Meniscus tear from diagnosis to treatment

The knee, as a joint, is one of the most important in the human body. It belongs to the major joints and bears significant loads—thus experiencing strain—during walking, running, and jumping.
Structures within the knee, such as the menisci, are tasked with the challenging job of distributing these loads and maintaining the stability of the joint to minimize wear from the use of the knee. Unfortunately, due to normal wear and tear over time or excessive forces that exceed their capacity, the menisci also undergo degeneration and can tear.
Individual tears occur due to rotational or shearing forces applied to the knee, particularly when these forces axially compress the knee through the menisci. Such movements can include kneeling or deep squatting from an upright position, lifting and moving heavy objects, and sports that require sudden accelerations/decelerations and changes in the athlete's direction, as well as jumping.
The force exerted in these situations can injure also the involved bones, ligaments, and generally threaten the overall stability and integrity of the joint.
In older age, the force required to cause tears in the menisci is less because age-related degeneration of the knee structures is considered a given.
Meniscus tear is usual at:
Adult male over 40y in combination with knee osteoarthritis
Proffesions requiring kneeling or deep squating
Profesional football, basket, skiing,wrestle athletes
Regarding the frequency of meniscal injuries, it is higher in the medial meniscus, likely due to its inherently reduced ability to move within the joint, leading to greater load-bearing compared to the lateral meniscus during knee movement. In fact, the likelihood of a medial meniscus tear increases when there is also a tear of the anterior cruciate ligament, and this risk remains elevated the longer we delay the repair of the anterior cruciate tear.
Meniscus tears, apart from being classified as belonging to the medial or lateral meniscus, are categorized based on their shape and location on the meniscus. This classification is part of the description of the injury in the knee MRI, which is a sensitive and specific examination for soft tissue injuries of the knee joint.
Based of this classification tears are described as:
 Horizontal when their direction is parallel to that of the joint.Horizontal tears occur within the mass of the meniscus, usually in patients over the age of 40 with already degenerated menisci, without necessarily requiring significant force.
 Longitudinal tears in the meniscus that run vertically along the body of the meniscus represent another category of tears. This type can evolve into a specific injury known as a "bucket handle tear," where a portion of the torn material displaces into the joint, causing immediate blockage of knee movement. The treatment for this type of injury is typically surgical initially (immediately) if the mobility of the knee cannot be restored through manipulation.
 Radial tears These are tears that run vertically relative to the joint and the body of the meniscus. They start from the inner edge of the meniscus and extend to its periphery. Depending on whether a part of the meniscus is detached from the rest or remains "hanging" in connection with it, they may be further classified. Complex tears are typically degenerative tears that contain features described in the above classifications.

Αναλόγως της θέσης της ρήξης εντός του μηνίσκου αυτές διαχωρίζονται σε :
 Ρήξεις της εξωτερικής περιφέρειας του μηνίσκου ή ερυθρη (red-red) ζώνη, περιοχή που ο μηνίσκος αιματώνεται άρα μπορεί να επουλωθεί
 Ρήξεις εντός μιας ενδιάμεσης ερυθρής-λευκής (red-white) ζώνης/περιφέρειας, περιοχή αμφισβητούμενης αιμάτωσης άρα και δυνατότητας επούλωσης.
 Ρήξεις εντός της λευκής (white) ζώνης / περιφέρειας,περιοχή μη αιμάτωσης άρα και μη επούλωσης.
Η σημασία της τοπογραφικής αυτής κατανομής της βλάβης έγκειται στην δυνατότητα αυτόματης ή μετά από χειρουργείο επούλωσης με δημιουργία ουλής όπως γίνεται σε άλλους αιματούμενους ιστούς στο σώμα όταν αυτοί τραυματίζονται.

Treatment

The initial treatment for a painful and swollen knee suspected of having a meniscal injury involves alleviating symptoms through cryotherapy, elevation of the leg, wrapping, and, of course, rest. This is followed by pharmacological pain relief and anti-inflammatory medication to address pain and swelling. Prophylactic knee braces may be used, and a physical therapy program is recommended to reduce pain and swelling while maintaining the range of motion in the affected limp.
Alongside the initial symptomatic treatment, it is recommended to conduct an MRI scan, which reveals the injury, its type, shape, and location of the tear, as well as any associated injuries.
Depending on the characteristics of the meniscus tear, the patient's age, and their specific needs, the treating physician will recommend the appropriate treatment for the case.
In cases where the damage is minor, of suitable morphology, and limited to the outer periphery of the meniscus as described, the goal is to promote healing of the meniscal injury, either conservatively or surgically.Arthroscopic meniscus repair).
In cases where the damage is in an area without blood supply and causes persistent symptoms and mechanical blockage in the movement of the knee, the recommended solution is the... arthroscopic meniscectomythat is the excision of the lesion causing problems
Aiming of achieving a good outcome in a meniscus tear, both the patient and the doctor must collaborate on a solution that meets the patient’s expectations, considers the biology of the injury, and ensures an intervention that guarantees longevity and proper function of the joint.