Despite surgery: What to do if the meniscus hurts again?

The menisci, the crescent-shaped disks of fibrocartilage tissue between the upper and lower legs, are quite small. One sits on the outside of the knee joint, one on the inside. And they are inconspicuous as long as they work.

But alas, a meniscus wears out or tears. It can then become jammed and the surrounding tissue becomes inflamed. The simplest movements then hurt.

An operation in which the meniscus is stitched or partially removed initially provides relief. But it is not uncommon for the symptoms to return after a few years. Why is this and what can affected patients do? Despite surgery.

Previously the removal was more generous

Just 25 years ago, medicine was far more inclined to cut away the meniscus more generously. That’s what Gregor Berrsche, senior orthopedic surgeon at the Joint Center at the Despite surgery Clinic in Heidelberg, says. “Today, thanks to improved surgical techniques and instruments, it is more often possible to completely preserve the affected part of the meniscus.” Or, according to the doctor, it can be repaired in such a way that only a little substance is lost.

And not every tear in the meniscus requires surgery. The main question is whether the crack is stable or unstable. Unstable torn parts of the meniscus increasingly move, get stuck and can rub the cartilage locally – this causes pain. There is usually no way around an intervention here. “Stable tears can be easily treated non-surgically,” says Gregor Berrsche, Despite surgery who is also a doctor for the Southwest Football Association.

The meniscus doesn’t grow back

He advises that meniscus problems should be diagnosed early, especially in children and adolescents. The meniscus has an important function: “It stabilizes the joint at the edges and, thanks to its special shape, increases the contact area between the upper and lower leg.” This means that the loads on the knee are evenly distributed across the cartilage surfaces.

Even if an operation initially relieves pain: “The meniscus naturally does not grow back and is more vulnerable afterwards,” says Prof. Matthias Hansen, a specialist in orthopedics in Mainz. “This can lead to the part of the meniscus, which was originally relatively intact but still internally affected by wear and tear, suddenly tearing again years later.” With a little luck, this can be treated again with a minimally invasive joint endoscopy, but this is not always successful.

Why sport is so important for the meniscus

What exactly can you do if you have recurring complaints? Both doctors strongly recommend sport and exercise. “The goal is to stabilize the joint through strength training using the muscles, like a muscle corset,” says Gregor Berrsche. In order for this to work, it should be exercises “in which the leg does not swing freely, but is in contact with the ground, for example, and therefore does not have to compensate for sideways movements.”

But where do you learn the right exercises? Even gyms that call themselves “orthopedic” don’t always have enough training when it comes to joint problems. Anyone who goes to a physiotherapy practice is on the safe side. The practices are often equipped with a small equipment course. For many exercises you only need your own body weight.

“Aqua jogging and aqua aerobics are also recommended. Here the leg is not supported, but due to the lack of body weight, the forces exerted on the joints are lower,” says Berrsche. “ Despite surgery Cycling training can also help, although you should only increase the resistance slowly.” Being overweight doesn’t help either. Better to reduce it. “That alone can bring significant relief,” says Hansen.

Another way to support the affected joint are so-called orthoses. These are firm bandages and structures that give the leg stability from the outside. According to Berrsche, Despite surgery they have another advantage: “These aids are an integral part of the health insurance benefit, just like rehabilitation sports, and are therefore often prescribed because they do not burden the medicine, bandages or remedy budget.”

Hyaluronic acid injections are not a miracle cure for meniscus problems

Medication, on the other hand, is only a temporary solution in the event of pain. Anyone who researches the topic of the meniscus often reads about hyaluronic injections and autologous blood treatments as additional options.

“The hyaluronic acid essentially lubricates the joint,” Despite surgery says Matthias Hansen. “This can certainly provide temporary relief, but the effect does not always occur and does not repair the cartilage and meniscus damage.” You also have to pay for the injections out of your own pocket.

The situation is similar with autologous blood treatments, which are intended to reduce inflammation but, according to Gregor Berrsche, have no clear, Despite surgery scientifically proven effect. Corresponding evidence is also lacking for dietary supplements that market themselves as “joint lubricants”.

Last resort: joint replacement

Another option is transplants: “These are actually absolute emergency solutions that can be considered in the event of a total loss of the meniscus and in very young patients without further damage,” Despite surgery says Matthias Hansen. On the one hand, collagen meniscus implants are used here, and on the other hand, cleaned and treated organ donations from deceased people are used.

However, both variants are affected in one crucial place, Despite surgery as Matthias Hansen explains: ” Despite surgery Since the meniscus does not have its own blood supply, the foreign matter is not supplied with blood and does not necessarily grow together with the existing tissue.”

If all attempts fail and the pain persists, there is often only one thing left: Despite surgery partial or full joint replacement. However, no doctor uses these prostheses lightly because they also have a limited lifespan, which depends on many factors. Reason enough, despite your weaker self, to start doing the right exercises in good time.

Despite surgery

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