Meniscus Repair & Transplantation
Menisci are two crescent shaped pads of tissues composed of cartilage and fibrous tissue. They are found within the knee’s joint capsule and act as an interface between the femoral condyles and the tibia. They confer stability to the knee joint during rotational movement, help in dissipating the force exerted on the tibia from the thigh bone and aids in lubricating the knee joint. Due to anatomical attachments, the lateral meniscus is more prone to injury compared to the medial meniscus.
Meniscal tears typically result from a twisting injury of the leg when knee is in a fixed position. It is frequent in athletes engaging in soccer, basketball and American football. Trauma is also a cause of such an injury especially in the older population. Patients will experience pain after the tear.
The pain is not of a defined character and it varies with individuals. There’s often a progressive increase in pain and swelling within the first day of injury. The pain may be aggravated by twisting movements. A patient often presents to a Los Angeles sports doctor with complains of the knee giving out, or having a knocking or popping noise from the knee.
Making a diagnosis of a meniscal tear is often difficult because of the generalized presentation. A presumptive diagnosis is often made once a physician listens to the history and complains of the patient. A musculoskeletal ultrasound and an MRI are common investigations that are used to confirm the diagnosis.
The initial management of a meniscal tear entails resting the knee and avoiding any positions that exert undue pressure on the knee. The limb should be elevated and an ice pack applied for 15 minutes every four or so hours. The use of walking aisd such as crutches is encouraged when the pain interferes with walking. In patients whose knee keeps giving out, a stabilizing brace is applied.
Definitive management of the tear depends on a number of factors such as the type of tear and the presence of significant swelling. Conservative treatment is reserved for patients who are able to bear weight, there is minimal knee swelling and the knee has a full range of movement. Surgery is stipulated for patients whose knee motion is severely restricted and pain is prominent, and there has been limited improvement with attempts of conservative management. Surgery can be performed through arthroscopy or via the open knee technique and repair of the damaged meniscus is done. The prognosis depends on the type of tear and the initial condition of the knee.
A meniscal implant is recommended for patients who have lost more than half of the meniscus. The meniscus comes from a cadaver donor. It is harvested, sized, tested for infections such as HIV, Hepatitis, West Nile virus and also certain bacteria. Once the patient’s eligibility is confirmed, the meniscus is sutured into place during surgery.