Does meniscus injury require surgical treatment?

This is the 4216th article of Da Yi Xiao Hu

Last week, a patient in his 30s came to see me because he accidentally sprained his right knee while playing football. He felt pain when he entered the field, but it was not severe. After he left the field, he felt the pain gradually worsening. He underwent an MRI examination at a local hospital. The report shows: 2nd degree injury of the medial meniscus of the right knee joint. Please combine clinical experience. The local doctor gave two options: one is conservative treatment, with brace fixation for 6 weeks. If the recovery is very good, it means that conservative treatment is effective; if conservative treatment is not effective, arthroscopic surgery can be performed. The second is direct arthroscopic surgery. If the injury is obvious during the operation, it will be sutured directly. After listening to it, the patient was in a dilemma and couldn't make up his mind, so he came to the clinic to hear my opinion. I carefully looked at the MRI film and performed a physical examination at the same time. No obvious signs of meniscus injury were found, so I suggested conservative treatment.

Meniscus injury is one of the most common knee injuries, more common in young and middle-aged people, more common in men than in women. Meniscus injury is most likely to occur when the knee joint moves from flexion to extension accompanied by rotation. Meniscus injuries are most common in the medial meniscus, and the most common is injury to the posterior horn of the meniscus. Congenital abnormalities of the meniscus, especially discoid cartilage, are more likely to lead to degeneration or injury. Poor muscle strength around the joint and poor joint stability are also prone to meniscus injuries.

What tests should be done after a meniscus injury?

MRI of the knee

It is the most sensitive and accurate imaging method for diagnosing meniscus injury so far, with an accuracy rate of up to 98%. Magnetic resonance imaging (MRI) is an electromagnetic wave scanning imaging without radiation damage.

Knee X-ray

Knee X-rays are not used to diagnose meniscal tears; their purpose is to rule out fractures, loose bodies, and other knee disorders similar to meniscal tears.

Arthroscopy

Arthroscopic technique has been recognized as an ideal means of diagnosis and surgical treatment of meniscus injury. However, routine arthroscopic examination is not recommended for a clear diagnosis.

How should meniscus injury be treated?

The meniscus is a fibrous cartilage with a blood supply at the edge, called the red zone, which has a stronger healing ability. The center has no blood supply, called the white zone. Most patients cannot heal this area on their own. Currently, there is no drug that is effective for meniscus healing. Treatment for meniscus injuries depends on the type of injury, the size of the tear, and the location. Other factors that determine treatment options include age, health status, activity level, and other comorbidities.

If the meniscus injury is minor, MRI shows grade 2 or grade 2 injury, and the symptoms are not obvious, conservative treatment can be temporarily performed; if the tear is large, the meniscus is unstable, there are mechanical compression symptoms such as locking and clicking, the patient has obvious symptoms, affecting life and exercise, and there is potential cartilage and ligament damage, arthroscopic minimally invasive surgery is recommended to repair the damaged meniscus.

Remember

In any case, a careful physical examination and careful reading of the film should be performed to determine whether the pain is related to meniscus injury and whether there are other injuries. The clinical symptoms should be combined with the imaging data to determine the best treatment plan.

Author: Department of Orthopedics, Tianjin Third Central Hospital

Guo ShuzhangChief Physician