Meniscus Preservation
The Knee Joint
The knee joint is formed by Femur (thigh bone), tibia (leg bone) and patella Damage to the joint is called arthritis and is caused by Obesity, Meniscus tears, Malalignment (“bow-leg”) deformity overloading one compartment, instability (ligament tears) and rheumatological disorders.
Arthritis - Non operative treatment
- Weight loss
- Muscle strengthening exercises
- Activity and Lifestyle modification
- Injections like cortisone and hyaluronate give short term pain relief.
- PRP and stem cells injections are being promoted, but are inferior to cortisone in pain relief and long term benefits are still questioned.
- Unloading braces can off-load the painful part of knee.
- Footwear modifications
Meniscus Tears
Meniscus is the shock absorber of knee and is vital for joint protection. It is a fibrocartilage and is devoid of blood supply except around the peripheral rim. Tears have poor potential to heal unless repair is done. Repair can be done only in zones with good blood supply. Meniscal tears in zones without blood supply are treated with trimming and shaving (partial meniscectomy)
HEALING ZONE TEARS
Tears like this, which occur in the peripheral rim with good blood supply are good ones to repair
BUCKET-HANDLE TEARS
Extensive tears can result in a mobile segment (bucket-handle tear) that gets locked inside the knee, blocking knee movements. These tears need an extensive
repair or trimming and shaving (meniscectomy)
NON-HEALING ZONE TEARS
Small flap tears, tears in zones without blood supply are treated with trimming and shaving to leave a stable meniscus behind
Meniscus Repair
Different techniques of repair : All-Inside, Inside-out and Outside-in, are used to repair meniscus tears in various zones.
MENISCUS ROOT TEAR & REPAIR
Root tears refers to the avulsion of meniscus from its bone attachment. As total shock absorption is loss it leads to wear and tear – arthritis, quickly. Patients have severe pain, pain at night and limp. Treatment involves repair of the root tear. It has to be done early before the arthritic changes set in.