Knee meniscus damage

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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A joint is where two bones meet.

Cartilage covers the end of the bones. Between the two bones is a small amount of thick fluid called synovial fluid. This fluid lubricates the joint and allows smooth movement between the bones. It also nourishes cartilage.

The synovial fluid is made by the synovium. This is the tissue that lines the joint capsule. The joint capsule gives the joint stability, and prevents the bones from moving out of joint. Surrounding ligaments and muscles also help to give support and stability to joints.

The knee joint consists of the femur (upper leg bone), the tibia (lower leg bone) and the patella (knee cap). The knee is stabilized by the anterior and posterior cruciate ligaments and the two collateral ligaments.

The knee joint contains a medial and lateral meniscus (inner and outer meniscus). These are thick rubbery pads of cartilage tissue. They are C shaped and become thinner towards the middle of the joint. The menisci cartilage sit on top of the thin layer of articular cartilage which covers the top of the tibia. The menisci act as shock absorbers to absorb the impact of the upper leg on the lower leg, and help with stability of the knee.

A meniscus can be torn by a forceful knee movement while weight-bearing. The classic injury is for a football player to rotate the knee while the foot is still on the ground.

Meniscus tears may also occur without a sudden severe injury. In some cases a tear develops due to repeated small injuries to the cartilage, or to degeneration (wear and tear) of the meniscus cartilage in older people.

Meniscus cartilage does not heal very well. This is because it does not have a good blood supply. The outer edge of each meniscus has some blood vessels, but the area in the center has no direct blood supply. So, some small outer tears may heal in time, but larger tears, or a tear in the middle of a meniscus, tend not to heal.

The symptoms of a meniscus tear include:

Pain when the leg is straightened. Severe pain occurs if a torn fragment of meniscus catches between the tibia and femur.

Swelling develops several hours after the injury if the joint fills with fluid.

Knee function. A person may be unable to straighten the knee. The knee may click, or may lock from time to time if the torn fragment interferes with normal knee movement.

In some cases the symptoms of meniscus injury go away on its own after a few weeks. However, in many cases the symptoms persist long-term, or flare up from time to time, until the tear is treated.

The initial treatment should be rest, ice, compression (with a wrap of some kind) and elevation. Combining these measures with anti inflammatory drugs helps to relieve the initial pain and swelling. Further treatment may then depend on the size of the tear, the severity of symptoms, the effect of the injury on activities of daily living, age, and general health.

Small tears may heal by themselves in time. Strengthening the supporting structures of the knee such as the quadriceps and hamstring muscles help protect the knee.

If the tear causes persistent symptoms, then an operation may be advised. Most operations are done via an arthroscope.

Arthroscopy is a thin telescope with a light source. It is used to light up and magnify the structures inside a joint.

In addition to simply looking inside, during an arthroscopy a doctor can use fine instruments to cut, trim, biopsy, grab, etc, inside the joint. So arthroscopy can be used to diagnose and to treat meniscus tears. Following surgery a patient will have physical therapy to keep the knee joint active and to strengthen the surrounding muscles to help support and strengthen the knee.

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