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Meniscal Injuries

WHAT IS IT?

The menisci (inner and outer) are structures of fibrocartilaginous tissue found on the tibial plateaus. They distribute the weight on the knee and the strain that is exerted on the surfaces of the knee joint. They also stabilise the knee and reduce friction. In meniscal injuries, there are tears or ruptures which have various causes.

CAUSES

In young patients, these tears may be caused by traumas due to abrupt turns in the knee or the foot carrying the weight, as the knee is supporting a weight and the menisci are compressed between the femur and the tibia. In older patients, these tears tend to have degenerative causes.

SYMPTOMS

As soon as a tear occurs, a click may be heard, accompanied by intense pain as well as leakage and inflammation. The knee may also lock and give the sensation of instability.

TREATMENT

If the injury is not severe, conservative treatment based on pharmaceutical therapy may be used, such as analgesics or non-steroidal anti-inflammatory medication. Occasionally, cortico-steroid injections may be administered. Rest from sport and rehabilitation exercises, such as cycling and front-crawl swimming are also recommended.

In degenerative meniscal injuries that lead to mechanical symptoms, such as locking, the use of biological therapies like platelet-rich plasma  (PRP) is recommended, reserving surgery for painful injuries or those with locking that don’t improve with conservative treatment.

PRP and meniscal injuries

Conservative treatment:

• Meniscal cysts: these are approached with conservative treatment, locating the meniscal cyst with an ultrasound scan and administering intra-cyst PRP injections, intra-articularly on a weekly basis.
• Meniscal degeneration: because of its functional importance, the meniscus will always be protected and preserved if possible, by carrying out weekly intra-articular PRP injections for three consecutive weeks. After activating the PRP liquid, the knee is injected via an external approach into the medial compartment of the patellofemoral joint.

Surgery:

• Following meniscectomy: The meniscal wall is injected with PRP from the outside inwards (extra-articularly). For the posterior horn of the lateral meniscus, the injection is given from the inside to avoid vasculo-nervous injury. A repair process is induced with partial scarring due to the biological elements of PRP, protecting the meniscal wall and stabilising the knee. Afterwards, PRP is injected.
• Meniscal suture: once suture is carried out, PRP is injected in the meniscal wall and in the suture area. It is then administered intra-articularly. If the prognosis is bad, another injection is administered 2 weeks later, on an outpatient basis.