Meniscal Lesions

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Meniscus Structure

Medial Meniscus

More open crescent shape.
Firmly attached to the tibial plateau and the joint capsule, making it less mobile and more prone to tearing.

Lateral Meniscus

More closed crescent shape.
Less firmly attached and more mobile, allowing it to better withstand stress.

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Role

Shock Absorption

Menisci absorb and distribute forces and loads applied to the knee during walking, running, and other activities, thereby 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

Menisci promote the distribution of synovial fluid within the knee joint, which helps lubricate and nourish the articular cartilage, essential for healthy joint function.

Load Distribution

They help distribute the load evenly across the knee joint, thereby reducing pressure on specific areas and minimizing wear on the articular cartilage.

Proprioception

Menisci contain sensory receptors that provide information about knee position and movement, contributing to proprioception, which is the body's ability to detect joint position.

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Classification of Meniscal Lesions

Menisci can be damaged by acute trauma, such as sudden knee twists, or by repeated microtrauma, often observed in athletes. Meniscal tears are common and can lead to symptoms such as pain, swelling, locking, or knee instability.
Meniscal lesions can therefore be classified according to their shape, location, and cause.

According to Tear Shape

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

Longitudinal Tear
Follows the curvature of the meniscus, parallel to its outer edge.
Can evolve into a bucket-handle tear.

Horizontal Tear
Extends through 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.

Bucket-Handle Tear
A torn meniscal fragment displaces towards the center of the joint, potentially causing mechanical locking of the knee.

According to Location
Red-Red Zone:

Peripheral zone of the meniscus with good blood supply.
Better capacity for spontaneous healing.

Red-White Zone:

Transition between the vascularized peripheral zone and the poorly vascularized central zone.
Intermediate healing capacity.

White-White Zone:

Central zone of the meniscus with little or no vascularization.
Poor healing capacity.

According to Cause
Traumatic:

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

Degenerative:

Results from progressive wear and tear of the meniscus with age.
More common in older individuals and those suffering from osteoarthritis.

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Causes of Meniscal Lesions

Acute Trauma:

Rapid changes in direction, sudden twists, or excessive knee flexion.
Sports injuries, particularly in sports like football, basketball, rugby, or skiing.

Progressive Degradation:

Natural wear and tear of the meniscus due to aging.
Knee osteoarthritis, which can lead to degenerative meniscal tears.

Repetitive Movements:

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

Pain:

Localized knee pain, often on the side of the lesion.
Pain may be aggravated by knee rotation or flexion.

Swelling:

Knee swelling, sometimes a few hours after trauma.
May be intermittent or constant depending on the severity of the lesion.

Knee Locking:

Sensation of locking or catching when the knee is moved.
May be associated with a bucket-handle tear where a meniscal fragment gets caught in the joint.

Instability:

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

Decreased Mobility:

Difficulty bending or fully straightening the knee.
Joint stiffness.

Clicking Sounds:

Sensation or sound of clicking in the knee, particularly during movement.

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

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Treatments

Conservative Treatments

 

Rest, Ice, Compression, Elevation (RICE):

Rest: Avoid activities that exacerbate pain.
Ice: Apply ice to reduce swelling and pain.
Compression: Use a compression bandage to minimize swelling.
Elevation: Elevate the leg to help reduce swelling.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs):

Reduce pain and inflammation.
Examples: ibuprofen, naproxen.

Physiotherapy:

Muscle Strengthening: Exercises to strengthen the muscles around the knee, particularly the quadriceps and hamstrings.
Mobility Improvement: Stretches to improve flexibility.
Proprioception: Exercises to improve balance and coordination.

Intra-articular Injections:

Corticosteroids: To reduce inflammation and pain in the short term.
Hyaluronic Acid: To improve joint lubrication and reduce pain.

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Meniscal Repair

Meniscal repair is a surgical procedure aimed at suturing and repairing a meniscal tear rather than removing the damaged part.
This procedure is performed when the tear is in a well-vascularized area (red-red zone or red-white zone), 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 the red-red or red-white zones where vascularization 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 assess 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 generally 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 visualize the inside of the joint.

Joint Inspection:

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

Suture Techniques:
All-inside Suture: Fully 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 tie 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 for natural healing.

Cleaning and Irrigation:

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

Postoperative Care and Rehabilitation
Recovery and Discharge:

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

Follow postoperative instructions given by the surgeon.

Pain and Swelling Management:

Prescribed pain medication to manage postoperative discomfort.
Application of ice and elevation of the knee to reduce swelling.

Rehabilitation:

Immobilization: A brace or orthosis 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 weight-bearing and deep knee flexion activities for several weeks to months to protect the repair.

Return to Activities:

Return to daily and sports activities is gradual, based on individual recovery.
Patients can generally resume light activities in a few weeks and more intense sports activities in a few months, as advised by their doctor.
Expected Outcomes and Potential Complications.

 

Positive Outcomes:

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 reoperation.
Joint stiffness or temporary loss of mobility.
Deep vein thrombosis (DVT).

Meniscal repair is a surgical procedure aimed at suturing a meniscal tear, particularly indicated for tears located in well-vascularized areas.
This procedure allows for meniscus preservation and maintenance of joint function, with appropriate rehabilitation essential for optimizing healing and preventing complications.

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Partial Meniscectomy

Partial meniscectomy is a surgical procedure aimed at removing 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 drugs.

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 generally performed under local, regional (spinal or epidural anesthesia), 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 visualize the inside of the joint.

Joint Inspection:

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

Removal of the 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 Care and Rehabilitation

Recovery and Discharge:

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

Pain and Swelling Management:

Prescribed pain medication to manage postoperative discomfort.
Application of ice and elevation of 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.

Return to Activities

Return to daily and sports activities is gradual, based on individual recovery.
Patients can generally resume light activities in a few weeks and more intense sports activities in a few months, as advised by their doctor.
Expected Outcomes and Potential Complications

Positive Outcomes:

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

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 part of the meniscus is removed.

Partial meniscectomy is an effective procedure for treating meniscal tears that cannot be repaired.
It provides pain relief and restores knee function with relatively quick recovery thanks to the minimally invasive arthroscopic technique.
Appropriate rehabilitation is essential to optimize results and prevent complications.

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Meniscal Transplantation

Meniscal transplantation is a surgical procedure aimed at replacing a damaged or absent meniscus with a meniscal allograft from a cadaveric donor.
This procedure is generally considered for young, active patients who have undergone total or partial meniscectomy and suffer from persistent pain or knee dysfunction.

Indications for Meniscal Transplantation
Persistent Pain: Continuous pain after partial or total meniscectomy.
Meniscal Failure: Significant loss of meniscal function leading to symptoms such as instability and swelling.
Osteoarthritis Prevention: Patients at risk of developing premature osteoarthritis due to meniscus absence or loss of function.
Young Active Patients: Preservation of long-term joint function in young people and athletes.

Preparation for Surgery
Medical Evaluation:

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

Graft Selection:

Search for a compatible meniscal allograft from a cadaveric donor.
Matching in size and shape to ensure adequate fit.

Anesthesia:

Meniscal transplantation is generally 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 visualize the inside of the joint.

Graft Site Preparation:

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

Graft Insertion:

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

Verification and Adjustment:

Verification of graft fit and position.
Irrigation of the joint to remove debris and clean the surgical site.

Incision Closure:

The incisions are closed with sutures or adhesive strips.

Postoperative Care and Rehabilitation

Recovery and Discharge:

Most patients can return home the same day or after one night of hospitalization.
Follow postoperative instructions given by the surgeon.

Pain and Swelling Management:

Prescribed pain medication to manage postoperative discomfort.
Application of ice and elevation of the knee to reduce swelling.

Rehabilitation:

Immobilization : A brace or orthosis 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 weight-bearing and deep knee flexion activities for several weeks to months to protect the repair.

Return to Activities:

Return to daily and sports activities is gradual, based on individual recovery.
Patients can generally resume light activities in a few months and more intense sports activities in 6 to 12 months, as advised by their doctor.
Expected Outcomes and Potential Complications

Positive Outcomes:

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 aimed at replacing a damaged or absent meniscus with a compatible meniscal allograft.
It provides pain relief, improves knee function, and prevents premature osteoarthritis, particularly in young, active patients.
Adequate preparation, precise surgical execution, and rigorous postoperative rehabilitation are essential to optimize results and minimize complications.

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