As a result of technical progress, meniscal injuriesare currently treated by arthroscopy.
Menisci are fibre and cartilage fragments located in the outer joint for improved matching of femur and tibia and they protect cartilage surfaces with premature wear. They are like a “mattress” or “telescope”reducing friction between joint surfaces.
They provide better stability of the knee and absorb shocks, protecting the uncovered bone surfaces found in the cartilage (cartilage is a flexible and smooth surface that covers the intra-articular bone parts).
Most of the meniscus is not vascularized and is fed by the liquid found in the knee (synovial fluid). When the meniscus is damaged, it does not heal, and the broken part must be removed.
Joint space between the femur and tibia is very narrow. When a meniscal fragment detaches, it hangs between these two bones. The knee becomes painful, swollen, and is difficult to fold or stretch it. Sometimes it blocks! It cannot be folded or stretched.
At elderly, meniscus is damaged and fragments tear and loosen in the joints. These fragments are removed through arthroscopy.
Diagnosis and treatment
Doctors will ask you questions about the circumstances of the accident, in which context trauma occurred, in what position was the knee at the time of injury. They will examine the knee and if pain is not too acute, will perform tests to check the meniscus and ligaments. X-ray is needed to rule out a possible fracture. The meniscus is not seen on X-rays. The best exam to confirm a meniscus injury is magnetic resonance imaging (MRI).
Depending on the result of the examination, an intervention is recommended. If the detached fragment of the meniscus must be removed, this will be done by arthroscopy. This intervention is not urgent and should be scheduled according to the wishes of the patient. If the knee is completely blocked by the meniscus fragment (knee hurts if we try to move it), intervention must be scheduled as soon as possible.
Intervention is carried out within a very short hospitalization period (day hospital). Anaesthesia is required. A tourniquet is placed at the thigh root to stop bleeding into the joint during surgery.
Small incisions are closed with absorbable thread.
The knee will beprotectedby a splint for a week, but the patient will be able to walk and support on the operated calf, even in the night of intervention. The splint can be removed overnight. The splint will be abandoned after the first week. The patient will use crutches to get around. These crutches are abandoned according to strength recovery in the thigh muscles, 5 to 10 days after the intervention. However the use of crutches at 3 at 4 weeks of intervention is not a “shame” knowing that every patient recovers in his/her own pace (age, muscular thigh strength, fitness).
Painkillers will be prescribed when leaving the hospital, and injections for reducing the risk of a possible venous thrombosis. These anti-thrombotic drugs are necessary for a week.
Physical therapy will begin after a few days, often after the first check-up, which will be performed a week after surgery.
I often advise choosing physical therapistswho are close to patients’ homes, for better comfort and better organization. The number of sessions required is from 10 to 15 at a rate of 3 times a week.
Stitches will be removed 14 days after surgery. The bandage shall be changed 3 times a week.
Sick leave will last between 2 and 6 weeks (about a month on average). Resuming sports is considered after full recovery of muscle strength and knee stability. Jogging can be resumed not earlier than 2 months after the intervention. Driving is permitted 3 weeks after surgery.
La suture méniscale
Sometimes a damaged meniscus can be repaired! This repair is done by arthroscopy.
As I described above, meniscus is not vascularized. This is why meniscus injuries do not heal. There are exceptions. When the meniscus injury is at its periphery, where the blood vessels end, healing is still possible! The injuryis in the red part of the meniscus where healing can occur! Injuryis found by magnetic resonance and confirmed by arthroscopy.
For a meniscus injuryto be repaired, several conditions are necessary:
- Patient age generally does not exceed 35 years
- Daily hygiene
- Health status (e.g. patient is not diabetic and has no vessel disease).
- Patient is motivated; surgery consequences are more complex, revalidation rigour is work stoppage length.
- Patient does not smoke.
- Meniscus injury is in its periphery where scarring is still possible.
- The injuryis small or medium.
- Associated injuries are minimal.
Despite these precautions, the result is not always guaranteed. Even if the surgeon repaired the meniscus well, it might not heal! A second intervention will be required for meniscus debris removal if the chances of recovery are limited ??By the fact that a healed meniscus will continue to protect the knee from an early wear. This is why such technique is basically indicated in young athletes!!
Intervention does not last longer than a conventional meniscus operation (when the damaged partis removed).
Suture is made with bio-absorbable implants or thread. Use of special instruments is required to pass the thread through narrow spaces.
After the meniscal suture
Patients leave the hospital the day of surgery or the next day. The knee remains immobilized in a special removable splint. These splints are “hinged” and allow the controlled flexion (it must not exceed 60° in the first month) of the knee. Splints can be removed only to dress or wash. When the splint is removed, the knee should be held flat!
Any support on the operated calf is prohibited for 2 weeks! Then, the patient can support only with knee in full extension, initially without putting any weight on it, and always using two crutches. Splint and crutches are needed for 4 weeks. Rehabilitation remains passive in the first two weeks. The rehabilitation program continues for about 3 months. Work can be interrupted for 3 months and sports resumption is not authorized for 4 to 6 months.