Meniscal pathologies are among the most frequently encountered conditions in knee surgery . They affect the two fibrocartilaginous structures located between the femur and the tibia, called menisci. Each knee consists of an internal (medial) meniscus and an external (lateral) meniscus. These structures play a vital role in joint stability, shock absorption, and load distribution during walking or more complex movements.
Meniscal injuries can occur at any age, but their mechanism and management vary depending on whether they are traumatic or degenerative in origin. Active or athletic patients are more prone to traumatic injuries, often related to sudden twisting or excessive bending. In older individuals, however, the natural degeneration of meniscal cartilage leads to progressive cracks or tears, sometimes silent, but often disabling in the long term.
What are the origins of meniscal lesions?
Tears of traumatic origin
Traumatic meniscal tears are usually seen in young patients, often in a sporting context. The mechanism is typical: a sudden twist of the knee while supporting, excessive flexion during a squat , or a rapid rise can lead to a meniscus tear. This situation frequently occurs in pivot sports such as football , rugby , skiing , and handball .
This type of movement is sometimes accompanied by an audible snap and locking of the knee in flexion . This latter clinical picture is suggestive of a meniscal blockage due to a dislocated bucket handle : the meniscus tears and then turns inside out in the joint, preventing full extension. In the majority of cases, these traumatic injuries require surgical treatment.
The injury may be isolated or associated with other joint injuries, including a ruptured anterior cruciate ligament or a knee sprain , which complicates treatment. The type of rupture (vertical, horizontal, bucket handle, etc.) and its location in the meniscus determine the surgical treatment to be considered.
Degenerative lesions
Degenerative lesions appear gradually, often in patients over the age of 50. Meniscal tissue weakens with age and becomes more vulnerable to mechanical stress. These include internal cracks, delaminations, or complete tears, usually without specific trauma. They may be asymptomatic at first, then cause chronic pain, a feeling of giving way, or recurrent inflammation of the knee with episodes of swelling. This type of pathology is often associated with the onset of osteoarthritis.
How to recognize the symptoms and diagnose meniscal pathologies?
Typical clinical manifestations
Symptoms associated with meniscal pathology vary depending on the nature and severity of the lesion. Typically, the patient experiences pain located in the medial or lateral joint line, felt when walking, bending, or in certain squatting positions. A clicking or locking sensation in the knee may be reported, particularly in cases of unstable lesions such as an unstable meniscal flap or a bucket-handle lesion . Episodes of swelling, sometimes recurrent, reflect an intra-articular inflammatory reaction.
In some cases, the patient complains of mechanical or functional discomfort without severe pain, but with limitations in daily activities. Subjective instability or loss of confidence in the affected knee may also be warning signs.
Clinical and radiological examinations
Diagnosis begins with a thorough clinical examination, including specific tests such as the MacMurray or Apley maneuvers , which reproduce pain by mobilizing the knee. The doctor palpates the joint line, looking for slippage or blockage.
A standard X-ray is prescribed as a first step to rule out a bone cause or to detect associated osteoarthritis. However, MRI remains the gold standard for visualizing meniscal structures, specifying the type of lesion, its location (red or white area), and the condition of the surrounding tissues. In some cases, an arthrogram may be suggested, particularly when MRI is inconclusive or contraindicated.
Treatments for meniscal pathologies: medical and surgical
Conservative treatment as first line
When it comes to a degenerative lesion without joint blockage, management is initially non-surgical. Treatment includes relative rest, the use of nonsteroidal anti-inflammatory drugs, corticosteroid, hyaluronic acid, or PRP injections, and a personalized rehabilitation protocol. Physiotherapy aims to strengthen the periarticular muscles, improve proprioception, and restore knee mobility. This approach is often effective in lesions with few symptoms or in patients with low activity.
Surgical intervention: arthroscopic menisectomy and meniscal suture
When pain persists despite proper medical treatment, or when mechanical blockage is observed, surgery is considered. Dr. Bruno Lévy performs arthroscopic menisectomy, a minimally invasive technique that involves removing only the damaged portion of the meniscus. The goal is to relieve symptoms while preserving as much healthy tissue as possible in order to preserve meniscus function over the long term.
In some cases, particularly in young, athletic subjects or those with a lesion in the red zone (well vascularized), meniscal suture is potentially an option. This technique aims to repair the meniscus rather than resect it, in order to maintain its biomechanical integrity. The choice between the two approaches is based on several criteria: location of the tear, age of the lesion, stability of the knee, expectations and age of the patient.
The procedure is performed on an outpatient basis, under spinal or general anesthesia. The surgeon makes two small incisions on either side of the knee, allowing for the insertion of a camera and microsurgical instruments. The operating time is short and complications are rare, thanks to the practitioner’s experience.
Please note: It is essential to stop smoking at least one month before surgery. Nicotine alters blood flow and impacts healing.
Post-operative care and functional recovery
Post-operative care and monitoring
After an arthroscopic menisectomy, the patient can go home the same day with a comfort splint and strict recommendations for icing and elevation of the operated limb. Walking is generally permitted with full weight-bearing. A surgical follow-up is scheduled approximately 30 days later to ensure proper healing.
In the case of meniscal suture, the aftercare is more stringent. The knee is immobilized in a hinged splint limiting the range of motion. This precaution is essential to promote healing of the sutured meniscus. A specific rehabilitation protocol is implemented in the immediate postoperative phase.
Rehabilitation and resumption of activities
Rehabilitation is an essential step in regaining a functional, pain-free, flexible, and well-muscled knee. It varies depending on the surgical procedure performed. After a menisectomy, the priority is to quickly regain full flexion. This goal is worked on primarily in the first few weeks, before focusing efforts on muscle strengthening. Recovery is generally rapid, with a gradual return to sports activities between three and four months.
In the context of a meniscal suture, the instructions are stricter. The knee must be mobilized while protecting the suture. It is therefore imperative not to bend beyond 90 degrees for the first forty-five days following the procedure. The patient wears a hinged splint that limits the range of flexion according to the surgeon’s recommendations. This splint, in addition to the support stocking, accompanies a long and progressive rehabilitation, where each phase is adapted to the healing of the tissues. The resumption of sports requiring pivots and changes of direction is usually considered around the sixth month.
Prevention advice is always given to limit the risk of recurrence or joint deterioration: avoid prolonged squatting, reduce excessive loads, favor gentle activities such as swimming or cycling, and maintain a stable weight.
Conclusion
Meniscal pathologies are common knee conditions that can affect people of all ages. Their management is based on a detailed analysis of the context, symptoms, and imaging results. Dr. Bruno Lévy offers a personalized approach, ranging from conservative treatment to minimally invasive surgery, while preserving the integrity of the meniscus as much as possible. Arthroscopic menisectomy or a well-performed suture, combined with good rehabilitation, can restore satisfactory and lasting joint function.
