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Wednesday, 4 March 2015

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A complete knowledge about Meniscectomy

Meniscal damage is a common site of intentional knee pain and injury that orthopedic surgeons regularly observe, and approximately 61 out of 100,000 meniscal damage sufferers undergo Meniscectomy. The goals of surgery for meniscal tears are to relieve pain, facilitate the pre-injury phase in daily activities, and prevent premature degeneration of the knee joint. In the past, Meniscectomy was the same old operation due to the fact that the meniscus was considered a remnant with no function. In 1942, McMurray described that inadequate meniscus removal was the cause of meniscectomy failure. Currently, the meniscus is essential to daily knee biomechanics, and efforts are being made to hold the meniscus as much as possible to prevent degenerative arthritis. With the accelerated experience of the structure, function and biology of the meniscus and the development of recent surgical methods, meniscal restoration strategies have been advanced and arthroscopic partial Meniscectomy is preferred over general Meniscectomy.


However, not all meniscal tears can be repaired, and in many cases, Meniscectomy is inevitable. This overview article reviews the literature applicable to anatomical traits and biomechanics of the meniscus and describes the standards and warning signs for arthroscopic Meniscectomy. According to Dr. Jonathan Shook, OrthoIndy sports medicine specialist, the most not uncommon reason for a meniscus tear is a brief twisting or rotating maneuver of the knee joint. This is commonly related to the knee being in a dishonest function as the character turns the knee.




We conducted a multicenter, randomized, double-blind, sham management study of 146 patients aged 35 to 65 with regular signs and symptoms of the knee with a degenerative medial meniscus tear and no knee osteoarthritis. Patients were randomly assigned to arthroscopic partial Meniscectomy or sham surgery. Consequences number one were adjustments in the Lysholm and Western Ontario Meniscal Evaluation Tool (WOMET) rankings (each ranging from 0 to 100, with decreasing rankings indicating more intense signs and symptoms) and in knee pain after exercise. . (rated on a scale of 0 to 10, with 0 indicating no pain) 12 months after the procedure.


●Meniscus - shape and characteristics-


The fundamental characteristic of a healthy joint is to distribute the energy forces optimally to distribute them in step with the load potential of the tissues. The forces acting internally under dynamic loading conditions on the tactile surface are evenly distributed over the cartilage-bone interface.11,12 The meniscus plays a fundamental role in bearing the load and in transmitting the load to the cartilage and subchondral bone. Due to the exceptional curvature of the femoral condyles and the medial and lateral tibial plateaus, the meniscus's main feature is the contact surface's extension (Figure 1). In the evaluation of the medial meniscus, the lateral meniscus covers a larger portion of the tibial joint surface (lateral joint surface: 75% –93%; medial joint surface: 51% –74%). 13 After removal of the meniscus, the contact area l decreases by 40% medially and up to 52% laterally. 14 Another key feature is that the shear forces are converted into circular tensile strain, thereby reducing the forces acting on the cartilage. 15 The meniscus is pressed by radially directed shear forces, but due to the bony attachment to each end, the shear forces are converted to circular tensile strain. The association of collagen fibres shows the sample of tensile strain trajectories.


 The reality of segmental defects underscores the intentional importance of those round marginal fibres. At the same time, radial or root tears with complete rupture cause comparable consequences such as an entire meniscectomy.16-18 On the other hand, the crest still has an excellent residual characteristic in a partial meniscectomy with an intact margin.


●Symptoms of a meniscectomy-


● Pain along the area where the knee bends both inside and outside the knee


● Swelling or stiffness of the knee


● At times, humans will experience a "click" or "click" sensation in the knee, mainly with squatting or twisting activities.




Since Fairbank22) suggested the development of degenerative adjustments after Meniscectomy in 1948, the modality's scientific efficacy has been controversial. The cutting-edge consensus is that the remedy for rupture of the meniscus must be achieved by focusing on the preservation of meniscal features. Studies have shown that degenerative adjustments after Meniscectomy may or may not be avoided in time by retaining as much daily tissue as possible with minimal meniscus resection.


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