The “Miniskirt” Tear
The meniscus (remembered as ‘miniskirt’ by some of my patients) is a rubbery, C-shaped cartilage inside the knee joint which provides smooth knee motion, stability and shock absorber effect.
It can be damaged or torn during activities that cause direct hit or pressure from a forced twist. For example, taking a hard tackle on the football field or a sudden turn on the futsal or badminton court. In elderly, as the meniscus ages, it weakens and become less elastic. Hence, even a minor event such as squatting can tear the meniscus. A meniscus tear can produce symptoms of pain, swelling, locking and imbalanced. It is common for a meniscus to injure concomitantly with other structures inside the knee joint such as the ligaments or cartilage.
Diagnosis is confirmed through a detailed history, physical examination, special tests and imaging studies such as the MRI (Magnetic Resonance Imaging). Arthroscopy (key hole surgery) is the best tool for diagnosis and it can provide immediate treatment if necessary.
Meniscal tears come in many sizes and patterns which influence the decision on treatment.
In the 1960s and 1970s, it was common to remove a damaged meniscus entirely. Unfortunately, this frequently led to early knee degenerative arthritis in many patients. Currently, the treatment decision is based on the patient’s activity level, age, location, size/type of tear, duration of injury and the presence of associated ligaments or cartilage injuries.
Immediately after an injury, the knee is put on rest, ice and compression bandage. Together with anti-inflammatory medications, these can reduce pain and swelling. Many small meniscal tears will heal without surgical treatment. However, a large tear causing locked knee or with concomitant knee ligament or cartilage injury may need an early surgery through arthroscopy.
Meniscal Repairs are performed on tears near the outer 1/3 of the meniscus where a good blood supply exists. The torn portion of the meniscus is repaired by using either sutures or absorbable fixation devices.
Partial Resection is for tears located in the inner 2/3 of the meniscus where there is no blood supply and poor healing potential. The goal is to stabilize the rim of the meniscus and only the torn part of the meniscus is removed. Complete Resection is performed if absolutely necessary and may leads to the development of arthritis.
To prevent this, meniscus replacement surgery is done following a complete meniscus resection. The replacement can be done either with a collagen meniscus implant or a meniscal transplant from a donor. Post-operatively, physiotherapy, brace and crutches are needed. Full recovery from surgery may take 4 to 12 weeks, depending on the severity of the meniscus tear and the type of procedure performed.
Risks of a meniscus tear can be reduced by regular exercises to keep the leg muscles strong, maintain flexibility, warm-up prior to sports activities, adequate rest in between workout and the use of proper shoes.
Keep fit, stay healthy and no ‘miniskirt” tear!