A meniscus tear is one of the most common causes of knee pain. The timely diagnosis and optimal treatment are important prerequisites to prevent permanent joint damage (osteoarthritis).
Meniscectomy / Meniscus smoothing
Formerly a torn meniscus was often removed completely. Studies have shown, however, that after a complete removal of the meniscus, the impact on the articular cartilage increases approximately 7-fold. Aim of the meniscus therapy should consequently be to preserve as much of the meniscal cartilage as possible. This means that only the torn portions should carefully be removed arthroscopc by the knee specialists and smoothed in order to preserve as much of the important buffer and to prevent further tearing of the meniscus. After a partial meniscectomy, the operated leg should be relieved of any strain for 3-5 days, i.e., meaning the patient should use crutches. The healing period should be supported by physiotherapy, electrotherapy, and lymphatic drainage. Participation in sports will be possible again after about 4-8 weeks.
The aim of meniscal fixation is to avoid removal of the torn meniscus parts. Rather, the meniscus is repaired and meniscal healing is ensured. The healing of a meniscus is promising only in the area of vascularized meniscus base. New arthroscopic meniscal fixation methods provide high quality and safe suture anchorage, with which a meniscal tear can also be treated minimal invasively in hard to reach areas of the knee joint. The suture is pulled through the two edges of the tear and then firmly knotted.
Aside from sutures in the traditional sense, today special suture anchor systems are used.
If a meniscus is sutured, the post-treatment takes longer in comparison to a meniscectomy since the sutured meniscus needs time to heal. The patient will have to use crutches for about three weeks. Moreover, the operated knee joint should be loaded for another 3 weeks just in a stretched position. The healing phase should be enhanced by a physiotherapy in order to prevent a greater loss of muscle mass. Sports that strain the knee more intensely should be avoided for at least 3 months. The in relation to meniscectomy prolonged healing period, should, however, be accepted by the patient since this type of procedure allows for the entire meniscus to be left intact.
Meniscal transplantation, i.e. the replacement of the torn meniscus by a body transplant, is unlike in the U.S., still very rare in Germany. One reason is the limited availability of donor meniscus due to the very restrictive Transplantation Act. Another reason might be a possible rejection by the patient’s immune system of the donor meniscus and the technically and financially very high cost.
Use of meniscal allograft tissue
Meniscus replacement (CMI, Menaflex™)
Menaflex™ collagen meniscus implant (formerly CMI) is a product that has been developed in order to allow for a formation of a meniscus-like replacement cartilage after removal of large parts of the meniscus. Here, a resorbable collagen structure is sutured to the remaining meniscus base, to grow into the new cartilage. The aim is to create a meniscus similar replacement buffer in the knee joint.
CMI for collagen meniscus implant. The implant consists of a sponge-like tissue of highly purified collagen, after an extensive partial resection of the damaged meniscus (subtotal meniscectomy) that can arthroscopically be inserted into the knee joint The
CMI has approximately the same shape as the meniscus and is sutured in place of the remote meniscal tissue to the remaining meniscus part close to the capsule. The aim is that within a few months new cartilage tissue grows from the rims of in the collagen scaffold, which functions in this process as a kind of forming guide for soft tissues. Simultaneously, the collagen fibers are broken down gradually. The goal is that at the end of the procedure the body has even formed a resilient meniscus replacement with form and function similar to the original situation. The treatment following such a procedure is quite lengthy. In addition to relieving weight and strain on the leg for approximately 12 weeks, intensive physiotherapy is required. Preliminary studies on the use of CMI seem promising, however they are currently not complete. Future studies will show, whether it is beneficial, technically and financially, to routinely perform this complex process. Both statutory and private health insurance carriers will not take over the cost of 2,000 € for a collagen meniscus implant.
It needs an experienced orthopedic surgeon specializing in knee injuries
Because of the rapid medical advances for the best possible treatment of a knee meniscus tear, the surgical procedures should be performed by an experienced orthopedist specializing in knee injuries, who is competent across the entire range of meniscus treatments. The knee specialists at the KLINIK am RING in Cologne perform more than 700 meniscus operations on a yearly basis.
Meniscus - more information:
- Cruciate ligament rupture
- Degenerative Arthritis / Osteoarthritis
- Arthroscopy Knee
- Cartilage transplantation
- Artificial Knee Joint / Endoprothesis
- Runner's Knee
- Anterior Knee pain