What are Meniscal Problems?
The menisci of the knee are small wedge shaped cartilages which act as a shock absorber
in the knee.There are two menisci in each knee, one on the outer (lateral) and one on the inner (medial) side of the knee. They help to transmit forces from the curved end of the femur onto a relatively flat upper tibial area. Menisci can be damaged both in sports related injury in your patients and also due to degeneration and weakness of the collagen fibres that give the meniscus its strength. As the collagen scaffold gets weaker there is a risk of tearing of the meniscal cartilage even with minor trauma such as twisting the knee.
What are the symptoms of Meniscal Problems?
The meniscus can cause a number of problems including pain and swelling of the knee. It can also cause mechanical symptoms where it flips into the joint and causes a physical block to movement of the knee. This can be associated with clunking and discomfort, along with sensations of the knee giving way due to something trapping in the joint. The main symptoms initially are of pain which can be localised either to the inner or outer side of the knee and associated mechanical problems.
What are the treatment options for Meniscal Problems?
As with all orthopaedic joint problems, physiotherapy can be helpful and certainly symptoms can be quite severe after an acute tear and then settle with time. It is often worthwhile having a trial of conservative treatment with pain relief, activity modification and physiotherapy.If symptoms persist then the diagnosis can be confirmed with x-rays and MR scanning. Dependent upon the type and location of the tear the meniscus can be either trimmed away or repaired. There is some early experience in the new field of meniscal transplantation and this is a specialist procedure that Mr Hoad-Reddick does not perform.
When should I see my doctor?
I would consider making an appointment with your general practitioner if symptoms persist and remain for 2-3 weeks following onset of localised discomfort as noted above. I would seek an early appointment with my doctor if mechanical symptoms were commencing, including locking or significant giving way.
What are the next steps?
In order to confirm a meniscal tear it is necessary to exclude arthritis with an x-ray and then obtain an MR scan to fully delineate the problem. If MR scanning confirms a significant tear that has failed to respond to non-operative management then arthroscopic surgery (keyhole) can be considered. This is performed under general anaesthetic as a day-case with two small cuts made, one each side of the kneecap tendon to allow a camera to be inserted into the knee and small instruments are inserted through the other incision so that the meniscal tear can be treated. Usually patients should not drive for a week following meniscal surgery and return to sports is usually limited for 4-6 weeks, but you would be advised regarding postoperative rehabilitation following your individual surgery.