Meniscus injury, to operate or not to operate?.
Damage to the meniscus can occur as a result of sports injuries. When your meniscus is damaged the knee often gives swelling within hours in most cases. 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, much 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?
- Steering of the knee especially during flexion and extension
- Agility, suppleness
- Protective effect; protecting cartilage
- Caring function
- Stabilizing 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)
Degenerative injury of the meniscus
In some cases, this can also occur as a result of an aging process. We call this degeneration. Just as we get gray hair or wrinkles, our bodies are also subject to aging inside. This aging is a normal process that occurs biologically in each individual person, starting at a certain age. The quality of the tissue so also the meniscus decreases. This increases the risk of injury. The symptoms often occur gradually and increase over time. Because the quality of the meniscus Later in life, the likelihood of an acute injury may also increase especially if there is still fanatical sports or physically demanding work.
Complaints associated with meniscus injury
The knee can often move less smoothly with meniscus injury. Because the meniscus is in the capsule of the joint, there may be fluid in the knee. We call this hydrops in the medical world. The bend of the knee often causes symptoms. We also see that activities such as climbing stairs or deep squat trigger the complaints.
Other symptoms that can occur with meniscus injury include:
- Pain in the knee; nagging/stinging/burning
- Instability complaints
- Obvious pain localization (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. Especially in the quadriceps
Does surgery make sense?
Research has shown that physiotherapy is as effective as operating on a meniscus tear. So physical therapy is 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 and tear 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. It cannot be moved. The meniscus is 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 depends in part on where the tear is located in the meniscus. We distinguish between three different zones. The outer zone we call 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. Here the blood supply is the least and therefore the chance of recovery is also minimal. The better the blood supply to a structure, the better nutrients can be transported to it. With these nutrients, new cells can repair the damaged tissue. Thus, the final recovery of the meniscus also depends on where the injury is located.
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 focus is placed on muscle function, gait and mobility of the knee. 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 determine 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 promote recovery.