What is the meniscus?
The meniscus is often referred to as “cartilage”. It is made of tough and robust material called collagen. The knee contains 2 meniscal cartilages, the inner (medial) and the outer (lateral). These are sometimes referred to as shock absorbers. They are situated between the femur (thigh bone) and tibia (shin bone). They provide protection to the joint surfaces in the weight bearing areas of the knee and also contribute to joint health and stability.
Meniscus can be damaged through injury or as part of a degenerative process. It can be isolated or associated with other injuries (e.g. anterior cruciate ligament tear) or pathologies such as osteoarthritis. Those specifically related to trauma and sports in an otherwise young healthy knee are more likely to be a significant source of irritation and restriction, therefore they can benefit from surgical treatments. Cartilage tears in the setting of a worn knee with features of osteoarthritis are much less likely to need surgery and be managed well non-operatively.
The diagnosis of a meniscal cartilage tear and the potential need for surgical treatment will be discussed during consultation and a treatment plan outlined.
With the ease of access to sensitive imaging techniques such as MRI, we readily identify meniscal cartilages with normal age related degenerative features and tearing but certainly not all need surgery.
We have guidelines from expert groups and specialist associations on the non-operative versus operative treatment options. It is indicated that most degenerative tears should start with an initial 12 week period of symptom control with relative rest, activity modification, physiotherapy/strengthening and analgesia/anti-inflammatories.
A surgical intervention maybe beneficial if the knee is not arthritic and the symptoms fail to settle adequately. A well preserved knee with clear mechanical symptoms and an unstable large or displaced tear seen on MRI may benefit from surgery. These are generally days case operations and “key-hole” type surgery. This includes arthroscopic partial meniscectomy (a cartilage trim/removal) and meniscal repair.
Meniscal substitutes are not yet a well proven option and a meniscal transplantation is not readily available in Ireland. On occasion, Mr Jackson has arranged an assessment with links to specialist centres in Europe for consideration of this type of procedure.