Meniscus

The component of the knee joint includes, among other things, both an inner and outer meniscus. They are designed as crescent-shaped disks and consist of fibrous cartilage. Due to their anatomical shape, they compensate for the different surfaces between the upper and lower leg.

The meniscus serves as a shock absorber and stabilizer. In this function, it reduces the load on the cartilage and protects it from damage and premature wear. In the process, it is often affected itself. Due to its position and lower mobility, the inner meniscus is much more susceptible than the outer meniscus. Meniscus injuries are among the most common injuries in sports. They account for about seven percent of sports injuries each year.

Meniscus tears are divided according to their form into horizontal, vertical and radial tears. In addition to complex damage, meniscal base tears can also occur. In some types of tears, parts of the meniscus can become detached and move around in the joint. A typical special form is the basket joint lesion. It can cause the meniscus tissue to become trapped and the knee joint to become blocked.
 

Cause

Age plays a central role in injuries to the meniscus. While in patients over the age of 40 the cause is often wear and tear, in younger ones the trigger is often a sports injury, especially in soccer, handball or skiing. Often, the affected person twists the knee joint while putting weight on it while standing or bending. It is not uncommon for a meniscus tear to occur in conjunction with an anterior cruciate ligament tear, and obesity is also a risk factor.
 

Symptoms

Typical symptoms of a meniscus tear are pain at the level of the inner, outer or also in the rear knee joint area. Since the meniscus itself does not contain any nerve fibers, the pain is triggered by irritation of the nerves present in the joint capsule.

Accompanying this may be swelling or joint effusion. This fluid is in turn formed by irritation of the synovial membrane.
 

Diagnosis

The diagnosis of a meniscus injury starts with the anamnesis. Thereby the treating physician considers regarding the origin of the complaints, whether an injury or an accident preceded as well as the duration, type and localization of the complaints.

During the clinical examination, the patient usually states a pressure pain over the inner or outer knee joint space. The physician checks whether there is a joint effusion or a joint snap or whether the knee joint is blocked. Magnetic resonance imaging (MRI) is also frequently used for diagnosis. With this examination procedure, a tear of the meniscus can be detected with a high degree of certainty.
 

Therapy

Basically, increased stress after the injury should be avoided, such as deep bending positions in the squat or twisting movements under load. Conservative treatment measures are varied. Depending on the extent of the complaint, temporary immobilization and the use of non-steroidal anti-inflammatory drugs (NSAIDs) may be used. Cushioned footwear can also reduce stress symptoms. Custom orthotics, a raised shoe edge, bandages or an orthosis can provide relief. In addition, physical or chirotherapeutic treatment with accompanying physical measures such as electrotherapy or ultrasound treatment is possible. Other conservative measures include the injection of hyaluronic acid into the knee joint and acupuncture.

In the case of surgical treatment, the treating physician first examines the shape of the tissue quality and the tear shape of the meniscus by means of a knee joint endoscopy (arthroscopy). The primary goal is to preserve the meniscus as much as possible and to suture the tear. Surgery is minimally invasive arthroscopic. If suturing the meniscus is no longer practical, only as much as necessary and as little as possible of the damaged portion is removed. If a larger portion must be removed, meniscus replacement surgery with insertion of an artificial meniscus implant or, in rare cases, a donor meniscus may be considered.
 

After the surgery

After the operation, the knee joint should only be loaded in an adapted manner until it has healed in accordance with the recommended rehabilitation. Rotational sports should even be avoided for up to three to four months until the injury has healed without exception. This increases the chance that you will be able to start playing sports again.

The motto "save the meniscus" applies in order to preserve knee joint function under all circumstances.