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North Sydney Orthopaedic and Sports Medicine Centre The meniscus is a commonly injured structure in the knee. The injury can occur in any age group. In younger people the meniscus is fairly tough and rubbery, and tears usually occur as a result of a fairly forceful twisting injury. In older people, the meniscus grows weaker with age, and meniscal tears may occur as a result of a fairly minor injury. The meniscus is a half moon shaped piece of cartilage that lies between the weight bearing joint surfaces of the thigh and the shin, and is attached to the lining of the knee joint. There are two menisci in a normal knee; the outside one is called the lateral meniscus and the inner one is called the medial meniscus. The menisci play an important role as a shock absorber in the knee joint, protecting the cartilage that lies on the surface of the bones from impact. The cartilage surface is a tough, very slick material that allows the surfaces to slide against one another without damage to either surface. This ability of the meniscus to spread out the force on the joint surface The most common problem caused by a torn meniscus is pain. as we walk is important because it protects the The pain may be felt along the joint line where the meniscus is cartilage from excessive forces occurring in anyone located or may be more vague and involve the whole knee. area on the joint surface. Without the meniscus, the Any twisting, squatting or impacting activities will pinch the concentration of force into a small area on the meniscus tear or flap and cause pain. Often the pain cartilage can damage the surface, leading to may improve with rest after the initial injury, but as soon as degeneration over time. The menisci also cup the aggressive activity is attempted the pain recurs. joint surfaces of the thigh and therefore provide some degree of stabilization to the knee. Swelling of the joint may occur although meniscal tears by themselves usually don’t cause a large, tensely swollen knee. Typically, low level swelling sets in the next day after the injury and is associated with stiffness and limping. There are two different mechanisms for tearing a meniscus. If the torn portion of the meniscus is large enough, locking Traumatic tears result from a sudden load being applied to may occur. Locking simply refers to the inability to completely the mensical tissue that is severe enough to cause the straighten out the knee. Locking occurs when the fragment of meniscal cartilage to fail and let go. These usually occur from torn meniscus gets caught in the hinge mechanism of the a twisting injury or a blow to the side of the knee that causes knee, and will not allow the leg to straighten completely. The the meniscus to be pushed against and compressed. torn fragment actually acts like a wedge to prevent the joint Degenerative meniscal tears are best thought of as a failure of the meniscus over time. The meniscus becomes less elastic There are long term effects of a torn meniscus as well. The and complaint, and as a result may fail with only minimal constant rubbing of the torn meniscus on the cartilage may trauma (such as just getting down into a squat). Sometimes cause wear and tear on the surface, leading to degeneration there are no memorable injuries or violent events that can be of the joint. The knee may swell with use and become stiff and tight. This is usually because of fluid accumulating inside Treatment: Initial treatment for a torn meniscus usually is directed towards reducing the pain and swelling in the knee. You may be asked to attend physiotherapy to reduce the pain and swelling and improve the range of movement. If the knee is locked and cannot be straightened out, surgery may be recommended as soon as reasonably possible to remove the torn portion that is caught in the knee joint. Once a meniscus is torn, it will most likely not heal on its own. If the symptoms continue, surgery will be required to either remove the torn portion of the meniscus or to repair the tear. North Sydney Orthopaedic and Sports Medicine Centre loading activities in order to prevent the onset of early Meniscal surgery is done using the arthroscope. Small incisions are made in the knee to allow the insertion of a small TV camera into the joint. Through another small incision, special instruments are used to remove the torn Potential Complications related to surgery: portion of meniscus while the arthroscope is used to see As with all operations if at any stage anything seems amiss it is better to call up for advice rather than wait and worry. In some cases the meniscus tear can be repaired. Sutures A fever, or redness or swelling around the line of the are then placed into the torn meniscus until the tear is wound, an unexplained increase in pain should all be repaired. Repair of the meniscus is not possible in all cases. brought to the attention of the Surgeon. Young people with relatively recent meniscal tears are the most likely candidates for repair. Degenerative type tears in • Pneumonia: Patients with a viral respiratory tract older people are not usually repairable. infection (common cold or flu) should inform the Surgeon as soon as possible and will have their surgery postponed until their chest is clear. Patients with a • Healthy patients are admitted on the morning of their history of asthma should bring their inhalers to hospital. surgery. You should inform your Surgeon and Anaesthetist of any medical conditions or previous medical treatment as embolus: Although this complication is rare following arthroscopic surgery, a combination of knee injury, • It is extremely important that there are no cuts, prolonged transport and immobilisation of the limb, scratches, pimples or ulcers on your lower limb as this smoking and the oral contraceptive pill or hormonal greatly increases the risk of infection. Your surgery will be replacement therapy all multiply to increase the risk. Any postponed until the skin lesions have healed. You should past history of thrombosis should be brought to the not to shave or wax your legs for one week prior to surgery. attention of the Surgeon prior to your operation. The • After the operation you will be required to stay in oral contraceptive pill, hormonal replacement therapy hospital for the day. Overnight stay may be required due and smoking should cease one week prior to surgery to to the affects of the anaesthetic or an inability to manage • Excessive bleeding resulting in a haematoma is known to occur with patients taking aspirin or operatively. A physiotherapist will supervise muscle nonsteroidal anti-inflammatory drugs - such as Voltaren, contractions, walking and weight bearing. Physiotherapy Naprosyn or Indocid. They should be stopped at least will continue on a daily basis following your surgery until the dressings are removed 7-10 days following surgery. • Surgery is carried out under strict germ free Sedentary and office workers may return to work conditions in an operating theatre. Antibiotics are approximately 2-3 days following surgery. Most patients administered intravenously at the time of your surgery. should be walking normally 7 days following surgery Any allergy to known antibiotics should be brought to the although there is considerable patient to patient variation. attention of your Surgeon or Anaesthetist. Despite these • Should the left knee be involved then driving an measures there is a less than 1 in 300 chance of automatic car is possible as soon as pain allows. Should the developing an infection within the joint. This may require right knee be involved driving is permitted when you are treatment with antibiotics or may require hospitalisation able to walk without crutches. You must not drive a motor and arthroscopic draining of the joint with intravenous vehicle whilst taking severe pain killing medications. antibiotics. Subsequent to such procedures prolonged • Return to vigorous activities will be determined by the periods of antibiotics are required and the post operative extent of the damage to your meniscus and the amount of meniscus that required removal. If minimal damage was present then you may return to vigorous activities after 6 weeks. If significant damage was present then you may be North Sydney Orthopaedic and Sports Medicine Centre Q. How long does it take for the swelling to go away? A. After 8 weeks most of the swelling should be gone. A. Sedentary and office workers may return to work approximately 2-5 days following surgery. A. Yes, unless advised otherwise by Dr Roe. A. You can travel domestically after 3 days and A. Yes. You will need to bring these with you on the day of your surgery and they can be organised through your own physiotherapist or through your local chemist. We advise patients to bring crutches for added support on the day. A. This will vary depending on your surgical outcome. Q. When do I see a physiotherapist after the surgery? A. Physiotherapy is commenced immediately. Your Q. When do I need to see Dr Roe after the surgery? physiotherapist will supervise strengthening and walking. A. You will return for removal of the superficial dressings and a wound check at 7-10 days from surgery, then at the Q. What medications should I cease prior to the surgery? A. Any blood thinning medication should be stopped. A. Driving an automatic car is possible as soon as pain allows after left knee surgery. Should the right knee be involved driving is permitted when you can walk For any questions please do not hesitate in conta cting our staff at NSOSMC on (02) 9409 0500 Yolanda Armstrong (Personal Assistant), Dr Lucy Salmo n (Physiotherapist), Alison Waller (Physiotherapist)

Source: http://www.nsosmc.com.au/resources/infosheet-MenxInfoRoe2012.pdf

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