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Meniscus

Meniskus
Draufsicht Meniskus

Meniscus tears and damage
The intact inner and outer meniscus, consisting of fibrous cartilage, enlarges the coating area of the joint, and is responsible for transferring power. It fulfills a kind of impact reducing function between the upper and lower leg bones. The two menisci are important as additional stabilizers of the knee joint and protect the cartilage from overload. Damage to the menisci is often found after sports accidents. Twisted spaces of the knee joint (e.g., in football or Alpine skiing) lead to overloading of the capsule-ligament apparatus, and result in typical injuries to the inner and outer meniscus area. Chronic overloading (e.g., from being overweight) or the aging process can also lead to damage. It is usually the interior meniscus that is affected. Patients complain about stabbing pains on the inside of the knee, often brought on by twisting movements. Many times the symptoms occur only during sports. Full bending or stretching is often limited. Typical symptoms are what are called joint blockages and repeated joint effusions. A defective meniscus works like a mechanical obstruction, and when not working leads to damage to the joint cartilage, the beginning of the arthrosis. Most patients can be helped with knee imaging (arthroscopy).

Operating technique
The inner and outer meniscus, the cruciate ligaments, and the cartilage surfaces can best be assessed and treated through two narrow skin incisions. We distinguish various typical tears, such as horseshoe tears, horizontal tears, and basket handle tears.  Damaged meniscus tissue is carefully removed using small punches and motor driven knives. Intact meniscus tissue is spared in order to retain its important protective function. Complete removal of the meniscus must absolutely be avoided. In certain cases, primarily younger patients, tears are sutured or bonded. Longitudinal tears or basket handle tears near the base of the meniscus, which is well supplied with blood, are particularly suited for this. Meniscus sutures are also possible by arthroscopy. For this purpose, we use special fixation pins or threads. These are made of resorbable material, which dissolve by themselves after several months. In such cases, the rehabilitation time is lengthened, since the sutured meniscus should not bear any weight for several weeks. Arthroscopic operations are performed on an outpatient or short-term inpatient stay basis. As a rule, patients are operated on under full anesthesia or spinal anesthesia. In some cases, such an operation can also be performed under local anesthesia.

Follow-up treatment
Immediate partial load bearing is permitted. We routinely give heparin for thrombosis prophylaxis for several days. Most patients achieve full weight-bearing after just a few days, and after 2 weeks begin sport activities once again. After meniscus suturing or additional operations on the cartilage, the joint may be only partially load bearing in the first few weeks. Physical therapy follow-up is recommended. The prognosis after meniscus operations is very good; in most cases, patients may continue their beloved sports activity without any problem.

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