All About Meniscus

Hi,

I am Dr. Akshay Lekhi, Orthopedist. There are 2 meniscus. Meniscus knee ke andar shock absorber structure hai jo ki rubbery structure hai. Humare ghutne ki jo 2 haddiyan hai femur and tibia, unke bich mein ek cushion shock absorber ki tarah kam karta hai. Uska kam hota hai lubrication, stress distribution, shock absorbing aur humare knee joint ke cartilage ko prevent karta hai from getting damaged. Har ek knee mein 2 meniscus hote hain, ek medial and ek lateral. Medial meniscus thoda chota hota hai as compared to the lateral meniscus. Jo rubber jaisa shock absorbing that is more prone to injuries. Iska surface area bhi thoda chota hota hai. Jab medial meniscus stress mein aata hai toh jaldi tut jata hai. Sports mein most common injury seen is meniscus tear and also it is one of the most common ignored injury. Sports injury ek terminology hai aur ye sirf sports person ko nahi hota hai. Koi bhi insan jise jerk lag jayega, excessive squat kar lega ya fir ek dum se dhodna ya bhagna hoga and sudden stop hone se knee is more prone in getting injured. Uske ligaments and structures are under stress. One of the reasons ki hum ise ignore karte hain. Kayi bar choti si chot lagne pe bhi jab ghutna atakta hai toh hum ignore karte hain aur tab ye progress karta hai. So, how can it be torned? There are 2 modes, one is degenerative modes, age ke sath sabka degeneration hona hai. So, what happens with age degeneration occurs, then there are degenerative tears.

This is a slow process and doesn't occur immediately. 2nd is traumatic, chot lagne ya girne se, sudden squatting, excessive bending of the knee, are more prone to injury. One can be degenerative and one is traumatic. If we talk about surgery, every meniscus tear does not require surgery. There are many meniscus tear which should be addressed to and diagnosed but they do not need surgery. But the problem is if you do not go for diagnosis, and do not catch them at the right time, the time passes by and sometimes the minor tear which could have been conservatively managed gets more and more stress and becomes bigger tear and gets into such a form which we call as a bucket handle which gets the knee into the locking mechanism. In this case, the knee gets locked. So that tear which is usually traumatic is a tear which needs surgery. But sometimes, the minor tear can be ignored, but they should be diagnosed. Clinical diagnosis has got 80-90% chances of correct diagnosis. They might not be telling the correct extend. Shayad ye na pata chale ki kitna fata hai lekin itna pata chal jata hai ki meniscus pe koi chot pahuchi hai.

And then the further investigation can be done. Surgery sare tears ke lia nahi chahiyai but definitely ye pata hona chahiyai ki tear ka size kya hai, location kya hai. Kuch locations jahan healing potential jyada hota hai bahar ki taraf jise red zone bolte hain vo repair ke lia amenable hota hai. If you repair the small zones, these are more likely to heal as compared to a tear which is in the middle. But the tears which are inside, that is also called a white zone, in that area, the tears usually do not heal. Agar aise area mein koi tear ho jata hai toh we trim it off. Every time that is also not required but as I said the diagnosis is very important. The location of the tear must be confirmed going for any type of treatment. First, you should rest, put ice which will keep the swelling away, meet a sports surgeon nearby. Every type of knee injury doesn't mean it will have a meniscus tear or ligament injury which require urgent surgery. Return to work. It depends on what type of injury do you have. If the meniscus injury is minor, or it not there in the weight-bearing area, so as I said the diagnosis is important.

In such cases, the patient can return to work in 2-3 weeks. If the tear is minor and causing some symptoms and we have to trim it. In such cases, the patient can start weight bearing the same evening of the surgery. We tell them to avoid some strenuous activities like jumping, running. In 5-6 weeks they can return to the normal activity of routine and sports as well. Once the repair is done, it usually takes up to 5-6 months for complete rehabilitation. But definitely as far as weight bearing is concerned started as early as possible. A major repair can take up to 6 months. So, in such cases, repair takes time. If surgery needs to be done, doesn't mean it is always osteoarthritis. Of course, if the meniscus is completely destroyed and it has to be removed completely, it will definitely lead to osteoarthritis or probably progress at a higher rate as compared to the normal structure. If the completely destroyed meniscus lies inside the joint, that will anyway lead to the more damage of the cartilage.

So, it has to be removed. In maximum cases, meniscus tear just requires trimming and it is sufficient for the symptoms to be relieved. And in such cases, it doesn't contribute to the progress of osteoarthritis. It is only when you have to completely remove the meniscus. In such cases, it progresses. The try is to prevent the natural structure. So, wherever the healing can be done even if it is a bit larger, the surgeon usually tries to prevent the same. You always have the choice to replace but it is difficult to retransplant. Repair is also one of the modes of surgeries. Cartilage damage and osteoarthritis can be present irrespective of a meniscus tear as well and that progresses in its own case. Many other factors are there which contributes to arthritis not only the meniscus tear.

Thank you!