Knee injuries: meniscopathy

By Cristiano Antonino On Jun 1, 2023

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The generic term ‘meniscopathy’ refers to all injuries that can affect the menisci, also known as ‘meniscus ruptures’, and is the most common category of knee disorders

Although most meniscopathies occur in sports patients, it is possible for it to occur in any person.

The problem affects men and women equally.

What is meniscopathy

As mentioned, the generic term meniscopathy is used to refer to a pathology – acute or chronic – affecting the menisci.

This type of injury is the most common of those that can affect the anatomical district of the knee.

Obviously, to better understand this topic, it is necessary to understand what the menisci are and what function they have.

The functions of the meniscus

Mistakenly, we usually speak of ‘meniscus’ in the singular, but in reality there are as many as four menisci in the human body, two in each knee.

These are hard, elastic fibro-cartilaginous ‘pads’ in the shape of a ‘c’ (more or less open) that are located at the level of the knee joint, specifically, located between the tibia and the condyles of the femur.

As mentioned, each knee has two menisci, the lateral and the medial, whose function is to:

Cushion every movement of the knee.
Distribute the load of the joint evenly.
Stabilise the joint.
Improve the distribution of synovial fluid in the joint.
Protect the knee from damage due to sudden rotations, hypertension and hyperflexion.

In the long run, problems affecting these structures, if neglected, can cause serious damage to the knee and promote the development of more serious and difficult-to-treat diseases, such as arthrosis.

Different types of meniscus injury

Meniscopathy is, as we have seen, a rather generic term for all injuries involving the menisci.

We recognise two broad categories into which meniscus pathologies can be divided, depending on what caused the problem:

Meniscopathies of traumatic origin. This problem is mainly found among sportsmen and young people: the cause of the injury is a particular trauma due to a certain movement that may have exceeded the tissue’s maximum resistance, leading to rupture.
Degenerative meniscopathy. This is a problem that occurs particularly in old age. There is no particular traumatic event, but the tissue undergoes a progressive degeneration, which increases with the passage of time, or is damaged by small and seemingly harmless traumas received repeatedly.

Generally, the most involved in injuries – both traumatic and degenerative – is the medial meniscus.

Causes of meniscopathy

The causes of meniscopathy are excessive wear and tear or trauma.

The latter are generally

Extrotation of the knee
Hyperflexion of the joint
Hypertension or so-called ‘drop kick’

Even minor traumas, such as those suffered by the menisci when squatting to pick up an object from the ground, can, if repeated over time, cause degeneration of the meniscal tissues.

The meniscus, in fact, tends to rupture more easily with advancing age, favouring the appearance of arthrosis, with all the problems that this pathology entails.

The symptoms

The most prominent symptom of a so-called ‘ruptured meniscus’ is pain in the knee, both under strain and at rest.

But there are other characteristic symptoms, such as:

Swelling of the joint. A meniscopathy frequently results in synovial inflammation, which causes an effusion in the joint. In addition to pain, it will therefore be impossible to perform certain movements.
Noise and the sensation of something ‘clicking’ or shifting as the knee joint moves, or creaking as the joint moves.
True functional blockage, which occurs when the broken part of the meniscus moves out of its seat and into the joint.
Leg stiffness and loss of muscle strength.
Difficulty bending or stretching the joint.

In degenerative meniscopathy these symptoms – in particular pain – may not be particularly acute or constantly present: they may only appear at times of great exertion, thus making the patient think that he or she has no particular problem.

This is different in the case of traumatic meniscopathy, in which the pain manifests itself immediately in the patient who, immediately after the trauma, will feel a sharp pain in the knee, which will probably be followed by difficulty in movement and swelling.

Diagnosis of meniscopathy

For a correct diagnosis of meniscopathy, certain diagnostic investigations must be carried out.

Let us preface this by saying that it is not possible to make a self-diagnosis, as the symptoms described above in the knee joint may also be present in other diseases.

Therefore, if you suspect a possible meniscopathy, you should contact an orthopaedist.

The specialist may suspect the presence of meniscopathy with an outpatient examination after a thorough history of symptoms and an objective test.

However, the suspected diagnosis must be confirmed through instrumental diagnostic tests such as CT or MRI.

How to intervene

In the past, it was possible to intervene surgically – in the case of meniscopathy – with the removal of the meniscus, known as a meniscectomy.

It has been shown, however, that the consequences of this type of surgery are significant, because the knee without the ‘cushion’ is irreversibly damaged, the cartilage covering the bony surfaces wears out, fragments and destroys itself, leading to arthrosis, which generally occurs 20-25 years after surgery.

In cases where an arthrosis process is already present, a meniscectomy may accelerate the degeneration to the extent that the symptoms experienced after the operation worsen.

For this reason, the trend today is to preserve the meniscus as much as possible, with selective meniscectomy operations, i.e. operations that only remove the damaged part of the meniscus or free elements that may have separated from it.

Obviously, the younger the patient, the more attempt will be made to preserve the biological heritage.

With this in mind, a new type of operation has been introduced, namely meniscal reconstruction and suturing: these operations are only possible in the case of a traumatic and recent rupture.

Through this operation, the orthopaedist will suture the injury that has been created, which should heal after a congruous period of convalescence and functional recovery.

Although rehabilitation is significantly longer, the risk of developing arthrosis has been significantly reduced over the years.

It may happen, however, even in a young patient that it is necessary to operate with a total meniscectomy: in this case, the possibility of replacing the irreversibly damaged meniscus with an artificial one (scaffold) or with a donor transplant will also be considered.

In any case, meniscus operations are all performed using arthroscopic techniques that are less invasive, reduce the length of hospital stay, post-operative pain and temporary disability.

Therefore, depending on the type of meniscopathy, the right mode of surgery will be determined, bearing in mind not only the severity of the injury, but also the patient’s age and previous health conditions.

In the case of very mild meniscopathies, it may be decided not to operate, but to opt for conservative therapy.

Conservative therapy involves:

Total rest, with immobilisation of the affected limb.
Application of ice packs to reduce pain and swelling.
Taking non-steroidal anti-inflammatory drugs or NSAIDs, under prescription and medical supervision, such as ibuprofen to reduce pain and inflammation.
Once the acute inflammation phase has passed, it is essential to strengthen the muscles of the affected limb, particularly the quadriceps, to give the joint more stability.

However, in most cases, this treatment is not decisive, but serves to delay surgery.

The surgical course is rather quick due to the reduced invasiveness of the operation and, afterwards, it is a good idea to follow a rehabilitation course to recover full joint mobility and muscle tone of the affected limb: it is essential that all the muscles that fit over the knee joint are strengthened, for greater stability and to avoid further damage.

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