Knee Pain: Preventing knee arthritis due to meniscus injury

One of the causes of knee pain is a meniscus tear. This is considered a precursor to knee cartilage lesions and degeneration, which will progress to knee arthritis if left untreated.

The meniscus is one of the important structures in the knee that functions as shock absorption, provides knee joint congruence and stability, protects the cartilage, and helps distribute load across the joint.

Once the meniscus is injured without proper healing, all the protective functions of the meniscus will be lost, further worsening the cartilage and causing progressive knee pain.

Most patients with a meniscus injury will experience pain during prolonged walking, turning, standing up, and during deep knee flexion. There are two groups of patients affected by this condition:

Young, active individuals who sustained a knee injury, in which pain and swelling tend to be acute with knee swelling and locking symptoms.

The aging population with meniscus degeneration (degenerative tear), where knee pain tends to progress slowly, with or without a history of knee injury. In long-standing cases, patients might present with swelling at the back of the knee (popliteal cyst) that usually started as an unrecognized knee meniscus tear. Chronic cases will have a deformed, bent knee with pain mostly on the medial/inner part of the joint.

The type of meniscus injury will predict the progression of the illness, and diagnosis can be confirmed with physical examination and magnetic resonance imaging (MRI) to assess the injury and tear pattern.

Meniscus contusion/mild tear usually heals without any complications, while a moderate to large tear will further progress and cause cartilage lesions and arthritis.

Treatment is symptomatic and supportive for contusions or mild tears, which most of the time can heal on their own. Larger tears need arthroscopic/keyhole surgery to repair the torn structure.

This is a minimally invasive surgery using a 4mm camera inserted into the knee joint to visualize and repair the torn meniscus and other structures. Expect the knee to be slightly swollen after the surgery, and patients might need to use a special knee brace and crutches to offload the joint, control knee motion, and facilitate ambulation and meniscus healing.

Full recovery is expected within six to eight weeks after surgery, with a return to full function and sporting activity within three months.

In cases with knee popliteal cyst and bent/varus knee, meniscus repair, arthroscopic cyst decompression, and knee alignment procedures might need to be performed to correct the deformity. More complex meniscus tears might need partial resection and synthetic meniscus replacement surgery to retain function.

For those who have knee pain that does not resolve within two to six weeks, they might have a knee meniscus injury.

To prevent knee arthritis due to a meniscus tear, it is advisable to get early orthopedic consultation for assessment and treatment. This is paramount to prevent cartilage degeneration and arthritis while preserving meniscus and knee functions.

Prepared by Dr Sazali Salleh, Consultant Orthopaedic, Arthroscopy and Sports Surgery atKPJ Pahang Specialist Hospital.

The views expressed in this article are the author's own and do not necessarily reflect those of Sinar Daily.