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NL Meniscus injury, to operate or not?
Damage to the meniscus can occur as a result of sports injuries. In most cases, when your meniscus is damaged, the knee often gives swelling within a few hours. The pain may be on either the inside or the outside. This is because the meniscus consists of two moon-shaped rings. One on the inside (medial meniscus) and one on the outside (lateral meniscus). In recent years, a lot of research has emerged that surgery after meniscus injury is not always necessary. In fact, in most cases, it is not! In this blog, we discuss what meniscus injury entails and what the options are for the rehabilitation process.
What is the meniscus?
The meniscus forms two crescents made up of cartilage. In the knee, there is an inner and outer meniscus. The meniscus has several functions. The main functions of the meniscus are:
- Steering of the knee especially during flexion and extension
- Agility, suppleness
- Protective effect; protecting cartilage
- Caring function
- Stabilising function
- Pressure distribution in the knee
When there is a meniscus injury one or more of these functions may be affected.
What happens during meniscus injury (genesis)
A meniscus injury often occurs during an 'acute' (sudden) moment. During this moment, the knee rotates while loaded, leaving the foot on the ground. Within Physiotherapy, we refer to this as a traumatic moment. Meniscus injury often occurs with contact sports. Especially in sports that involve a lot of rotational movements (pivoting). Some examples are football, hockey and handball. When the forces on the knee are too great, a possible bruising or possible tear of the softer parts in the knee occurs.
Degenerative injury of the meniscus
In some cases, this can also occur as a result of an ageing process. We call this degeneration. Just like we get grey hair or wrinkles, our bodies are also subject to ageing inside. This ageing is a normal process that occurs biologically in every individual person, from a certain age onwards. The quality of tissue, including meniscus, deteriorates. This increases the risk of injury. Symptoms often occur gradually and increase over time. Because the quality of the meniscus diminishes at a later age, the risk of an acute injury may also increase, especially if you still play fanatical sports or do heavy physical work.
Complaints for meniscus injury
The knee can often move less smoothly with meniscus injury. Because the meniscus is located in the capsule of the joint, there may be fluid in the knee. We call this hydrops in the medical world. Bending the knee often causes symptoms. We also see that activities such as climbing stairs or deep squatting trigger the symptoms.
Other symptoms that can occur with meniscus injury are:
- Pain in knee; nagging/stinging/burning
- Instability complaints
- Clear pain localisation (clearly identifiable), at the level of joint gap of knee.
- Unstable feeling or uncertainty in movement
- Decrease in muscle mass, we then speak of muscle atrophy. Particularly in the quadriceps
Does surgery make sense?
Research has shown that physiotherapy is as effective as operating on a meniscus tear. Physiotherapy is therefore a good first choice to meniscus complaints improve. Physiotherapy has an edge in this sense precisely because we see that among those who have undergone surgery of the meniscus develop faster wear in the knee. This will require further investigation. Because of this development, we see that meniscus complaints are often first conservative be treated. That is, without surgery. The only exception is with structural locking complaints. It may be that a significant tear in the meniscus causes the knee to lock. So it cannot be moved. The meniscus is then trapped between the two parts of the bone. This should operative be treated. The stuck part of the meniscus is removed or sutured back into place. The chance of natural recovery also partly depends on where the tear is located in the meniscus. We distinguish between three different zones. We call the outer zone the red zone. This part of the meniscus is well supplied with blood. For this reason, the chance of recovery is greatest here. The middle zone is the red-white zone. Here there is blood supply but a lot less than in the outer zone. The inner zone is called the white zone, where the blood supply is least and therefore the chance of recovery is also minimal. The better supplied blood a structure is, the better nutrients can be transported to it. With these nutrients, new cells can repair the damaged tissue. The eventual recovery of the meniscus is therefore also related to the location of the injury.
Conclusion
Conservative Treating a meniscus tear is always preferred initially. Natural recovery often occurs within a few weeks to months. An average rehabilitation of a tear in the meniscus takes 12-16 weeks. During this period, there should be a noticeable reduction in symptoms. During this treatment the focus is placed on muscle function, gait pattern and knee mobility. Should there be no structural improvement after this period, further examination of the knee is necessary. A keyhole surgery or MRI can be used to assess the extent of the injury. Suturing of the meniscus to preserve as much function as possible. If this is not possible, the damaged part of the meniscus can be cut away. Physiotherapy is also advisable after surgery to aid recovery.
