DAMAGE TO THE MENISCUS/CARTILAGE
There are two menisci in the knee – lateral and medial. They are flexible “C”-shaped structures located between the articular surfaces of the tibia and the thigh. Their main role is to absorb stresses to which the knee is exposed during physical activity. They also help to keep the movements of the joint smooth and stable.
The ends of the femur, tibia and the articular surface of the patella are covered with the so-called hyaline cartilage – smooth and elastic tissue. It minimizes friction during movement and provides cushioning, which makes the movements in the joint painless.
Both the above structures can be damaged. The condition can be acute or chronic. The first appears suddenly, e.g. after an injury during physical activity. The second is the result of long-term overloads or changes in the structure of the tissues, e.g. prolonged process of destroying the structures due to osteoarthritis.
Injuries of the meniscus can be painful, e.g. when bending or straightening the knee. Sometimes there are mechanical symptoms, such as the feeling of clicking, shooting in the knee until joint mobility becomes blocked. These symptoms can be accompanied by joint swelling.
Damage to the articular cartilage can give similar symptoms, especially pain, which depends on damage to other joint structures.
The initial diagnosis is often made after taking medical history and performing a clinical examination of the joint, it is confirmed by a diagnostic examination – magnetic resonance imaging of the knee.
The treatment of damage to the articular cartilage and menisci depends on the form (acute vs. chronic), the extent of the disease and injuries of other structures of the knee. Minor damage can be treated conservatively – after the acute symptoms subside, rehabilitation is implemented. With larger damage, surgery is sometimes necessary.
Type of operation
The operation is performed by arthroscopy. Usually, two incisions are made – arthroscopic portals are located on the frontal surface of the knee. During the operation, an orthopedist confirms the preliminary diagnosis and examines all the structures for other damage. After a thorough intraoperative assessment, the doctor proceeds to the next stage of the operation.
Meniscal injuries are treated either by suturing the damaged fragment or removing the structure. A decision is influenced by many factors, especially the extent and location of damage. Meniscus transplants can also be applied – this method is still new, though high hopes are held for this procedure.
The treatment of cartilage also depends on the extensiveness of damage – the final decision is always intraoperative, and requires careful evaluation of the joint. The treatment options include “debridement” or “cleaning” of the damaged fragment, “microfracturations” or stimulation of the tissue at the site of damage to form a functional “scar”. There are also possibilities of cartilage transplantation or filling defects with biological matrices.
In most cases, the day after surgery, drains are removed and the patient gets out of bed with the help of elbow crutches. Post-operative management depends on the treatment method. The limb usually does not require immobilization, quite the contrary, quick returning to full functionality is crucial for the patient to regain fitness. If everything is fine, the patient is discharged from the hospital. Rehabilitation should begin as soon as possible.
In the Szpital Zakonu Bonifratrów, arthroscopy of damaged meniscus/cartilage is performed by a team of specialists in orthopedics and traumatology:
Stanisław Szymanik, MD – Head of the Diagnostic and Treatment Department
Michał Latos, MD
Michał Starmach, MD