Perhaps the most successful comparison for the menisci, the two fibrocartilaginous “pads” on the knee, is that they act as a shock absorber between the convex surface of the thigh and the flat surface of the tibia. This is because they have the ability to absorb shocks and protect the articular cartilage from friction, but also because they normalize the movement and equally distribute the loads.
The medial and lateral menisci, in the inner and outer knee, respectively, play an extremely important role in the normal joint function. They are composed of collagen and proteoglycans (they somehow resemble the outer part of the ear) and have the shape of a crescent moon, hence their name. The meniscus tear, namely, its rupture, is one of the most common knee injuries, especially in those who are at young or middle age – in the US alone, 750,000 arthroscopies are performed for a meniscus tear every year.

Poor blood supply to the meniscus renders it particularly vulnerable and deprives it of the possibility of self-healing. Its tears may be either traumatic (partial or total) or degenerative, due to the normal aging of the joint - the countdown begins at the age of 30. Any activity causes the knee to rotate abruptly and sharply, especially if it is done with all body weight, a meniscus tear can happen.
In patients aged over 60, osteoarthritis is also considered “responsible” for a possible tear, without a previous knee injury. A simple movement, like a squat, is enough for the degenerate meniscus to be torn.

The clinical picture is pain in the inside or the outside of the knee, swelling, even several hours after the injury, and stiffness that results in the joint being locked and the patient being unable to fully straighten his knee. Diagnosis is made through the obtaining of a detailed history and a proper and complete clinical examination. Initially, a full radiography testing - which is deemed necessary in ages over 40 - and next, an MRI will confirm the diagnosis and help with finding other cartilage or ligament lesions.

Depending on the severity of the rupture, whether it is traumatic or degenerative, its position, the concomitant pathology, the age and the patient’s activity, the orthopaedist shall propose the appropriate treatment. Conservative treatment (anti-inflammatory drugs, physiotherapy, ice therapy and rest) is usually recommended in older patients with mild symptoms and low activity levels. In addition, intra-articular injections of hyaluronic acid are an option to relieve symptoms, or, upon specific indications, activated platelet injections are another option.
However, in cases where there is an acute damage accompanied by both an effusion (water / swelling in the joint) and severe symptoms - the meniscus may block the knee and other ligament injuries, such as a rupture of the anterior cruciate ligament may coexist – then, an arthroscopy is required. The primary objective of the surgeon should be to save (suture) the meniscus. If this is not possible, the aim is to remove a portion from the meniscus, being as small as possible, and to “clean” the area (partial meniscectomy). Studies have shown that a knee without a meniscus has a 1.500% relative risk of developing osteoarthritis within 20 years.
Post-operative recovery after a partial meniscectomy is quick. The patient can return to their daily routine a week later, and to sports activities, after 3-4 weeks. However, if a repair is attempted, then crutches should be used for 4-6 weeks, so that the loading and active mobilization of the knee happen gradually. Return to sports activities after a meniscal repair shall take about 2 months.

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