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The meniscus is a rubber-like elastic cushion, located between the femur and tibia, and acts as a shock absorber for the knee. The meniscus consists of two parts, the inner and the outer. In which, meniscus tear in grade 2 is often severe. A meniscal tear in grade 2 can be split in half or tear around the circumference in a C-shape and often requires surgical intervention.1. Anatomical features of the medial meniscus
Similar to the external meniscus, the inner meniscus is also meniscus with a length of about 3.5cm. The anterior horn of the medial meniscus is attached to the anterior surface of the tibia and distal to the tibial plateau. The anterior fibers of the anterior cruciate ligament fuse with the transverse ligament connecting the anterior horns of the medial meniscus. The posterior horn of the medial meniscus is firmly attached to the posterior surface of the capsule. At the midpoint, the medial meniscus is attached to the femur and tibia also by ligaments, called the deep medial ligament.
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2. Mechanism of damage to the internal meniscus
The most common mechanism of medial meniscus injuries is torsional force with the foot on the ground, usually during competition or sports training. Accordingly, turning quickly on the football field or handling forcefully while the foot is steady can cause a meniscus tear. However, low speed torque can also cause meniscal tears.
In cases of traumatic meniscus tear, the medial meniscus tears are usually of the following types:
Longitudinal tears Horizontal tears Flap tears Beak-shaped tears Shoulder-shaped tears Compared to the external meniscus, the medial meniscus tears It is more common because it adheres to the deep cruciate ligament and the capsule. Also, because the medial meniscus is a significant shock absorber on the medial side of the knee joint and absorbs about 50% of the shock in the medial compartment, in the event of a knee injury such as a second-degree meniscal tear, suturing tear is essential. If not repaired, the load placed on the medial space of the knee joint rapidly increases, eventually leading to osteoarthritis and disabling sequelae.
3. How is an internal meniscus tear diagnosed?
The diagnosis of an internal meniscus tear begins with a history and physical examination. If there is an acute injury, the doctor will ask about how the injury occurred to help understand the pressures placed on the knee. Accordingly, the diagnosis of an internal meniscus injury is considered quite certain if three or more of the following signs are present:
Pain tenderness at a point on the mid-joint line Pain in the area of the mid-joint line with increased upper pressure knee or knee flexion Pain on external rotation of the foot and lower leg when the knee is bent at different angles of about 70–90° Quadriceps weakness or decreased activity.
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With chronic knee pain, the initial injury pattern may not be well remembered. At this time, after a physical examination, the doctor can order X-rays and MRIs and to diagnose whether the patient has an internal meniscus tear or not, describe the characteristics to guide treatment.
4. Treatment for an internal meniscus tear
4.1 Non-surgical treatment
If the meniscus tear is in grade 2 due to degenerative damage or if the tear is small, the doctor will recommend conservative, non-surgical treatments, such as:
Knee bandage Rest the leg Anti-inflammatory medication non-steroid Using a brace to stabilize the knee Physiotherapy with a specialist to strengthen the knee
4.2 Surgical treatment
If symptoms do not improve with nonsurgical treatments or if the tear is severe, as in most 2nd degree meniscal tears, the person may need surgery to repair it. repair or remove the damaged part of the meniscus.
The type of surgery performed depends on the type of tear as well as the severity of the tear. For example, if the tear is on the outer rim of the meniscus and there is a good blood supply to the area, it can be repaired. If the tear is not peripheral or cannot be repaired, the tear is removed.
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Thus, the types of surgery performed to treat a meniscus tear include:
Repair surgery: The torn part of the meniscus will be stitched back together. The recovery after repair will require more time than intervention to remove the meniscus from the beginning, however, this method has the advantage of preserving the maximum cartilage tissue. Cartilage: During a meniscusectomy, the damaged tissue of the meniscus is carefully trimmed and removed. The surgeon will attempt to remove only the damaged tissue to preserve as much cartilage as possible. These surgeries are all performed arthroscopically, meaning they are performed using a minimally invasive method. Laparoscopic surgery is done through several small incisions to access the damaged part of the meniscus. An image of the inside of the joint will be projected on a screen, allowing the orthopedic surgeon to locate the tear. From there, special instruments will be inserted in turn to repair or remove the damaged tissue.
4.3 Recovery
The time it takes for knee function to recover from an internal meniscus tear depends on the type of tear, the severity of the tear, and the treatments used to repair the damaged tissue.
Of which, if only non-surgical treatments are used, recovery can take six to eight weeks. In contrast, if corrective surgery is needed, as in a 2nd degree meniscal tear, recovery can take up to three months for repair surgery while only about three to four weeks for meniscusectomy. .
In a nutshell, the medial meniscus is located in the middle or inner part of the knee, acting as a shock absorber and providing stability to the knee. Although lateral meniscus tears vary in severity, grade 2 meniscal tears are often severe and require surgical intervention. After that, the patient needs to arrange a reasonable rest time combined with phased physical therapy exercises to quickly restore knee function.
Vinmec International General Hospital has implemented and successfully applied many surgeries and rehabilitation for musculoskeletal diseases, including treatment of meniscus tears in grade 2. With facilities With modern technology, there is a team of qualified doctors who are well trained at major Orthopedic Trauma Centers in the country as well as specialized training in Joint Replacement, Arthroscopy, Surgery.. Experts of the Foreign Orthopedic Trauma Association are directly trained.
