Physical Therapy and Rehabilitation Specialist Associate Professor Ahmet İnanır gave important information on the subject.
What is meniscus?
The menisci are two circular wedge-shaped fibro-cartilaginous structures located between the femoral condyles and the tibial plateau. It basically consists of water and Type 2 collagen fibers.
What Does the Meniscus Do?
In addition to providing resistance to the loads and impacts on the knee joint, it contributes to the distribution of the load and stabilization. In addition, the menisci are responsible for the lubrication (lubricity), nutrition, and proprioception of the articular cartilage (the process of creating responses that will perceive joints, limbs, ligaments, and keep these areas in the safest position, and the proprioceptive process is governed by the deep senses). There are peripheral fibers that meet the axial loading and radial fibers that hold these fibers together and prevent vertical (vertical) separation. This information is very important.
What are the symptoms?
Among the many causes of knee pain, meniscus injuries play a very important role. Along with knee pain, swelling, limitation of movement, snapping, clicking sound, locking, even ejaculation, and even impairment in walking and balance can be seen. Tears separated from the main tissue cause locking by shifting between the joints.
The patient describes tenderness and pain in the medial (inner) l and lateral (outer) joint lines. Especially in knee extension (knee straightening) movement, loss and stuck can be detected.
Who is it most common?
Although it is known as an athlete's disease because it is frequently seen in athletes, it can also be encountered with knee traumas, especially sudden rotational movements and overloading, and as a result of aging.
How is it diagnosed?
Meniscal tears are diagnosed by examination and magnetic resonance (MRI) imaging. However, meniscal tears can be detected in 20% MRI in people with no knee complaints. The following meaning comes from here; Considering the rupture, it should be operated immediately and this valuable support tissue should not be removed and discarded.
How should it be treated?
The aim of treatment should not only be to relieve pain. Because if only pain relief is targeted, the way for knee deterioration will be opened in the next day / month / years. Although the number of non-surgical methods in the treatment is quite high, the treatment performed by a competent specialist should be chosen. The most important option among these is the stem cell combination, which is a newly developed and regenerative approach. In addition, osteopathic manual therapy, kinesiobanding, prolotherapy, neural therapy, ozone therapy can be used. In addition, the necessary exercises should be given and the necessary restrictions (weight loss in the first place) should be made so that we can protect this precious tissue, which is necessary for a lifetime check. Otherwise, low-grade tears may progress and require surgical treatment. If it is taken easily, joint slipperiness and position perception will deteriorate and the ground will be prepared for knee calcification. In patients with meniscus tear, rapid loss of cartilage volume and an increase in knee pain were found with increased weight. It has also been shown that 1% weight loss results in a reduction in cartilage loss and knee pain.
Treatments that repair tissue instead of treatments aimed at eliminating the symptoms should be considered and applied first. In the differential diagnosis, other disorders such as cartilage damage must be reviewed. With increasing age, artosis changes begin in the knee joint and progress gradually. In older patients, if the meniscus tears are accompanied by cartilage damage, the surgical methods to be applied for the meniscus tear do not provide good enough results. There is no difference between surgery and physical therapy in these patients. The main purpose of treatment should be to prevent recurrence in the next years. The age (year), type and location of the tear should be taken into consideration in the treatment.
Meniscus tears can be found in avascular (non-blood supply) and vascular (blood-fed) regions, depending on their localization. Tears in the vascular area have the ability to heal conservatively. Tears in the avascular region have a very low ability to heal even after surgical repair. Again, acute tears occur suddenly, while chronic tears occur as a result of wear over the years. With the advancement of age, the deterioration process of the meniscus begins. With increasing age; Meniscus quality decreases, water content increases, cellular content decreases, collagen and glucosaminoglycan ratios decrease. As a result, the meniscus becomes vulnerable to degeneration and injury.
Degenerative meniscal tears can occur in physically active people as well as elderly patients. There are 7-8 types of meniscal tears (vertical, longitudinal, oblique, radial, horizontal, root, bucket handle and complex). Surgery should not be recommended immediately for tears other than radial, oblique, and bucket handle tears. Surgery should be considered primarily in the presence of locked knee due to displaced bucket handle meniscus tear. Among the surgical methods, repair should be considered first, and meniscectomy in the second place. Removing 15-34% of the meniscus reduces the shock absorbing effect of the knee and increases the contact pressure by 35%. This means to increase the rate of arthritis in the knee.
Whether the continuity of the peripheral fibers is impaired or not should be taken into account in the choice of treatment. To date, there is no sufficient evidence to show that surgical treatment is superior to physical therapy in middle-aged and older people with stable meniscal tears.
Günceleme: 18/01/2023 10:06