Meniscal tear: when and why it occurs

The menisci are structures made of fibrocartilage found inside the knee. They are shaped like semifinals and increase the congruence between the joint surfaces of the femur and tibia during movement. In addition, they help in the absorption of loads by the knee, increasing the contact surface.

By performing the aforementioned functions, they are considered to reduce the deterioration of the articular cartilage. If they did not exist, the force that the knee receives during the movements when walking or running would pass directly from one bone to another, with the consequent deterioration of the cartilage.

What types of meniscal tears are there?

There are two types of meniscal tears:

  • Traumatic. These injuries usually occur in young people during sports practice, mainly on healthy and good quality menisci.
  • Degenerative. They are tears that are produced by a trauma of low intensity, if it exists. However, the patient usually does not remember the moment, since the injury is sustained on menisci that have already started the degeneration process, since they are less elastic.

It is more common for traumatic tears to occur during twisting movements where the foot is fixed to the ground, while degenerative tears are more often caused by prolonged hyperflexion (kneeling, for example).

How should meniscal tears be treated?

As not all patients are the same and the type of tear is not the same, the treatment cannot be the same and must be individualized.

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In degenerative tears, conservative treatment is fundamental. A good physiotherapy and rehabilitation program, with specific exercises, is able to recover full knee function. Only in cases where, more than 3 months after the rupture, if there are repeated effusions, knee locking or uncontrolled pain, conservative treatment will be considered to have failed.

When this occurs, meniscectomy via arthroscopy, i.e. removal of the tear site, usually gives a high percentage of good results, although not 100%, as post-meniscectomy pain may occur in 1 to 5% of patients.

In traumatic injuries, especially in young people, saving the meniscus should be paramount, although the recovery time is longer. Suturing the meniscus is essential but sutures cannot be made in all areas of the tear, since the blood supply necessary for good healing only occurs in the area of attachment to the joint capsule. If the removal of the meniscus is large and the patient is young, it may be necessary for the traumatology specialist to consider the possibility of a meniscal implant to reduce the possibility of degeneration of the knee.