Meniscal lesions

Role of the Menisci

Shock Absorption
The menisci absorb and distribute forces and loads applied to the knee during walking, running, and other activities, reducing direct impact on the articular surfaces of the femur and tibia.

Joint stability
They contribute to knee stability by increasing the congruence between the articular surfaces of the femur and tibia, limiting excessive movements that could damage the joint.

Joint Lubrication and Nutrition
The menisci promote the distribution of synovial fluid throughout the knee joint, which helps lubricate and nourish the articular cartilage, essential for healthy joint function.

Load Distribution
They help to evenly distribute the load across the knee joint, reducing pressure on specific areas and minimizing wear and tear on the joint cartilage.

Proprioception
The menisci contain sensory receptors that provide information about the position and movement of the knee, contributing to proprioception, which is the body's ability to sense joint position.

Classification of Meniscal Injuries

The menisci can be damaged by acute trauma, such as sudden twists of the knee, or by repetitive microtrauma, often seen in athletes. Meniscal tears are common and can cause symptoms such as pain, swelling, locking, or instability of the knee.
Meniscal injuries can therefore be classified according to their shape, location and cause.

According to the Shape of the Tear

Radial Tear
Spreads from the inner edge of the meniscus outward.
Often located in the avascular region (poorly supplied with blood), which complicates spontaneous healing.

Longitudinal Tear
Following the curvature of the meniscus, parallel to its outer edge.
May develop into a bucket handle tear.

Horizontal Tear
Propagates across the horizontal plane of the meniscus.
Often associated with meniscal cysts.

Complex Tear
Combination of several types of tears, often irregular and affecting different parts of the meniscus.

Tear in Anse de Seau
A torn meniscus fragment moves toward the center of the joint, potentially causing mechanical locking of the knee.

Depending on Location
Red-Red Zone:

Peripheral zone of the meniscus well supplied with blood.
Better spontaneous healing ability.

Red-White Zone:

Transition between the irrigated peripheral zone and the poorly irrigated central zone.
Intermediate healing ability.

White-White Zone:

Central area of the meniscus with little or no vascularization.
Poor healing ability.

According to the Cause
Traumatic:

Often occurs following acute trauma, such as a twisted knee.
Common in young people and athletes.

Degenerative:

Resulting from the progressive wear of the meniscus with age.
More common in older people and those with osteoarthritis.

Causes of Meniscal Injuries

Acute Trauma:

Rapid changes in direction, sudden twists or excessive knee bending.
Sports accidents, particularly in sports such as football, basketball, rugby or skiing.

Progressive Degradation:

Natural wear of the meniscus due to aging.
Osteoarthritis of the knee, which can lead to degenerative meniscal tears.

Repeated Movements:

Repetitive activities that constantly stress the knee.
Demanding physical work or certain professions.
Symptoms of Meniscal Injuries

Pain :

Localized pain in the knee, often on the side of the injury.
Pain may be made worse by rotating or bending the knee.

Swelling :

Swelling of the knee, sometimes a few hours after the injury.
May be intermittent or constant depending on the severity of the injury.

Knee Block:

Sensation of locking or catching when the knee is moved.
May be associated with a bucket handle tear where a fragment of meniscus becomes stuck in the joint.

Instability:

Feeling of unstable or loose knee.
Less common but can occur with severe tears.

Decreased Mobility:

Difficulty bending or straightening the knee completely.
Joint stiffness.

Cracking Sounds:

Cracking sensation or sound in the knee, especially during movement.

Meniscal injuries vary in their shape, location, and cause, with symptoms ranging from pain and swelling to instability and locking of the knee. Proper diagnosis and treatment are essential to managing meniscal injuries, preserving knee function, and preventing long-term complications.

Meniscal Repair

Meniscal repair is a surgical procedure to suture and repair a torn meniscus rather than removing the damaged part.
This procedure is performed when the tear is in a well-vascularized area (red-red area or red-white area), where healing is more likely.

Indications for Meniscal Repair
Longitudinal Tears: Often repaired because they are generally located in better vascularized areas.
Recent Tears: Acute tears in young, active patients are good candidates.
Location: Tears in red-red or red-white areas where vascularity allows for better healing.
Meniscus Preservation: Particularly in young patients to preserve long-term joint function.

Preparation for Surgery
Medical Evaluation: Consultation with an orthopedist to evaluate the meniscal tear and discuss medical history.
Imaging: MRI or other imaging tests to determine the location and extent of the tear.
Anesthesia: Meniscal repair is usually performed under regional or general anesthesia.

Surgical Procedure
Incisions:

Small incisions (portals) are made around the knee to insert an arthroscope and surgical instruments.
An arthroscope, a thin camera, is used to view the inside of the joint.

Joint Inspection:

The surgeon inspects the meniscus, cartilage, and other intra-articular structures to assess the extent of damage.
Tear Repair:

Suture Techniques:
All-inside Suture: A completely internal suture technique using special devices that do not require additional incisions.
Inside-out suture: The suture is passed from the inside of the joint to the outside, requiring small incisions to attach the sutures.
Outside-in suture: The suture is passed from the outside of the joint to the inside.
Sutures are placed to bring the torn edges of the meniscus together, allowing natural healing.

Cleaning and Irrigation:

The joint is irrigated to remove debris.
The incisions are then closed with sutures or adhesive strips.

Postoperative and Rehabilitation
Wake up and Return Home:

Most meniscal repairs are outpatient procedures, allowing patients to return home the same day.

Follow the post-operative instructions given by the surgeon.

Pain and Swelling Management:

Pain medications prescribed to manage post-operative discomfort.
Apply ice and elevate the knee to reduce swelling.

Rehabilitation:

Immobilization: A splint or brace may be used to immobilize the knee for the first few weeks.

Physiotherapy Program:
Mobility exercises to prevent joint stiffness.
Progressive exercises to strengthen the muscles around the knee.
Proprioception and balance to prevent future injuries.
Activity Restrictions: Limitation of loads and deep knee flexion activities for several weeks to months to protect the repair.

Back to Activities:

The return to daily and sporting activities is gradual, based on individual recovery.
Patients can usually return to light activities within a few weeks and more intense sports activities within a few months, depending on medical advice.
Expected Results and Potential Complications.

Positive Results:

Preservation of the meniscus and joint function.
Significant reduction in pain.
Improved knee stability and function.
Potential Complications:

Risk of infection, although rare.
Repair failure requiring re-intervention.
Joint stiffness or temporary loss of mobility.
Deep vein thrombosis (DVT).

Meniscal repair is a surgical procedure to suture a meniscal tear, particularly indicated for tears located in well-vascularized areas.
This procedure helps preserve the meniscus and maintain joint function, with appropriate rehabilitation essential to optimize healing and prevent complications.

Partial Meniscectomy

Partial meniscectomy is a surgical procedure to remove the damaged part of the meniscus in the knee.
This procedure is commonly performed arthroscopically, a minimally invasive technique that uses small incisions and a special camera to guide surgical instruments.

Indications for Partial Meniscectomy
Irreparable Tears: Meniscal tears that cannot be sutured, often located in the avascular zone of the meniscus.

Unstable Fragments: Detached pieces of meniscus that cause locking, pain, or instability in the knee joint.

Failure of Conservative Treatments: Persistent pain or other symptoms despite non-surgical treatments such as physiotherapy and anti-inflammatory medications.

Preparation for Surgery
Medical Evaluation: Preoperative consultation with an orthopedist to assess the condition of the knee and discuss medical history.

Imaging: MRI or other imaging tests to locate and characterize the meniscal tear.
Anesthesia: Partial meniscectomy is usually performed under local, regional (spinal or epidural) or general anesthesia.

Surgical Procedure
Incisions:

Small incisions (portals) are made around the knee.
An arthroscope (a thin camera) is inserted through one of the incisions to view the inside of the joint.

Joint Inspection:

The surgeon inspects the meniscus, cartilage, and other intra-articular structures to assess the extent of damage.

Removal of Damaged Part:

Special surgical instruments are inserted through the other incisions to cut out and remove the damaged part of the meniscus.
Only the torn or irreparably damaged portion is removed, leaving as much healthy meniscus as possible to preserve joint function.

Cleaning and Irrigation:

The joint is irrigated to remove debris.
The incisions are then closed with sutures or adhesive strips.

Postoperative and Rehabilitation

Wake up and Return Home:

Most partial meniscectomies are outpatient procedures, allowing patients to return home the same day.
Follow the post-operative instructions given by the surgeon.

Pain and Swelling Management:

Pain medications prescribed to manage post-operative discomfort.
Apply ice and elevate the knee to reduce swelling.

Rehabilitation:

Physiotherapy program to restore knee mobility and strength.
Progressive exercises to strengthen the muscles around the knee and improve flexibility.
Proprioception and balance to prevent future injuries.

Back to Activities

The return to daily and sporting activities is gradual, based on individual recovery.
Patients can usually return to light activities within a few weeks and more intense sports activities within a few months, depending on medical advice.
Expected Results and Potential Complications

Positive Results:

Significant reduction in pain.
Improved knee function.
Reduction of mechanical symptoms such as blockages.

Potential Complications:

Risk of infection, although rare.
Deep vein thrombosis (DVT).
Risk of nerve or vascular damage.
Development of long-term osteoarthritis if a large portion of the meniscus is removed.

Partial meniscectomy is an effective procedure to treat meniscal tears that cannot be repaired.
It provides pain relief and restoration of knee function with relatively rapid recovery using the minimally invasive arthroscopic technique.
Proper rehabilitation is essential to optimize outcomes and prevent complications.

Meniscal Transplantation

Meniscal transplantation is a surgical procedure to replace a damaged or missing meniscus with a meniscal graft from a cadaveric donor.
This procedure is typically considered for young, active patients who have undergone a total or partial meniscectomy and are experiencing persistent pain or knee dysfunction.

Indications for Meniscal Transplantation
Persistent Pain: Continued pain after a partial or total meniscectomy.
Meniscus Failure: Significant loss of meniscal function resulting in symptoms such as instability and swelling.
Prevention of Osteoarthritis: Patients at risk of developing premature osteoarthritis due to absence or loss of function of the meniscus.
Young Active Patients: Long-term preservation of joint function in youth and athletes.

Preparation for Surgery
Medical Assessment:

Consultation with an orthopedist to assess the condition of the knee and discuss medical history.
Imaging tests (MRI, X-rays) to assess the condition of the joint and plan surgery.

Graft Selection:

Search for a compatible meniscal graft from a cadaveric donor.
Size and shape match to ensure proper fit.

Anesthesia:

Meniscal transplantation is usually performed under regional or general anesthesia.
Surgical Procedure

Incisions:

Small incisions (portals) are made around the knee to insert an arthroscope and surgical instruments.
An arthroscope, a thin camera, is used to view the inside of the joint.

Preparation of the Graft Site:

Removal of any remaining meniscal tissue and preparation of the area for the graft.

Insertion of the Graft:

The meniscal graft is inserted into the knee joint.
Fixation of the graft to the bone and cartilage using sutures or special anchors to ensure optimal stability.

Checking and Adjusting:

Checking the fit and position of the graft.
Irrigation of the joint to remove debris and cleaning of the surgical site.

Closing the Incisions:

The incisions are closed with sutures or adhesive strips.

Postoperative and Rehabilitation

Wake up and Return Home:

Most patients can go home the same day or after an overnight stay in the hospital.
Follow the post-operative instructions given by the surgeon.

Pain and Swelling Management:

Pain medications prescribed to manage post-operative discomfort.
Apply ice and elevate the knee to reduce swelling.

Rehabilitation:

Immobilization : A splint or brace may be used to immobilize the knee for the first few weeks.

Physiotherapy Program:
Mobility exercises to prevent joint stiffness.
Progressive exercises to strengthen the muscles around the knee.
Proprioception and balance to prevent future injuries.
Activity Restrictions: Limitation of loads and deep knee flexion activities for several weeks to months to protect the repair.

Back to Activities:

The return to daily and sporting activities is gradual, based on individual recovery.
Patients can usually return to light activities within a few months and more intense sports activities within 6 to 12 months, depending on medical advice.
Expected Results and Potential Complications

Positive Results:

Pain relief.
Improved knee function.
Joint preservation and prevention of premature osteoarthritis.

Potential Complications:

Risk of infection, although rare.
Graft rejection, requiring monitoring and appropriate treatment.
Graft failure, requiring reoperation.
Joint stiffness or temporary loss of mobility.
Deep vein thrombosis (DVT).

Meniscal transplantation is an advanced surgical procedure to replace a damaged or missing meniscus with a compatible meniscal graft.
It helps relieve pain, improve knee function and prevent premature osteoarthritis, particularly in young, active patients.
Adequate preparation, precise surgical execution and rigorous postoperative rehabilitation are essential to optimize results and minimize complications.