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Meniscal Lesion: Causes, Symptoms & Treatment

A meniscal lesion is damage to one or both menisci in the knee joint. It commonly results from twisting movements or wear and tear, causing pain and restricted mobility.

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Things worth knowing about "Meniscal lesion"

A meniscal lesion is damage to one or both menisci in the knee joint. It commonly results from twisting movements or wear and tear, causing pain and restricted mobility.

What is a Meniscal Lesion?

A meniscal lesion refers to damage or a tear affecting one or both menisci within the knee joint. The menisci are two crescent-shaped fibrocartilaginous discs – the medial meniscus (inner) and the lateral meniscus (outer) – situated between the femur (thigh bone) and the tibia (shin bone). They act as shock absorbers, improve joint congruence, and contribute to knee stability. Meniscal lesions are among the most common knee injuries, affecting both athletes and older individuals due to degenerative changes.

Causes

Two main categories of causes are distinguished:

  • Traumatic meniscal lesion: Results from a sudden twisting or rotation of the knee, often during sports activities such as football, skiing, or tennis. Ligament injuries frequently occur simultaneously.
  • Degenerative meniscal lesion: Caused by age-related deterioration of the meniscal tissue. Even routine daily movements can trigger a tear in this context.

Additional risk factors include obesity, pre-existing knee osteoarthritis, and repetitive stress from kneeling or squatting activities.

Symptoms

The symptoms of a meniscal lesion vary depending on the type and severity of the tear. Common symptoms include:

  • Knee pain, especially during weight-bearing, rotational movements, or stair climbing
  • Swelling of the knee joint
  • A feeling of locking or catching in the knee
  • Limited range of motion, particularly when bending or straightening the knee
  • Tenderness along the joint line

In the case of an acute tear, an audible pop may be heard at the time of injury.

Diagnosis

The diagnosis of a meniscal lesion is established through various methods:

Physical Examination

The physician performs clinical tests such as the McMurray test, the Apley test, or the Thessaly test, which can indicate meniscal involvement.

Imaging

  • MRI (Magnetic Resonance Imaging): The gold standard for visualising meniscal lesions, allowing precise assessment of the location and extent of the tear.
  • Ultrasound: Can be used as a complementary method.
  • X-ray: Does not show soft tissue injuries but helps rule out bony changes.

Arthroscopy

Diagnostic arthroscopy (joint inspection using a small camera) is performed in uncertain cases or as part of simultaneous surgical treatment.

Treatment

Treatment depends on the type and location of the lesion, the chronicity of the injury, the age and activity level of the patient, and the severity of symptoms.

Conservative Treatment

Many meniscal lesions – particularly degenerative and smaller tears – can be managed conservatively:

  • Rest and offloading of the knee (PRICE protocol: Protection, Rest, Ice, Compression, Elevation)
  • Physiotherapy to strengthen the knee-stabilising muscles
  • Pain-relieving and anti-inflammatory medications (e.g., NSAIDs such as ibuprofen)
  • Intra-articular corticosteroid injections for severe pain

Surgical Treatment

Surgery is considered when mechanical symptoms (locking), extensive tears, or failure of conservative treatment are present:

  • Meniscal repair (meniscal suture): Preferred in younger patients with fresh tears in well-vascularised tissue. The goal is to preserve the meniscus.
  • Partial meniscectomy: Removal of the torn portion. The most commonly performed surgical procedure.
  • Total meniscectomy: Complete removal of the meniscus; avoided whenever possible due to the increased risk of osteoarthritis.

Recovery and Prognosis

Recovery depends greatly on the type of treatment and the location of the tear. Tears in the outer, well-vascularised region of the meniscus (the so-called red zone) have better healing potential than tears in the inner, poorly vascularised region (white zone). Following meniscal repair, rehabilitation typically takes three to six months. After partial meniscectomy, an earlier return to full weight-bearing is possible, but the long-term risk of developing osteoarthritis is increased.

References

  1. Englund M. et al. - Incidental Meniscal Findings on Knee MRI in Middle-Aged and Elderly Persons. New England Journal of Medicine, 2008.
  2. Deutsche Gesellschaft für Orthopädie und Unfallchirurgie (DGOU) - Guidelines on Meniscal Disorders, 2020.
  3. Beaufils P. et al. - Clinical practice guidelines for the management of meniscal lesions and isolated lesions of the anterior cruciate ligament of the knee in adults. Orthopaedics & Traumatology: Surgery & Research, 2009.

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