Knee meniscus degenerative
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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There is a difference between the meniscus on the inner aspect of the knee (the medial meniscus) and the one on the outer part (the lateral meniscus).
Here are some of the differences:
• The medial meniscus tightly adheres to the capsular wall of the joint around its outer edge.
• The lateral meniscus is different - it is rounded, and there is a section where the meniscus is not attached to the capsular wall of the joint. It can slip around on the surface of the tibia and is more mobile.
• The medial meniscus is subject to more torsion forces, and is more commonly torn than the lateral meniscus.
In a primary tear of the meniscus, there is usually a twisting force with significant torque. Examples would be a skier with tight bindings who catches his ski or a football player who plants his leg to pivot and change direction.
Degenerative tears occur in association with arthritic disorders where gradual wear and tear along with chronic inflammation causes damage to the meniscus. It becomes frayed. There is usually no injury.
An acute meniscal tear may be heard as a "pop" and felt as a tear or rip in the knee. The pain or discomfort is usually along the joint line.
Tenderness is elicited by palpation. Twisting the knee while flexing it will occasionally reproduce the patient's symptoms.
MRI scans are helpful in further evaluating the meniscus.
Some meniscal tears, especially in relatively inactive people, will be asymptomatic. This is particularly true in older patients. Few meniscal tears will heal on their own.
Treatment must be individualized according to the symptoms and the patient's activity level. Some patients can live with a meniscal tear without worsening. Others will not be able to function without treatment.
A torn meniscus is a mechanical problem that requires surgery. This means means either partial excision or repair of the tear. In general, due to the essential role of the meniscus in protecting the knee it is best to leave as much viable meniscal tissue as possible.
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