Rajesh Bhalla

Effects of a Partial Meniscectomy on Articular Cartilage

A meniscus is a c-shaped fibrocartilaginous pad which partly divides a joint cavity. The meniscus provides cushion-like support and acts as a shock absorber for joint bones. It separates the Femur (Thighbone) from the Tibia (shin bone or the long bone in front of the legs). The meniscus is very important for normal gait or manner in which an individual walks as well as it also provides stability to the knees. Starting with first we need to understand the role of partial meniscectomy on a patient’s gait or locomotion pattern along with the overall load exerting on the joints that occur when there is a need to perform partial meniscectomy on the patient. It is unfortunate but in the majority of times, the meniscus tear is not able to be repaired due to its poor blood supply and also due to the fact that the inner part of the meniscus in the joint is so thin that it may often not be sutured or stitched. However, because of the vital role played by meniscus in all the factors, it is very important to try to repair the meniscus tear in order to preserve joint health.

Partial Meniscectomy

Effects of a Partial Medial Meniscectomy

There is a large number of outpatients who are suggested to undergo Arthroscopic partial medial meniscectomy for meniscus injury. Meniscus injury and subsequent resection in a way lead to a 7 times greater risk in developing knee osteoarthritis in later part of life. In today’s world, it is a general belief that after undergoing arthroscopic partial medial meniscectomy most of the patients have an uncomplicated recovery of the condition.

On closure examination of the patient’s condition, it is found that at least 1 out of 3 patients continues to suffer from a deficiency in the strength of a large group of muscles at the front of the thigh called the Quadriceps muscle, later overloading of knee joint caused due to poor absorption from the quadriceps muscle resulting in decreased or restricted physical function which can last for few months or even years. Thus after the arthroscopic partial medial meniscectomy surgery quadriceps weakness can be one of the most challanging risk factors ,strengthening of which will slow down the progress of arthritis.

It is better suggested to start some physical therapy immediately after the arthroscopic partial medial meniscectomy surgery in order to prevent persistent strength deficit and limitation in performing activities. Apart from this, it is also important to decrease the postoperative pain along with working on immediate restoration of quadriceps activation and restoration of motion in joints. This potentially helps in improving the overall quadriceps strength and the physical activity would help in minimizing the risk of progression of knee arthritis in the future.

It is very important to understand that the weakness in quadriceps muscle can lead to an increase in the overall load to knee joints which in result an lead to arthritic changes as early as 2 to 5 years after the arthroscopic partial meniscectomy. Thus it is very important to work on restoring the joint strength as early as possible so that the progression fo arthritis can be slowed down too much extent after the meniscectomy.

Partial Meniscectomy on Articular Cartilage

In young athletes, it is seen that due to meniscus injury or prior not – treated ACL tears, young athletes undergoing a partial or full meniscectomy develop high chances of suffering from osteoarthritis later in life which has been found in 65 – 90% of the cases.

Osteoarthritis is a degenerative articular cartilage joint disease which is characterized by articular cartilage maturation and hypertrophy ,degeneration and erosion of cartilage matrix and formation of osteophyte (bone spur) which is the major cause of disability in the world, which affects a third of the population who are of age group of 65 or above 65 age.

It is very unfortunate that to date there is no medicine existing that can completely treat, slow down or effectively prevent osteoarthritis . Also, there is no surgical process that can specifically and reliably treat partial articular cartilage lesions so that the progression of arthritis towards the end stage can be prevented.

In the majority of the cases of osteoarthritis in older people currently, they are managed by treating the symptoms of pain and inflammation with certain exercises, corticosteroid injections,visco supplementation and still if there is no relief then total joint replacement ultimately.This must be done by best knee replacement surgeon in India or best doctor in your vicinity, because this is a one in a life time procedure and decide the quality of your future life .

It has been reported that untreated meniscal tear which also includes macerated tissue tearing is one of the known factors for the development of arthritis over a time span of 2 – 2 ½ years of time which increases the risk of arthritis by 5 times. In addition to this in case of partial meniscectomy the risk of arthritis increases by 4 times by the time of 16 years after undergoing surgery and in the case of total meniscectomy, the risk of arthritis is increased by 5 to 9 times by 21 years of postoperation.

Effects of Meniscectomy on Gait Mechanics

A gait is a manner of walking of any individual. It is seen that patients who are having meniscectomy are having gait mechanics which are altered because of the lack of meniscal support at the joints. It is seen that there is an increase in the external rotation in walking in patients who have undergone partial menial meniscectomies these lead to an overload on cartilage tissues. With the increase in external rotation, the cartilaginous layer becomes thinner and is not adapted to receive much force as it is the main source of joint loading.

This can lead to further progression of arthritis in patients. The knee motion, in operated versus contralateral limbs is also consistently decreased due to the structural changes after meniscectomy. As patients postoperative rehabilitation it is very important to go for early physical therapy to restore the motion. It is also important to recognize and understand the large effect of small alteration and joint kinematics on cartilage which can also lead to arthritis.

When a joint injury occurs, apart from the loss of mechanical function and loss in shock absorption due to the meniscal tear, inflammation is also developed at the affected joint. The inflammatory condition often sets of cytokines, specifically interleukin – 1 and tumor necrosis factor-alpha (TNF – alpha) which in term leads to the development of cartilage wear and even breakdown as well.

Apart from meniscal damage due to traumatic injury it is also found that obesity and aging can also result in the increase in inflammatory cytokines in the knee joint with the passage of time thus there should be some means to slow down this systematic inflammation.

It is very important to know that apart from the local effect of inflammatory cytokines on the cartilage causing cartilage wear the acute inflammation can also lead to an increase in pain. With the increase in pain, it also results in the changes in the patient’s gait pattern which can change the pattern of walking and can also end up leading to wearing up of cartilage.

After a meniscus resection process in the same (ipsilateral) compartment, it is seen that in patients who are having varus knee alignment shows greater signs of medial cartilage overload and the patients having valgus aligned knee shows greater signs of lateral cartilage overload . Thus on losing the meniscus and affected compartment in cases where there is joint malalignment can cause the cartilage to wear out faster with time.

The change in the location and the amount of load which is exerted on the articular cartilage can still be significant even if meniscectomy surgery is not performed after the meniscus injury. This can also lead to arthritis thus it is very important to know that it is not the surgical meniscectomy that can alone cause these changes.

So it is very important to understand that if the patient has pain it can also lead to changes or loss in gait mechanics and muscle strength and is an important indication to undergo for the meniscectomy surgery so that even if there is a degenerative tear in the meniscus the progression of arthritis can be slowed down.

So we can say menical is the paramount factor to prevent the development atheritic changes in knee.

Due care must be taken for the prolonged health knee life by doing daily exercise and certain food supplements. Proper dose of high quality Coallagen peptides,Vitamin C , Calcium and certain anti inflammatory supplements have shown longevity of the knee health viability.

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