Meniscus injuries in the knees. How and when to treat them?


Dr. Francisco De la Rosa, Rehabilitation Physician, Physical Medicine and Rehabilitation of the General Hospital of the Plaza de la Salud.

Knee pain is very common in physiatry consultations. People come daily seeking opinions on the best way to manage their condition. Menisci are one of the structures that can be injured in the knee, causing pain and disability related to work and sports activity.

Much of our consultation consists of educating patients about their condition and guiding them around what they should expect from the process.

We used to make a simile with pillows that are on the knee, which allows to cushion the weight they support and provides stability in the process.

We have two menisci in each knee, one lateral or external, and another medial or internal, which is more frequently injured by its disposition and firmness, although the treatment is similar for lesions of one meniscus or another.

The way they can get hurt is also diverse. The most common is to find tears in adolescents and young adults, related to sports or work activity, and degenerative changes in older adults.

That is, since the meniscus is a fibrocartilaginous structure, it is likely to have a tear of its fibers by friction or direct bruising, or chronic damage related to overuse, obesity and the passing of the years. If you feel symptoms related to the feeling that you "lock" your knee or "leave" your knee, it would be good to evaluate yourself to consider this type of injury, as well as if you feel pain when standing or climbing stairs.

Other structures that your treating physician should review are injuries related to articular cartilage, ligaments or musculotendinous lesions, of course, having ruled out bone lesions themselves. The medical history and physical examination are the most important elements to diagnose a symptomatic lesion of a meniscus, and the images are only complementary to confirm the suspicion.

A surgical decision, for example, cannot be taken under any concept based solely on resonance, without having evaluated the patient, since it is demonstrated that there are magnetic resonance findings in patients without symptoms in the knee.

Culvenor and collaborators, for example, published in 2018, in the "British Journal of Sports Medicine" (-BJSM- the most prestigious worldwide in the field), an article with overwhelming and high quality evidence that raised up to 43% of patients who had findings of magnetic resonance meniscus changes had no knee pain at any time. This supports the premise taught at the School of Medicine, that the medical history and physical examination are the most important, and surgical decisions cannot be taken as lightly as seeing a resonance.

Another article published in the "Journal of Bone and Joint Surgery" presented similar results to meniscus surgery, with conservative management in patients who had no symptoms of "locking" the knees at two years of treatment.

In the same way many aspects are evaluated before deciding surgery and it is not the only answer to the problem, as perhaps it was thought 20 years ago.

Posted in: Hoy Digital newspaper.

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