I know a teen athlete who, unfortunately, by the age of 16 had meniscus surgery of both knees. Meniscus tears in the knee can range from minor to severe, depending on the extent of the damage
, and they can make it difficult for the knee to function properly. For teens, meniscus tears usually happen because of an injury, often after twisting or turning the knee while it is bent and the foot is firmly planted.
A soccer, basketball, lacrosse, tennis, or football player who plants a foot to change directions or who takes a hit from another player is vulnerable to meniscus injuries. Runners who misstep or step in a hole can sustain the same injury.
Men are more likely to tear a meniscus than women, but that may be because of the number of men that participate in sports as opposed to a gender-specific cause.
The National Center for Biotechnology Information investigated the outcome of 29 youth meniscal surgeries (average patient age being 15)
. The follow-up was 2 years post surgery. The results were that 24 of the 29 healed (patient was clinically symptom-free)
regardless of location or type. Four patients re-ruptured their menisci at an average of 15 months after surgery.
Recurrent meniscal tears were located in the pars intermedia; the poorer blood supply in this region may give a higher risk of re-rupture. In 2 of the re-ruptures, degeneration of a central part of the meniscus demanded removal. In the other 2 cases, the initially repaired meniscus had to be partially removed, but the remaining meniscus had healed and could be preserved. The recurrent tears were all located in the same zone as the original injury.
Minor tears usually don't need surgery, especially if they are on the outer part of the meniscus where there is a good supply of blood. These tears should heal on their own fairly quickly. For severe tears or tears that don't respond to other forms of treatment, a doctor may have to perform surgery. Sometimes a surgeon can repair a torn meniscus.
The options for surgery involve either a meniscus repair (sewing the meniscus back together with stitches and/or anchors)
or a partial meniscectomy (trimming the torn part of the meniscus out)
. Which of those two options is necessary depends on the location and orientation of the tear itself, and the patient and surgeon have little ability to affect that outcome.
Obviously, if the tear is repairable, that is good in the long term, although the rehab and overall recovery take longer and there is unfortunately a sizeable percentage of those repairs that don’t heal. But if the repair heals, the surgeon has preserved the entire meniscus to serve as a shock absorber.
Potentially, problems could result from removing some of the shock absorber in an athlete or exercise fan who continues to engage in repetitive impact.
Over time, that impact will start to take a toll on the articular cartilage and later, the bone, and lead to degenerative changes. Arthritis tends to be the most likely result, appearing years following a partial meniscectomy.
What exactly is the meniscus?
The meniscus is a small “c” shaped structure within the knee that represents itself as a piece of cartilage, acting as a cushion in the knee joint.
The meniscus sits between the Femur (thigh bone) and the Tibia (shin bone) acting as a shock absorber
— one of these is located on the outside of the knee (the lateral meniscus)
and the other on the inside of the knee (the medial meniscus)
. The medial meniscus bears up to 50% of the load applied to the inside compartment of the knee, while the lateral meniscus absorbs up to 80% of the load on the outside compartment of the knee.
The meniscus plays an important role in the knee because it aids in joint stability, helps protect ligaments against force and it provides lubrication.
Years ago, it was a common practice to remove damaged meniscus following a knee injury. This frequently led to arthritis and other degenerative conditions including a “bow-legged” or “knock-kneed” deformity. Today, the approach is to try and repair the meniscus because orthopedic physicians agree that it plays a significant role in the overall health of the knee.
The National Center for Health Statistics reports that meniscus surgery is the most frequent surgical procedure performed by orthopedic surgeons in the United States, performed about 700,000 times a year at an estimated cost of $4 billion.
There are many variables that must be looked at when diagnosing a meniscus injury — including where the injury is located within the meniscus, the pattern of the tear and how it was injured.
The front portion of the meniscus is referred to as the anterior horn, the back portion is the posterior horn, and the middle section is the body. A posterior horn tear is the most common meniscus injury. In addition, the meniscus is also broken down into the outer, middle, and inner thirds. Tears in the outer 1/3 area have the best chance of healing because blood supply in this area is the strongest and helps aid in the healing process.
Meniscus tears also come in many shapes including horizontal, longitudinal and radial. A complex tear will involve more than one pattern.
Complete vs. Incomplete Tear:
In addition, a meniscus tear will be classified as complete or incomplete. A tear is complete if it goes all the way through the meniscus and a piece of tissue becomes separated from the rest of the meniscus. If the tear is still partly attached to the body of the meniscus, it is considered incomplete.
Acute vs. Degenerative Meniscus Injuries:
Meniscus injuries will be classified as acute or degenerative. If a person is bearing weight on his or her leg and the knee is bent, an acute meniscus injury will occur if the knee is forcefully twisted while in this state. Statistics show that about 61 of 100,000 people experience an acute tear of the meniscus. Degenerative tears of the meniscus are more common in older people. 60% of the population over the age of 65 probably has some sort of degenerative tear of the meniscus. These tears are most likely to result from minor injuries involving regular or sporting activity. They eventually will weaken and become less elastic and may or may not present symptoms.
Symptoms of a Meniscus Injury:
Depending on the extent of the meniscus injury, pain will be mild to severe. Most patients will experience swelling and a throbbing or sharp, knee pain. In addition, a clicking or popping sound will be heard. If the injury is small, symptoms will usually go away without treatment.
Look at these numbers related to a torn meniscus...
The increased amount of body weight force placed on the knee joints when walking.
The increased amount of body weight force placed on the knee joints when running.
The inside (medial) meniscus is five times more likely to be injured than the outside (lateral) meniscus.
The percent of meniscus tears that can be diagnosed (by a physician) with a careful injury history and physical examination.
If a meniscus tear has occurred on the outer rim, there are enough blood vessels to allow the structure to heal. If the tear is in the central area where there isn't a good supply of blood, the tissue may not ever heal and may need to be removed through arthroscopic surgery.
- Recovery without surgery may take six to eight weeks.
- Recovery with surgery may take three to four months.
- Wear a knee brace or sleeve for protection.
A 2013 study, conducted in Finland, added to recent research suggesting that meniscal surgery should be aimed at a narrow group of patients; that for many, options like physical therapy may be as good as a meniscal surgery
. The Finnish study does not indicate that surgery never helps; there is consensus that it should be performed in some circumstances, especially for younger patients and for tears from acute sports injuries. But about 80 percent of tears develop from wear and aging, and some researchers believe surgery in those cases should be significantly limited.
There is another recent study which shows that exercise therapy is just as effective for treating meniscus injuries as surgery.
Orthopaedic surgeon, Nina Jullum Kise, was in charge of the study. She is a senior consultant at the Department of Orthopaedic Surgery, Martina Hansen's Hospital in Bærum. A total of 140 patients with meniscus injuries took part in the study -- half having surgery and half having exercise therapy. Two years later, both groups of patients had fewer symptoms and improved functioning. There was no difference between the two groups. However, those who had exercised had developed greater muscular strength.
This is consistent with previous research, which showed that surgery yielded no additional benefits
for patients who had had exercise therapy. Jullum Kise believes that as many as three in four could be spared surgery with the right exercise therapy program. The exercise therapy program involves a warm up and various types of strength training. It is built up in stages that become more challenging as the patient improves and becomes stronger. "We hope that the stronger muscles of the exercise therapy group may counteract osteoarthritis, a type of arthritis that often occurs in patients who have undergone surgery for a meniscus injury,"
says Dr Jullum Kise.
From Him, Through Him, For Him (Romans 11:36),
Paul J. Staso
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