Complex

“The complex ultra structure of the meniscus determines its vital functions for the knee, the lower extremity, and the body. “ (Effort Open Reviews)

Your knee is made up of three bones: the thighbone (femur), the shinbone (tibia), and the kneecap (patella), as well as the soft tissue that connects them. Between your femur and your tibia are two C-shaped discs of cartilage. They act as shock absorbers for the bones and help keep your knee stable. These C-shaped discs are your menisci (plural meniscus). They can be torn particularly if the knee twists suddenly while it is bent.

Viewed from the front or back, the meniscus is wedge shaped. This shape helps keep the rounded surface of your femur from sliding off the flat top of your tibia. The outer edges of this wedge receive a good supply of blood, and tears in this part of the meniscus heal well on their own. The inner part of the meniscus has no direct blood supply to help it heal, and might need surgery.

The symptoms of a torn meniscus will vary depending on the severity of the tear. Someone who gets a minor tear may only have slight pain and swelling that goes away after 2 or 3 weeks. Moderate to severe tears also might cause these symptoms:

·         A "pop" in the knee when the tear occurs

·         Pain in the center or side of the knee especially when twisting the knee or squatting. This will usually go away after a couple of weeks, but can come and go for much longer if the tear is not treated.

·         Swelling and stiffness in the knee that gets worse over the first 2 or 3 days after the injury occurs

·         Limited range of motion

·         The knee feeling as if it is locking or popping when bending; it might not straighten

·         The knee feeling like it is giving way without warning

Older people often get meniscus tears because their menisci become brittle and less flexible with age. But for teens, meniscus tears usually happen because of an injury — often after twisting or turning the knee while it is bent and the foot is firmly planted. This might happen when:

·         Lifting heavy objects

·         Making sudden changes in direction or slowing or stopping quickly, as can happen in sports like soccer, baseball, basketball, tennis, and racquetball

·         Taking a direct hit to the knee while playing a contact sport, such as football, hockey, or rugby, where the knee may be forced to twist or turn awkwardly

·         Falling in a way that puts a lot of strain on the knee during a fall, as can happen in sports like skiing or snowboarding

Minor tears usually don't need surgery, especially if they are on the outer part of the meniscus where there is a good supply of blood. These tears should heal fairly quickly. Treatment can include the RICE formula:

·        Rest: Stop doing the activity that caused the injury, and give your knee plenty of time to rest. In some cases, this may involve using crutches to keep weight off your knee while it recovers.

·        Ice: Apply ice or a cold compress to your knee several times a day for 15 minutes at a time until the pain and swelling go down. Wrap ice or ice packs in a towel. Don't put them directly on the skin as this can cause tissue damage.

·        Compression: Use an elastic compression bandage to keep swelling down and help support your knee.

·        Elevation: Lie down and put pillows under your knee to raise it above the level of your heart. This will help keep swelling to a minimum.

Sometimes a surgeon can repair a torn meniscus. Other times, the surgeon will trim away the torn piece of the meniscus to stop it from interfering with the way the knee works. If you get surgery, the doctor may put your knee in a brace afterwards. This keeps the knee from moving around it while it heals. You might need to use crutches for a while.

When deciding how to treat your torn meniscus, you and your doctor will consider many things such as your age, lifestyle, severity of injury, location of the tear, and pain level. Depending on these factors, your treatment options may include:

1.   Injections-The two most common injections that can be helpful in reducing inflammation within the joint are cortisone injections and hyaluronic acid – originally derived from the combs of roosters – which can lubricate the knee joints and provide short-term relief. While injections temporarily reduce pain, they will not help heal the meniscus tear.

 

2.   Meniscus Surgery-If an injury is severe or if symptoms persist after nonsurgical treatment, many turn to surgery to repair a meniscal tear: a partial meniscectomy if the meniscus can be trimmed (or removed) or a meniscus repair if the tear can be sewn together.

 

While meniscus surgery remains one of the most common orthopedic procedures performed in the U.S., several recent studies have shown that surgery to repair a torn meniscus may not offer any benefit or pain reduction over physical therapy. In addition, those who undergo these surgeries have a much higher probability of getting a total knee replacement in their lifetime.

3.   NUsurface Meniscus Implant-If you are suffering from knee pain following meniscus surgery or are without viable treatment options, the NUsurface Meniscus Implant may provide an alternative option once approved by the U.S. Food and Drug Administration. NUsurface is designed to mimic the function of the natural meniscus and redistribute loads transmitted across the knee joint.

The implant is made from medical grade plastic and, as a result of its unique materials, composite structure and design, does not require fixation to bone or soft tissues. NUsurface has the potential to address the treatment gap of those suffering from meniscus deficiency and deterioration that are too old for meniscus repair and too young for total knee arthroplasty. U.S. clinical trials completed enrollment in June 2018, and the company is expecting to file for approval by the U.S. Food and Drug Administration within the next two years.

4.   Physical Therapy-Meniscus injuries can often be managed by controlling the pain and swelling as well as possibly working with a physical therapist to restore full knee strength and mobility. Your therapist or physician may recommend a special at-home exercise regime, or may use a treatment called neuromuscular electrical stimulation (NMES) to help improve your strength. Medications like aspirin and ibuprofen may also be recommended to reduce pain and swelling.

 

5.   Stem-Cell Therapy-Researchers have been developing stem-cell therapies that may help heal the injured tissue. During treatment, stem cells from your own body or some other source are injected into the injured knee area, where they grow, differentiate, and assist with the healing of the meniscus. Keep in mind that while this type of therapy is promising, it is relatively new and is still considered experimental in some countries. As such, most insurance won’t cover the cost, and it is unknown if this will be a long-term cure or how long the effects will last.

“The most common knee surgery performed on people over 65 is repair of torn meniscus cartilage. The procedure is costly, at up to $10,000 a patient — and it’s also usually a waste, if not outright harmful.” (Tim Mullaney) [i]

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[i] Sources used:

·        “5 Meniscus Tear Treatments to Consider Before Total Knee Replacement” by Active Implants

·        “Meniscus Tears” Reviewed by: Suken A. Shah, MD

This post is dedicated to my wife, Bobbi, who has this.