TREATMENTS

Arthroscopy for meniscal injuries

Knee arthroscopy is a minimally invasive surgical procedure in which the inside of the knee is reached through two small incisions of approximately one centimeter long, called arthroscopic portals. Through one of these portals a small camera, the arthroscope, is placed inside the knee, and all the structures of the joint can be viewed on a high-quality video monitor. Through the other portal the surgeon can introduce specific surgical instruments to treat the injuries.

The menisci are fibrocartilaginous structures that act to disperse the weight of the body through the knee. There are two menisci in each knee, the external or lateral meniscus and the internal or medial meniscus. Without menisci the knee cartilage bear a mechanical overload that accelerates its wearing and can result in an early osteoarthritis.

The meniscal injuries are treated by arthroscopy. Most of them are tears of one or both menisci. They can have different shapes and sizes. The diagnosis is confirmed by magnetic resonance imaging (MRI).

The treatment aims to preserve as much of meniscus as possible. At Clínica Adler we attempt to perform a meniscal repair whenever possible, by suturing the torn fragment with high-strength implants.

The meniscal repair is the best way to preserve the meniscus. The recovery after the operation is long, because the mobility of the knee and the weight bearing must be limited for some weeks. But it cannot always be performed, because some specific conditions related to the shape of the tear and the quality of the meniscal tissue are required.

When the meniscus cannot be repaired, a partial meniscectomy is performed, in which the torn fragment is removed. The recovery after this operation is faster, as full range of motion and weight bearing are allowed from the first moment, with crutches.
There is another kind of meniscal injury, the meniscal root tear, where the attachment of the meniscal root must be repositioned back to its anatomical position. This treatment is more complex, as bone tunnels must be made for the reattachment.

The results after the treatment of meniscal injuries are generally good. The surgical technique is not difficult, except in some complex cases. Nevertheless, sometimes the result is not as good as expected, generally because the treatment was not correctly indicated. Sometimes the meniscal injury diagnosed in the magnetic resonance imaging (MRI) is not the cause of the patient’s pain, and thus treating the meniscal tear is not effective. At Clínica Adler we assess carefully the symptoms in order to correlate them to the MRI findings before indicating the treatment. Moreover, we do not indicate the alone treatment of a meniscal injury when other knee injuries are present, like ligament or cartilage injuries, which are going to remain or even aggravate after the meniscectomy.