- What is a meniscus?
- How can a meniscus be torn?
- Can a meniscal tear heal by itself?
- What are the symptoms of a meniscal tear?
- How does the doctor know I have a meniscal tear?
- How do you treat a meniscal tear?
- What is arthroscopy?
- What happens during arthroscopic surgery?.
- How long do I need to stay in hospital after arthroscopic surgery?
- What is a meniscectomy?
- Is it safe to remove part of my cartilage?
- How long will it take to recover from arthroscopic surgery?
- When will I start to feel better after arthroscopic surgery?
- What and where is the anterior cruciate ligament (ACL)?
- What are the symptoms of an ACL injury?
- Do I need to have surgery on my ACL?
- Is physiotherapy necessary before ACL reconstruction?
- What’s the best technique for ACL reconstruction?
- Can I do without my hamstring(s)?
- Should I wear a knee brace to support my knee rather than undergo major surgery for ACL reconstruction?
- How can I tell if I’ve got a serious ACL injury?
- Is ACL reconstruction a big operation?
1. What is a meniscus?
The meniscus is a circular shaped disc of cartilage tissue. There are two menisci (plural of meniscus) in the knee – one on the inside, called the medial meniscus, and one on the outside, called the lateral meniscus. Their main function is to act as shock absorbers in the knee, helping to reduce wear and tear on the joint.
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2. How can a meniscus be torn?
The medial and lateral menisci are fixed between the two weight-bearing surfaces within the knee, and as such can become “pinched” by the other structures of the knee between the joint when an injury occurs. Typically, the injury involves twisting on a bent knee. When this happens the menisci can become torn (“torn cartilage”).
Any form of physical movement can potentially cause a meniscal tear, although they tend to be associated with sporting activities. A classic example is of a footballer tackling another player, but meniscal tears can occur following everyday pursuits, such as gardening or even just taking a long walk.
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3. Can a meniscal tear heal by itself?
Most of the meniscus does not have its own blood supply, and so cannot always get the nutrients needed for self-repair. Whether or not the meniscus can heal therefore depends on where it becomes torn. Tears on the outer rim of the meniscus, which attaches to the knee capsule, do have the potential to heal because they are close to a blood supply. However, the more common site for meniscal tears is on the peripheral rim, or the inner aspect of the meniscus, and these have no capacity for self-repair.
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4. What are the symptoms of a meniscal tear?
The classic symptom of a torn meniscus is pain, often felt as a sharp, almost “knife-like” stabbing sensation on the inside (medial tear) or outside (lateral tear) of the knee. This pain is often felt in waves, with bouts of severe discomfort, followed by no pain, felt over the course of several days/weeks. However, the pain may also be felt as an aching sensation or even just as stiffness of the knee.
The knee may also become swollen or “locked” in place, making it impossible to straighten it, or even collapse, or give the impression that it will collapse, from beneath you.
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5. How does the doctor know I have a meniscal tear?
A meniscal tear can be diagnosed based on your description of how your injury occurred, and by taking a specialized photograph of your knee known as a magnetic resonance imaging or MRI scan. An MRI scan uses very strong magnetic fields to look at the inside of the knee, and allows all the soft tissues, ligaments and cartilage to be seen clearly.
X-rays are not very useful in making a diagnosis, as these show only the bony structures of the knee, but may be used in the emergency setting to check that there are no broken bones.
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6. How do you treat a meniscal tear?
Meniscal tears are treated using arthroscopic or keyhole surgery, but not everyone will need surgery. As with all injuries there are options and the most important thing to be considered is the level of discomfort and whether it interferes with your ability to function normally. All surgical procedures carry some element of risk, and your doctor must ensure that the benefits of any treatment you receive outweigh any potential risks.
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7. What is arthroscopy?
Arthroscopy is a minimally invasive or “keyhole” procedure that allows surgeons to see inside a joint with a fiberoptic telescope called an arthroscope which projects an image onto an external television screen.
Arthroscopy has the advantage of not only being a diagnostic procedure but also allows operations to be carried out within the joint cavities. These joints include the knee, shoulder, ankle, wrist, and hip. When the procedure is used to carry out surgery it is termed arthroscopic surgery.
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8. What happens during arthroscopic surgery?
Before the procedure, you will be given a general anesthetic and, when you are unconscious, the orthopedic surgeon will make a small (3–4 mm) cut in your joint to allow a small camera-like device (arthroscope) to be inserted into the joint. Fluid is then pumped into the joint through the arthroscope to increase the size of the joint and improve the view inside for the surgeon.
The surgeon will look at an external television screen to see what the problem is inside your joint, and once the diagnosis has been confirmed, a second small cut is made to allow the surgeon to insert the relevant instruments needed to perform the surgery.
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9. How long do I need to stay in hospital after arthroscopic surgery?
Arthroscopic surgery is usually performed as a “day case,” meaning that you can go home the same day as the operation. Some people may need to stay in hospital for a couple of days to recover from the operation, but your surgeon will advise you on this.
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10. What is a meniscectomy?
This is a relatively simple operation that involves the removal of all or part of a torn meniscus (cartilage) during arthroscopy.
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11. Is it safe to remove part of my cartilage?
Yes, because the cartilage that is being removed is no longer functioning. In most cases, surgeons will try to preserve as much cartilage as possible, and generally only remove around 20–25%.
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12. How long will it take to recover from arthroscopic surgery?
This depends on the procedure being performed, but in the case of arthroscopic meniscectomy, which is the commonest procedure, you will generally be able to walk unaided the same day. Your doctor will recommend that you take at least four to five days off work. The time needed will depend on the type of work that you do, and people with physically demanding jobs may be advised to take a minimum of two weeks off work.
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13. When will I start to feel better after arthroscopic surgery?
Although it depends on your injury and the type of surgery being performed, you should start to feel better within a couple of weeks and may be able to participate in certain sporting activities (eg, going to the gymnasium) approximately a month or so after the operation. It could, however take several months before you are able to train fully or as you would normally. Your doctor will again advise you on details of this.
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14. What and where is the anterior cruciate ligament (ACL)?
The ACL is a ligament in the middle of the knee that connects the tibia (shinbone) to the fibia (thighbone).
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15. What are the symptoms of an ACL injury?
A key feature of a serious ACL injury is a feeling of instability (i.e. that the knee may collapse from underneath you).
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16. Do I need to have surgery on my ACL?
Not always. Some people are able to function normally without surgery, so long as they have physiotherapy, but others need reconstructive surgery no matter how much physiotherapy they have. Whether or not you have your ACL reconstructed also depends on how active you are, and how your injury impacts on your daily and sporting activities.
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17. Is physiotherapy necessary before ACL reconstruction?
Early surgical intervention to repair a torn ACL is not recommended in the vast majority of cases, and physiotherapy for at least four to six weeks is almost always recommended first in the amateur sportsperson. This approach has the advantage of allowing any other associated injuries to settle, and any inflammation to subside. Taking time to have physiotherapy also gives the patient and physiotherapist the opportunity to assess whether they feel there is a genuine need for reconstruction.
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18. What’s the best technique for ACL reconstruction?
It is widely accepted that the best substitute for one’s own ACL is to use an autologous graft, which is term used to describe another tissue, such as a ligament or tendon, taken from your own body. The autologous graft most usually used is that of the hamstrings. These are a large group of muscles in the back of the thigh that run from the hips down to the knees. The hamstrings most commonly used are that of semitendinosus and gracilis.
Obviously many other techniques exist, although the choice of graft will depend on your surgeon’s experience and familiarity with the preferred procedure.
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19. Can I do without my hamstring(s)?
Yes. Although you might initially feel a sense of weakness in your hamstring muscles, you can quite quickly regain almost full muscle power without a hamstring.
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20. Should I wear a knee brace to support my knee rather than undergo major surgery for ACL reconstruction?
Many older people find that wearing a well fitted, ACL-specific knee brace gives them the confidence and stability to return to the sport they enjoyed previously without the need for surgery.
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21. How can I tell if I’ve got a serious ACL injury?
Any injury that involves the knee being twisted while the foot is planted on the ground can result in a serious ligament injury. Key features of a serious knee injury include a feeling of instability (i.e. a sense that the knee may collapse from underneath you). Recurrent episodes of the knee collapsing with associated swelling and pain are an obvious sign that all is not well, and that medical attention should be sought.
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22. Is ACL reconstruction a big operation?
Compared with surgery for meniscal tears, ACL reconstruction is a much more involved procedure as it involves taking a tendon graft as indicated (usually the hamstring) from another part of the leg and using this to substitute the broken ligament.
The time taken to recover from this type of surgery is much longer than for meniscal tears, and it may take up to nine months before you are able to undertake full sporting activities again. Generally, patients are advised that it can take up to one year to feel confident to participate in all their previous sporting activities, especially contact sports.
When performed by an experienced surgeon, however, this type of surgery is highly successful, with 85–95% chance of patients experiencing good to excellent results.
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