Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.Thomson, Alexis
Science
Manual of Surgery Volume Second: Extremities—Head—Neck. Sixth Edition.
Thomson, Alexis
Surgery
#Recurrent Displacement.#--In cases of recurrent displacement, each
attack is accompanied by symptoms similar in kind to those above
described, but less severe, and the patient usually learns to carry
out some manipulation by which he is able to return the meniscus into
position. He seeks advice with a view to having something done to
prevent displacement occurring, and to restore the stability of the
joint, which, in many cases, is impaired, preventing him following his
occupation. There persists a variable amount of fluid in the joint,
the ligaments are stretched and slack, and the quadriceps muscle is
markedly wasted.
The symptoms closely resemble those of a "loose body," and it is often
difficult to differentiate between them. In the case of a body free in
the cavity of the joint, the site of the pain varies in different
attacks, and the body can sometimes be palpated. Loose bodies wholly
or partly composed of bone may be identified with the X-rays.
Attempts may be made to retain the meniscus in position by pads,
bandages, or other forms of apparatus, so arranged as to prevent
rotation and side-to-side movement at the knee. In the majority of
cases, however, the best results are obtained by opening the joint and
excising the meniscus in whole or in part, as may be necessary.
The limb is flexed on a splint until the wound has healed, after which
massage should be employed and movement of the joint commenced. At the
end of two or three weeks the patient is allowed up, wearing an
elastic bandage. In most cases the use of the joint is completely
regained in from four to six weeks. As an indication of the perfect
recovery of the functions of the joint after removal of the meniscus,
professional football players are often able to resume their
occupation.
#Displacement of the lateral meniscus# is comparatively rare. It is in
every way comparable to displacement of the medial meniscus, and is
treated on the same lines.
#Torn or Lacerated Meniscus.#--In a large proportion of cases of
displaced meniscus in which the condition assumes the recurrent type,
it is found, on opening the joint, that, in addition to being unduly
mobile, the meniscus is torn or lacerated. The experience of surgeons
varies regarding the nature of the laceration. In our experience the
most common form is a longitudinal split, whereby a portion of the
inner edge of the cartilage is separated from the rest and projects as
a tag towards the centre of the joint (Fig. 86). As a rule, it is the
anterior end that is torn, less frequently the posterior end.
Sometimes the meniscus is split from end to end, the outer crescent
remaining in position, while the inner crescent passes in between the
condyles and lies curled up against the cruciate ligaments.
Occasionally the anterior end is torn from its attachment to the
tibia, less frequently the posterior end. In one case we found the
meniscus separated at both ends and lying between the bones and the
capsule.
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