Importance of the Knee Joint

The knee is one of the important joints in the body because it carries the weight of the human being but is also important for sporting activities. So in the knee, there are structures like meniscus which are the rubber pad for cushioning, ligaments which support the stability of the knee. 

The most common injuries to the knee are rubber pad injury or meniscus injury,  ligament injuries, cartilage injuries. Meniscus injuries are quite common because of the sporting population. Usually, when we do sports the twisting movements can cause meniscus and ligament injuries. Also slipped in the house or fall, twisting in the house can also cause meniscus injuries. 

What is a meniscus?

The meniscus is a C-shaped structure in the knee, there are two menisci, inner menisci called middle menisci, outer menisci called lateral meniscus. It is divided into three zones:

• Outer Zone also called Red-red zone

• Middle zone is called the white-red zone

• The inner zone is called the white-white zone

These meniscus injuries can result in a tear of the meniscus. These tears are classified into radial, horizontal, complex, oblique, horizontal cleavage and root tears. 
Meniscus root tears are the tears in which menisci are attached to both the front and back of the leg bone or the tibia bone through a structure called root. So we have inner meniscus front attachment and back attachment, other meniscus front and back attachment. The detachment of the root from the bone is called root tears.

Meniscus Tears Surgeries

Not all meniscal tears require surgery, some can be managed conservatively. Small peripheral tears are red-red zone tears that can be managed conservatively without surgery because the blood supply to the outer portion of the meniscus is present whereas small tears can heal by itself.
If the tears are extending from the Zone 2 to zone 1 that is the red-white zone and white-white zone then the surgery is contemplated or bigger tears in the periphery of the outer zone (red-red zone) need surgical treatment. 

Types of Surgeries

Removal of the meniscus - It is called a meniscectomy. It should be done when the tears are in the white-white zone and which is not repairable and also in the complex tears where the meniscus is crushed and the tissues are not good. One should be very very careful to remove as least meniscus as possible because removal of too much of meniscus ends in losing the cushioning effect of the meniscus. The thigh bone and leg bone start crushing each other and develop cartilage damage or arthritis. 

Repair of the meniscus - It is called meniscus repair. There are three techniques used in meniscus repair:

• Outside- in technique - Putting needles from outside and stitching the meniscus though suture materials. This is usually done for the front half of the meniscus.

• Inside-out technique - It is done for the posterior half of the meniscus

• All inside technique- There are very variegated uses in all inside techniques such as biodegradable material, peek material, all suture material. 

These all suture devices come with disposable devices which help in delivering the implant into the meniscus and which creates a knot or suture around the meniscus which helps in repairing the meniscus.

In the last five years, at Sakra, we have performed almost 10000 meniscus repairs. If meniscal repairs are followed up well you can do MRIs and see how the meniscus is healed and at the same time if you have retained the meniscus you can allow the patient to go back to complete sports activities after 6-9 months. Post-surgery good physiotherapy and rehabilitation are required, first, we start with walking, then we do weight-bearing, then we train the patient for balance agility and sports training in future.

What is JuggerStitch by Zimmer Biomet?

We are happy to introduce JuggerStitch by Zimmer Biomet, which is all inside a knotless meniscus repair device which doesn’t carry any implantable peak or biodegradable implant. It is made up of only suture material. This device has been introduced for the first time in the country by Sakra World Hospital. We are one of the premium hospitals in the country to do the meniscal repair. 

The benefit of JuggerStitch by Zimmer Biomet is that it is knotless, all suture implant which allows easy implant insertion.

At Sakra, we always suggest doing meniscal repair because if you remove the meniscus then there is no other option and the meniscus cannot regrow. If too much of meniscus is removed then the only option left with is meniscus transplant where you have to get the meniscus from the cadaver labs and do the meniscal transplant. So it is better to save as much as possible.

FAQs

1. What is meniscal tear repair surgery?

Meniscal tear repair surgery is a procedure used to treat a tear in the meniscus, a piece of cartilage that cushions and stabilises the knee joint. The surgery aims to repair the damaged cartilage and preserve its function whenever possible.

2. What are the common symptoms of a meniscal tear?

Common symptoms include knee pain, swelling, stiffness, difficulty bending or straightening the knee, and a catching or locking sensation. Some people may also feel that their knee is giving way while walking or moving.

3. What causes a meniscus tear in the knee?

A meniscus tear commonly occurs due to sudden twisting or turning of the knee, especially during sports or physical activity. It can also develop gradually as the cartilage weakens with age, making it more vulnerable to injury during everyday movements.

4. When is surgery required for a meniscal tear?

Surgery may be recommended when a meniscal tear causes persistent pain, knee locking, or movement difficulties despite appropriate non-surgical treatment. It may also be needed for certain tears that are likely to benefit from repair, particularly when the knee's movement is significantly affected.

5. How is meniscal tear repair surgery performed?

The surgeon examines the tear and either stitches the damaged meniscus back together or removes only the damaged portion if repair is not possible. The choice depends on the tear's location, size, pattern, and the condition of the cartilage.

6. Is meniscal tear repair surgery performed using arthroscopy?

Yes, meniscal tear repair is usually performed using knee arthroscopy, a minimally invasive procedure. The surgeon inserts a small camera and specialised instruments through small incisions to examine and treat the damaged meniscus.

7. How long does it take to recover from meniscal tear repair surgery?

Recovery after meniscus repair generally takes around 3 to 6 months, although some patients may need longer to return to sports or strenuous activities. Recovery depends on the type of tear, the surgical technique, and adherence to rehabilitation and weight-bearing instructions.

8. Can a meniscal tear heal without surgery?

Yes, some meniscal tears can improve without surgery through rest, ice, activity modification, physiotherapy, and pain management. Small tears near the outer edge of the meniscus may have a better chance of healing because this area has a better blood supply, while persistent symptoms or certain types of tears may require surgery.