The meniscus act as shock absorbers of our weight, there are two, they create the proper functioning of the knee, allowing the bones not to collide between each other, but other than that it its an element which gives stability to the knee as well as lubrication, so in some injuries of ligaments, the meniscus is damaged, causing pain and instability. As shown in the picture above, we have two menisci toward one side inside and the outside.

Figure 2: layout of your meniscus.

The image below shows the appearance of a meniscus in normal conditions.

Figure 3: A view inside a knee of a normal meniscus.

Meniscal Injury:

It can be seen at any age, and the mechanism for its injury depends on the circumstances, (as we see, it may be by direct trauma, a car accident or just doing some exercise like skiing or football) in other words some type of intense activity or not.

The image below shows an injury of the meniscus, see the difference in relation to the normal meniscus.

Figure. 4: meniscus injury. Note the battered appearance, compare with Figure 3

Figure. 4: Injured Meniscus.

But it also can be injured with age. There are factors that can contribute to injury, as is the case of very bow-legged (varus where the knees are not touching or in valgus knees where they are touching), or significant overweight. As shown in the images below.

Figure. 5: varus knee

Figure. 6. knee valgus

Pain:

It is the most frequent symptom, it can sometimes be difficult to fully extend the knee (blocking meniscus) and it is due to fibro cartilage fragments that should not be mobile or semi mobile, it can also disrupt the march (walk) by making it uneven (limping) and of course you can hardly bend the knee as it tends to swell several times, and only partial use of medicines soothe the pain. If you have these symptoms, you have a meniscus injury.

Figure. 7 Increased volume of your knee.

Figure. 8 Pain from a meniscus injury.

What tests should be performed:

Mandatory Examinations: MRI scan (see medical glossary) if 50 years or older an X-ray is also needed. Please communicate directly with office to receive examination orders.

Figure.9 Schuss x-rays

Treatment

Meniscus affection treatments include an ample spectrum of options: regular treatment, partial meniscectomy, meniscus reparatio, reinsertion of the meniscus etc. The course of the treatment depends on the patient's age, level of activity, chronicity of symptoms, and type of rupture and lesions. The type of treatment we offer does not require general anesthesia, hospitalization or open surgery.

The technique is described as arthroscopy which, along with laser (Light Amplification by Stimulated Infrared Emission), in the moment of the surgery the laser cuts, destroys, coagulates and retracts tissue allowing for a harmonious regularization of the injury as well as, studies indicate, a higher recuperation rate. There is little blood loss and inflammation, rapid scarring of the tissue, accuracy in the cutting and absence of edema or swelling.

The following are images of menisci reconstruction and of arthroscopic meniscectomy, all performed with the Holmium-Yag Laser.

Figure. 10 Complex injury of the anterior horn of external meniscus

Figure. 11 Arthroscopic Menniscectomy with Holmium Yag Laser.

The laser treatment utilized in our institution has demonstrated superiority above other lasers, thanks to its precision and potency which act solely upon the meniscus without damaging other structures within the knee (See Fig. 12). The laser can be wielded practically as a chisel with a burn depth of no more than 0.5 mm. Histological studies have demonstrated that there is no damage if a certain distance is respected. A proven, higher recuperation rate allows for a rapid return to work or labor as well as sports and other leisure activities.

Figure. 12 : Laser comparison. Note that the Holmium-Yag laser is the least traumatic towards tissue.

Menisci affections at times require a combination of techniques so that the patient may be able to retake his o her life perfectly. In some complex injuries, a reinsertion is associated (See Fig. 13-14).

Fig. 13: Complicated injury of the anterior horn of internal meniscus "en anse de seau" or "bucket handle"; referring to the shape of the injury.

Fig. 14: Post-operatory view after reinsertion of the meniscus.

After intervention

You may walk immediately after the intervention, on average driving the car is allowed 72 hours later, work rest for 5 to 7 days and a physical rest for 10 days. There are no stitches on the skin, you should not apply ointments, rehabilitation will only be indicated in some cases. A checkup is provided by our staff at 2 months without radiographies (X-rays).

Meniscal Allograft

In a certain number of cases, meniscus injuries cannot be repaired and justifies an almost complete resection of such. In these situations, one the surgical solutions available is the meniscal allograft, a ten-year old technique practiced in some European countries, to be used in patients under fifty years old with an equilibrated knee, regarding mechanical and joint functions, and with little or no cartilage degeneration. An alternative to the allograft are synthetic polyurethane grafts that can be rehatched with cells. Recent studies show good integration in the body but still some biomechanical aspects must be corrected.

Fig. 16: Meniscal Graft.

Fig. 17. Post-operatory view after graft reinsertion.

Category: The knee

Doctor

Alain Daher

The meniscus act as shock absorbers of our weight, there are two, they create the proper functioning of the knee, allowing the bones not to collide between each other, but other than that it its an element which gives stability to the knee as well as lubrication, so in some injuries of ligaments, the meniscus is damaged, causing pain and instability. As shown in the picture above, we have two menisci toward one side inside and the outside.

Figure 2: layout of your meniscus.

The image below shows the appearance of a meniscus in normal conditions.

Figure 3: A view inside a knee of a normal meniscus.

Meniscal Injury:

It can be seen at any age, and the mechanism for its injury depends on the circumstances, (as we see, it may be by direct trauma, a car accident or just doing some exercise like skiing or football) in other words some type of intense activity or not.

The image below shows an injury of the meniscus, see the difference in relation to the normal meniscus.

Figure. 4: meniscus injury. Note the battered appearance, compare with Figure 3

Figure. 4: Injured Meniscus.

But it also can be injured with age. There are factors that can contribute to injury, as is the case of very bow-legged (varus where the knees are not touching or in valgus knees where they are touching), or significant overweight. As shown in the images below.

Figure. 5: varus knee

Figure. 6. knee valgus

Pain:

It is the most frequent symptom, it can sometimes be difficult to fully extend the knee (blocking meniscus) and it is due to fibro cartilage fragments that should not be mobile or semi mobile, it can also disrupt the march (walk) by making it uneven (limping) and of course you can hardly bend the knee as it tends to swell several times, and only partial use of medicines soothe the pain. If you have these symptoms, you have a meniscus injury.

Figure. 7 Increased volume of your knee.

Figure. 8 Pain from a meniscus injury.

What tests should be performed:

Mandatory Examinations: MRI scan (see medical glossary) if 50 years or older an X-ray is also needed. Please communicate directly with office to receive examination orders.

Figure.9 Schuss x-rays

Treatment

Meniscus affection treatments include an ample spectrum of options: regular treatment, partial meniscectomy, meniscus reparatio, reinsertion of the meniscus etc. The course of the treatment depends on the patient's age, level of activity, chronicity of symptoms, and type of rupture and lesions. The type of treatment we offer does not require general anesthesia, hospitalization or open surgery.

The technique is described as arthroscopy which, along with laser (Light Amplification by Stimulated Infrared Emission), in the moment of the surgery the laser cuts, destroys, coagulates and retracts tissue allowing for a harmonious regularization of the injury as well as, studies indicate, a higher recuperation rate. There is little blood loss and inflammation, rapid scarring of the tissue, accuracy in the cutting and absence of edema or swelling.

The following are images of menisci reconstruction and of arthroscopic meniscectomy, all performed with the Holmium-Yag Laser.

Figure. 10 Complex injury of the anterior horn of external meniscus

Figure. 11 Arthroscopic Menniscectomy with Holmium Yag Laser.

The laser treatment utilized in our institution has demonstrated superiority above other lasers, thanks to its precision and potency which act solely upon the meniscus without damaging other structures within the knee (See Fig. 12). The laser can be wielded practically as a chisel with a burn depth of no more than 0.5 mm. Histological studies have demonstrated that there is no damage if a certain distance is respected. A proven, higher recuperation rate allows for a rapid return to work or labor as well as sports and other leisure activities.

Figure. 12 : Laser comparison. Note that the Holmium-Yag laser is the least traumatic towards tissue.

Menisci affections at times require a combination of techniques so that the patient may be able to retake his o her life perfectly. In some complex injuries, a reinsertion is associated (See Fig. 13-14).

Fig. 13: Complicated injury of the anterior horn of internal meniscus "en anse de seau" or "bucket handle"; referring to the shape of the injury.

Fig. 14: Post-operatory view after reinsertion of the meniscus.

After intervention

You may walk immediately after the intervention, on average driving the car is allowed 72 hours later, work rest for 5 to 7 days and a physical rest for 10 days. There are no stitches on the skin, you should not apply ointments, rehabilitation will only be indicated in some cases. A checkup is provided by our staff at 2 months without radiographies (X-rays).

Meniscal Allograft

In a certain number of cases, meniscus injuries cannot be repaired and justifies an almost complete resection of such. In these situations, one the surgical solutions available is the meniscal allograft, a ten-year old technique practiced in some European countries, to be used in patients under fifty years old with an equilibrated knee, regarding mechanical and joint functions, and with little or no cartilage degeneration. An alternative to the allograft are synthetic polyurethane grafts that can be rehatched with cells. Recent studies show good integration in the body but still some biomechanical aspects must be corrected.

Fig. 16: Meniscal Graft.

Fig. 17. Post-operatory view after graft reinsertion.

Category: The knee