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Torn meniscus

an introduction

Explanation of the meniscus
The meniscus is composed of connective tissues containing a high concentration of collagen fibers, including cartilage cells

In the knee joint, there are two cartilage pads separating the thigh and tibia, which are the inner meniscus and the outer meniscus.

The main functions of the meniscus
1- They contribute to the stability of the knee joint

2- It acts as a cushion to reduce the friction between the thigh bones and the shinbones and to absorb shocks resulting from walking and running

3- It distributes knee fluid to the surface of the joint cartilages to feed it.

4- It distributes weight over the entire surface of the tibia, which preserves the articular cartilage that covers the bone surfaces.

The medial meniscus takes the shape of a meniscus and is connected to the medial collateral ligament, and the greatest pressure or load on it is during the rotation of the knee outward

The lateral meniscus tends to be more circular than the meniscus, and is not connected to the lateral ligament and therefore has a greater level of movement than the medial meniscus, as the movement is impaired when bending the knee, and therefore it is less prone to injuries than the medial meniscus. The meniscus is connected to each other by a transverse ligament that connects them from the front.

The meniscus provides the task of distributing pressure on the articular surface, except that it absorbs 30-70% of the stress and pressure on the joint surface with a greater load on the posterior horn of the meniscus, and the percentage of pressure distribution on the meniscus depends on the degree of bending of the knee as it absorbs 50% of the stress in When stretching the knee and 80% in bending.

Scientific experiments and studies have shown that the complete removal of the medial meniscus leads to a decrease in the area of ​​contact of the joint surfaces by 50-70%, which means an increase in the stress on the cartilage of the joint surface significantly.

Causes of a torn meniscus
The reason for cutting the meniscus varies according to age:

In the early stages of the tooth, a disc cut may accompany a disc.
In youth and athletes, a cut may occur in one of the menisci as a result of injury to the knee joint, such as falls or sprained knee. A meniscus tear may occur along with other knee injuries, such as severing the anterior cruciate ligament.
In old age, cartilage cutting may occur without a severe knee injury, due to weak cartilage and its erosion with age, especially in cases that suffer from roughness in the knee
There are also two causes: external injuries and degenerative changes.


External injuries:
It often results from a sprain of the knee joint, which may result from a fall or during sports injuries, and in this case, the meniscus injury may be alone or accompanying other injuries such as a tear of the front cruciate ligament.


Degenerative changes in the meniscus:
It often occurs with age or sometimes with chronic meniscus stress, as is the case when there is an injury to the meniscus.
The possibility of a rupture of the meniscus increases with the presence of curvature of the legs, where there is an increase in the load on the inner cartilage in cases of inward curvature and on the outer cartilage in cases of curvature in the outside.


Symptoms
Symptoms of inner cartilage injury

Pain in the inner side of the knee. Pain may occur during and after activities.
The joint closes or closes suddenly in different positions, and this means that the patient cannot extend or bend the knee, but rather the knee is in a certain position that cannot be moved.
Pain in the inner facet of the knee in the case of total extension and flexion, and also occurs when rotating the knee outward in the degree of bending between 70-90 degrees.
Slight swelling of the knee caused by the accumulation of joint fluid, and usually occurs after activities, especially strenuous ones
Show injury to the outer cartilage
Pain at the outer surface of the knee during and after activities. The pain usually recurs after certain activities.
Sudden locking or closing of the joint
The pain at the extension and total flexion, as well as the pain when the inner rotation of the knee at a degree of flexion between 70-90 degrees.
Slight swelling of a joint and sometimes joint runny

treatment
Non-surgical treatment:

The decision to treat in the event of a torn meniscus depends on several factors, including
Factors related to the patient, such as age and type of activities
Factors related to the type, location, and symptoms of the tear.
Another important factor that influences early surgery decision is the severity of symptoms and the time elapsed after an injury.


Non-surgical treatment: conservative

When the injury occurs
Ice is placed on the patient's knee with the knee up.

A compression garment is placed on the knee to reduce the chance of a leak.

The patient is given medications that help reduce pain and swelling.
The patient should avoid violent sports for a period specified by the attending physician.
Cartilage cutting associated with osteoarthritis
It is treated without surgery as long as it is not accompanied by a mechanical problem such as sudden stopping of movement of the knee. Also, some studies have shown that in about 60% of the elderly who do not suffer from knee pain, there is a cut of the meniscus when making an MRI for them.
But if the knee is stopped, the tear is removed with the endoscope
Recently, the knee is injected with platelet-rich plasma to help heal the cartilage pieces.
If the non-surgical treatment leads to the disappearance of the symptoms of the infection, there is no need for any other intervention.

Minimally invasive techniques: 

for mild menisceal tear, prp (platelet rich plasma) and hyaluronic acid in addition to intra-articular radio-frequency helps alot with the pain induced by the menisceal tear. 
it's done in the operation room in a hospital, it takes around 20-30 minutes. It's a day case when you get out of the hospital on the same day. 
it's a non-surgical technique, simple, easy and most importantly safe

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