Meniscal tear: early surgery could reduce the risk of arthrosis

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MunichMeniscus injuries not only affect professional footballers. The fiber rings in the knee joint suffer minor or major tears in almost everyone in the course of their life. These are now only operated on if there is permanent pain or restricted mobility. Now it is clear that even minor meniscus injuries increase the risk of arthrosis.

Not so long ago, the recommended treatment for a meniscus tear was clear: the ring of fibrous cartilage, with poor blood supply by nature and hardly healing, was simply removed completely or almost completely. “It's hard to believe, but 20 years ago people were of the opinion that the menisci did not play an important role in the knee joint,” says Trent Guess, physiotherapist and biomechanic at the Orthopedic Clinic of the University of Missouri-Columbia.

Complete meniscus removal always leads to osteoarthritis

It turned out that almost all patients suffered premature, severe joint wear in the operated knee joint as a result of the operation - a so-called gonarthrosis. The complication occurred so reliably that medical professionals nowadays refer to total and subtotal meniscus removal as "pre-arthrosis", ie as a preliminary stage of joint wear and tear. However, it could start much earlier, as Guess and his team have now demonstrated in a study of patients with minor meniscus injuries. "Even if the connections between the tibial head and the cartilage ring loosen, the menisci can lose their function completely," says Guess.

Computer calculates the pressure in the joint

The researchers examined the gait pattern of their test subjects using an elaborate measuring device with numerous movement and pressure sensors. In addition to the forces involved in rolling the foot, this also determined the exact sequence of movements of the thighs, knees and lower legs and the muscular work required for this. A computer program then used detailed knee joint images (CT and magnetic resonance imaging) to calculate the exact pressure loads that acted on the cartilage covering the joint surfaces. And even with rather small meniscus damage, they were well above the normal range.

Extreme force peaks on the cartilage

"If the function of the menisci is disturbed, the physical forces are concentrated on a very small joint surface and the pressure on the cartilage is very high in relation to the surface," explains Guess.Even when you just get up from a chair, the knee joint has to support four times your body weight for a short time. "Let me imagine the forces that can arise when jumping in basketball."

If this is not absorbed by the menisci, the force peaks could damage the cartilage and ultimately lead to premature osteoarthritis, says Guess. "We have now recognized the importance of the meniscus for all movement sequences in the knee and how important it is for protecting against joint wear." His studies showed that it makes sense to surgically correct injuries to the meniscus at an early stage. "Otherwise, if left untreated, they can quickly lead to osteoarthritis."

Wear-prone shock absorber

The meniscus on the head of the tibia has roughly the shape of a double crescent moon. In this way, it forms a precisely fitting bearing in the knee joint for the two roles of the thigh bone. In a healthy state, it not only cushions shocks, but also distributes the pressure evenly over a large joint surface. However, as a result of aging processes or overloading, small or large tears develop in the menisci in almost everyone in the course of their life. Parts of the shin plateau can also become detached.

Since only a small part of the meniscus tissue is supplied with blood, it can hardly regenerate and does not heal by itself. It then has to be surgically sewn and reattached to its base. Today, operations on the meniscus are usually carried out using an arthroscopy.

Sources:
T. Guess et al .: “Predicted Loading on the Menisci During Gait: The Effect of Horn Laxity,” Mizzou Motion Analysis Center, January 2015.

University of Missouri, Columbia press release, May 4, 2015

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