The medial meniscus and lateral meniscus are specialized structures within the knee. These crescent-shaped shock absorbers between the tibia and femur have an important role in the function and health of the knee. Once thought to be of little use, the menisci (plural) were routinely removed when torn. Now we know that the menisci contribute to a healthy knee because they play important roles in joint stability, force transmission, and lubrication. When possible, they are repaired if injured. There are even experimental attempts to replace a damaged meniscus, possibly an important advance in orthopaedic medicine.
There are two categories of meniscal injuries - acute tears and degenerative tears.
There are two categories of meniscal injuries - acute tears and degenerative tears.
An acute tear usually occurs when the knee is bent and forcefully twisted, while the leg is in a weight bearing position. Statistics show that about 61 of 100,000 people experience an acute tear of the meniscus.
Degenerative tears of the meniscus are more common in older people. Sixty percent of the population over the age of 65 probably has some sort of degenerative tear of the meniscus. As the meniscus ages, it weakens and becomes less elastic. Degenerative tears may result from minor events and there may or may not be any symptoms present.
What are the menisci?
The two menisci of the knee are crescent-shaped wedges that fill the gap between the tibia and femur. The menisci provide joint stability by creating a cup for the femur to sit in. The outer edges are fairly thick while the inner surfaces are thin. If the menisci were missing, the curved femur would move on the flat tibia.
The medial meniscus, located on the inside of the knee, is more of an elongated "C"- shape, as the tibial surface is larger on that side. The medial meniscus is more commonly injured because it is firmly attached to the medial collateral ligament and joint capsule. The lateral meniscus, on the outside of the knee, is more circular in shape. The lateral meniscus is more mobile than the medial meniscus as there is no attachment to the lateral collateral ligament or joint capsule. The outer edges of each meniscus attach to the tibia by the short coronary ligaments. Other short ligaments attach the ends of the menisci to the tibial surface. The inner edges are free to move because they are not attached to the bone. This lets the menisci change shape as the joint moves. The front portion of the meniscus is referred to as the anterior horn, the back portion is the posterior horn, and the middle section is the body. Under the microscope, the meniscus is fibrocartilage that has strength and flexibility from collagen fiber. Its resilience is due to the high water content in the spaces between the cells. There is not much blood supply to the menisci. Blood flows only to the outer edges from small arteries around the joint. The poor blood supply to the inner portion of the meniscus makes it difficult for the meniscus to heal. What does the meniscus do? The meniscus acts as a shock absorber for the knee by spreading compression forces from the femur over a wider area on the tibia.
The important role of the meniscus in force transmission can be seen when the menisci are removed.
In the 1960s and 1970s, it was common to remove a damaged meniscus entirely. This frequently led to early degenerative arthritis in many patients.
What is a meniscus injury?
Patients describe meniscal tears in a variety of ways. Knowing where and how a meniscus was torn helps the doctor determine the best treatment.
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