniscus where in we use meniscus mender set inside the knee to pass sutures at desired area of meniscus tear and tie the knot outside over capsule of the knee to secure the repair an hence the term inside-out. The sutures used in this repair are fibre wire the strength of which is very good. It is one of the most cost effective surgery for meniscus repair in terms of affordability.

Outside-in technique is used to repair the anterior horn of the meniscus. In this technique a needle is passed from outside the joint aiming the tear inside and fibre wire is loped inside the joint and secured outside over the capsule hence the term Outside-In technique.

So with all the evolved techniques and with proven documented results we now try to save the meniscus and repair it in best possible manner.