Case study provided by Dr David Sweetnam, FRCS (Ortho) Dip Sports Med, London, UK. The patient's name has been changed to maintain confidentiality.
When John fell and twisted his knee during a football game, he got more than he bargained for and needed to have surgery to remove part of the cartilage in his knee.
Presentation
Having landed awkwardly after attempting to head the ball, John felt a sharp and searing pain on the inner aspect of his right knee.
Although the 22-year-old telephone engineer continued to feel pain after being helped to his feet, he stayed on the pitch for the remaining five minutes of the game.
Unfortunately he did not ice his knee until later that evening, by which time it had swelled quite significantly and was uncomfortable to walk on.
The next morning John noticed that his knee was stiff, and he was walking with a limp. As this did not improve over the course of the day, he decided to go to his local doctor. His doctor examined him and felt that he should be treated with physiotherapy, which he arranged locally.
Unfortunately as things didn’t improve after a couple of weeks of physiotherapy, John returned to his general practitioner who felt he should get a further specialist opinion from an orthopedic surgeon at his local hospital.
Diagnosis
John was subsequently seen in the local hospital by the orthopedic surgeon who noted during his examination that John felt tenderness on the inner aspect of his right knee.
In light of this, the surgeon suspected a cartilage tear and arranged for a magnetic resonance imaging (MRI) scan to be taken. MRI scans allow the soft tissues, including the ligaments and cartilage in the knee to be examined thoroughly.
A few days later, when the results of the MRI scan were available, John saw the consultant orthopedic surgeon again, who confirmed that he had indeed damaged the inside cartilage of his knee. More specifically, John was told that he had a small tear in the posterior horn of his medial meniscus.
 MRI Scan showing a torn medial meniscus (red arrow)]
The consultant explained that the meniscus acts as a shock absorber in the knee, and is typically damaged by twisting as in John’s case. Unfortunately, when these cartilages (menisci) become torn, the body is rarely able to repair them, as they don’t have a blood supply. As such, surgery to cure this problem is required in most people.
Treatment
Since the injury John has experienced several episodes of sharp pain in the knee, whilst at work and at home. He felt unable to run and so he could not get back to playing football.
On one occasion at work the knee had become stuck (locked) in a bent position whilst kneeling, and on several other occasions the knee had almost “given way” although he had just managed to stop himself from falling over.
Because of all these symptoms, and the result of the MRI scan, the consultant decided to perform arthroscopic (keyhole) surgery to remove a torn fragment of the medial meniscus using a procedure known as a partial medial meniscectomy. An appointment was made for John to undergo arthroscopic surgery as a day case a few weeks later.
Surgical intervention
On the day of his operation, John was admitted to the day case ward, from where he was taken to the operating theatre. Once in the theatre he was given a general anesthetic so the procedure could be performed.
The consultant made a small (4mm) cut on the outer aspect of the front of John’s right knee, and inserted a small telescope or arthroscope into the knee to allow him to look directly inside the knee. Fluid was pumped into the knee at the time of the operation to expand the cavity slightly, thus improving the view.
A second small (4mm) cut was made, on the inner aspect of the front of the right knee, to allow the surgeon to pass the necessary surgical instruments into the knee that would allow the redundant piece of cartilage to be removed.
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