[Medical Insight 55th] Symptoms and treatment of 'menorrhea cartilage plate rupture' informed by orthopedic surgeons

□ Broadcast Date and Time: October 25, 2024 (Fri) 10:20 pm
□ Producer in charge: Lee Siwoo
□ Author in charge: Kim Bae-jeong and Kim Hyun-jung
□ Cast: Park Young-sik (Orthopedic surgeon)
□ Broadcast channel
IPTV - GENIE TV No. 159 / BTV No. 243 / LG Uplus No. 145
SkyLife Number 90
Cable - Delive No. 138 / Hyundai HCN No. 341 / LG HelloVision No. 137 / BTV Cable No. 152

* The text below may differ from the actual broadcast content, so please check the broadcast for more accurate information.


◆ Park Young-sik: Hello. I'm Park Young-sik, an orthopedic surgeon. The story I prepared for this time is the symptoms and treatment of meniscus rupture.

◇ Voice actor Park Sang-hoon: Joint diseases that should be suspected when pain occurs with a cracking sound in the knee during exercise or when the knee loses strength without feeling weak. The meniscus cartilage plate is a structure located between the joint surfaces of the knee and plays an important role in absorbing the impact on the knee. However, it is frequently caused by extreme sports activities or trauma in young people, and in middle-aged people, the cartilage plate is worn out due to repeated shocks, causing the meniscus to rupture. Let's take a closer look at the symptoms and treatments of meniscus cartilage plate rupture, which is inevitable for surgical treatment.

<Understanding Diseases>
◆ Park Young-sik: After being diagnosed with a ruptured meniscus cartilage plate recently, many people come to consult on what to do in the future or whether to undergo surgery or not. In the past, most people had resection surgery when they ruptured, but recently, it is known that arthritis comes quickly after resection, so there are too many people who don't want to do it. Then I'll tell you what the actual situation is and when it should be done.

<Cartilage vs. cartilage plate>
◆ Park Young-sik: But I use a lot of cartilage plates and cartilage, and you have to know that even if the names are similar, they are completely different. Articular cartilage is what covers the surface of the joint and the cartilage plate is what acts as a cushion between the joints. And it's completely different, so you have to use it differently.

<What is an articular cartilage plate? >
◆ Park Young-sik: What I'm going to tell you today is a cartilage plate, but I'll tell you what articular cartilage is. Most of the lower limb joints have very stable ball-socket configurations. However, the characteristic of the knee joint is that it is convex up and down. The stomach is convex and the bottom is convex, so it's very unstable. So ligaments, cartilage plates, tendons and so on maintain stability. The cartilage plate is also a structure that maintains stability by acting as a cushion in the knee, but it is unstable, so it is very easy to hurt. That's why I have a lot of arthritis. Compared to other joints, the shape of the cartilage plate is C-shaped. There are one on the inside and one on the outside per knee, and it is mostly composed of collagen. The edge of the blood supply is very important, and the blood supply is only about 3mm at the edge, and the supply is barely good inside, and the nerves are distributed only to the area where the supply is blood supply.

<Function of cartilage plate>
◆ Park Young-sik: But this is very important, so in the future, it acts as a very important factor in determining the treatment policy. As for the function of the cartilage plate, the joints are convex up and down, so when they come into contact, they come into contact with one point, and the articular cartilage cannot withstand and is damaged, and the meniscus cartilage plate plays a role in distributing the distribution load to various broad sides. And it's composed of collagen and protein, and water enters the hard part and gives it elasticity. So, it plays a very important role in shock absorption, and if you look at the cross-sectional area, it is wedge-shaped, so it enters between the joints and increases stability, and when it is pressed again, moisture escapes and forms a lubricating film. Therefore, it also plays a role in lubricating.

<∀> { 유병률}◆ Park Young-sik: It is known that 60-70 out of 100,000 people usually have cartilage plate rupture, and men are at about four times higher risk than women. Since men have a lot of activities like this, they tear up more easily. Usually, when it is torn by trauma, men are in their 20s and women are mainly injured in their teens, and in this case, about a third are accompanied by an anterior cruciate ligament rupture. And in the case of degenerative rupture, it usually occurs in the middle age around the age of 50, and in this case, it is not a large trauma, but it also occurs in minor daily life and minor shocks.

<Type of cartilage plate rupture>
◆ Park Young-sik: Cartilage plate rupture is classified according to the shape, and if it is torn in the longitudinal direction of the cartilage plate, it is called longitudinal heat, and if the longitudinal heat is longer, the cartilage plate rupture area moves inward. In this case, there's always a bucket. Because it is similar to a bucket handle, it is also called a bucket handle rupture, and the case of tearing across the cartilage plate is called a radial rupture, and the case of tearing the cartilage plate obliquely is called a filamentous rupture. And the rupture by dividing the cartilage plate up and down is called transverse rupture and horizontal rupture.

<Symptoms of Disease>
◆ Park Young-sik: Then what kind of symptoms occur in the knee when the cartilage plate is torn? When the torn area moves and fits between the joints, it feels tight. It's called a jam, and sometimes the knee bends and stretches at all, but it doesn't work well. It's called locking and locking, so my knees don't move very well. Sometimes you have to shake it like this to spread it out, and in this case, there may be a glass body in your knee or a cartilage plate is torn like this, so in this case, you should go to a hospital for a diagnosis. And when the torn part gets caught between the joints and pulls the broken cartilage plate, the nerves distributed on the cartilage meniscus at the edge are stimulated and pain occurs. So I may have symptoms of knee bending as I relax my legs unconsciously to avoid pain. Even in this case, it is recommended that you be diagnosed at a hospital, and if you touch the torn area well, you can feel this joint line, but if you press it on that area, you may have tenderness.

<∀>
◆ Park Young-sik: If you suspect a cartilage plate rupture, you will be examined when you come to the hospital, and what is the result of the examination is that if you touch your knee, it may be a little swollen in your knee. So, if you press the patella a little bit, you can feel the patella going up and down, and another very characteristic examination finding is that it holds the ankle and bends the knee considerably. If you twist your ankle like this while stretching your knees while stretching, you may feel pain or a click at the ruptured area. And as I said earlier, you can feel the joint pressure by pressing the joint line. That's the case with the examination findings, but now you have to do an examination, but when you see an orthopedic treatment, you usually take a general X-ray first. However, radiographic x-rays do not show the meniscus cartilage or cartilage, so it cannot be diagnosed with radiographic x-rays. But the reason why we take this is because we have to check the accompanying fractures, delamination osteochondritis, or glass bodies in the knee, and we have to check them to take pictures because they can help with future surgery or treatment plans. And recently, MRI scans are essential for accurate diagnosis. This MRI is said to show the accuracy of meniscus cartilage rupture usually about 85-95%. In this way, it is not diagnosed even in MRI, and it continues to hurt. In this case, diagnostic endoscopy is performed for joint endoscopy, which is much more accurate than MRI. Diagnostic endoscopic surgery has a confirmed rate of about 98%. It can also be diagnosed that it is not diagnosed in MRI. Diagnostic endoscopes used in diagnostic endoscopy are very thin, about 2-3mm, so it is also possible to use local anesthesia. If an abnormality is found here, it can be converted to surgery immediately. The advantage of joint endoscopy is that the diameter of the joint endoscope is very small, so you can make a very small incision, and because it magnifies more than three times, you can perform surgery while looking very closely. Since it is not operated by incision, there is little pain after surgery, recovery is fast, and recovery is fast, so the hospitalization period is very short and the treatment cost is low, but what is very important here is that you can see it to the back of the knee. Because you can see it to the back, you can do ablation levels and sutures that you can't do in the back incision. However, joint endoscopy is expensive equipment, and the technology is very complicated. So, the entry barrier is a little high because there is a difficulty in acquiring skills.

<Surgical Treatment>
◆ Park Young-sik: Cartilage plate surgery is now performed using joint endoscopy, and the types of surgery are usually resected to remove the torn cartilage plate in the meniscus and sutures to seal the torn area. In resection, there is a partial resection that only removes parts and there is a total resection that reveals all of them. But how to resect when performing resection? In 1948, a doctor in Europe called Fairbank saw and announced what would happen after removing the meniscus cartilage plate after a resection. About four to five years after the resection, there was a degenerative change. There were more degenerative changes in a lot of resection and less degenerative changes in a lot of resection. If you announce it and then what to do when resecting the meniscus cartilage plate, let's reduce the resection as much as possible. It has become a principle to leave as much as possible and only remove unstable shaking. It is important to make the part that is bent rapidly and can be torn further because it is the starting point, and it is important not to do so because if you try to make the cut side too clean, it will be more traumatic, so it is important to continue to check whether the cartilage plate is hard or not. The semi-walsa cartilage plate is harder than you think, but the cartilage plate is deformed because it is mushy. So the principles like stop and stop when hard spots appear while removing them were established. Therefore, there are several papers that reported what happens after the meniscus cartilage plate is resected, and there are many reports that arthritis is observed in 40% after 4 to 5 years of partial resection. Age is important, but cartilage is more important than that. The worse the cartilage, the worse the outcome after resection. I'm reporting that. So, if the preoperative radiographs are normal, 90% of them showed good results 10 years later. Depending on the pattern of the rupture, the outcome is a little different after surgery, but the results are much better after the ablation of bucket ruptures, bucket handle ruptures, filamentous ruptures, and radioactive ruptures than those associated with degeneracy, and we now know that we are usually much more satisfied in young men, young patients, and men. However, when I actually studied it, it was said that there was no significant difference, and the most important thing in the end was that there was a difference in the outcome of surgical resection and postoperative results depending on the progress of arthritis before surgery. If the articular cartilage was healthy, I can tell you that the postoperative results were also good. In some cases, all cartilage plate ruptures can be sutured, not just resected, and in some cases, if they are torn by trauma, or if they are ruptured by a bell rupture bucket handle. However, the important thing is that blood circulation is supplied only to the edge of the cartilage plate meniscus and cartilage plate rupture. Areas where blood supply is not possible will not be naturally healed or healed even if sutured. I mean, it doesn't heal. So, if the edge is torn, if the edge is torn on the meniscus cartilage plate, it is adapted to suture. And importantly, if there is a degeneration or degenerative change in the ruptured area, it will not heal even if sutured. So, even if it's a traumatic rupture, if it's a few months later, the area will have metamorphosis, so it won't heal well even if you suture it. So in this case, if it's ruptured like this, it's better to hurry up and suture surgery. When the ruptured meniscus cartilage plate is sutured, the success rate is usually about 80-85%. It is said that the sooner the surgery, the better. If it's accompanied by an anterior cruciate ligament rupture, this is a hole in the bone during the anterior cruciate ligament surgery, from which bone marrow flows out. So because of this bone marrow, the cartilage plate suture is much better and occurs more easily. So, during cartilage plate suture, blood is drawn and fibrils are coagulated. If you coagulate and attach it to the sutured part of the cartilage plate, the sutured part sticks better. And the ruptured area is much better sutured to the suturing environment at the edge, and it doesn't matter whether the age itself is older or younger. However, in old age, if you are a little older, there will be a lot of degenerative changes in the meniscus cartilage, so it's not good for older people. In fact, it doesn't matter whether you are old or not as long as there are degenerative changes in the meniscus cartilage.

<∀>
◆ Park Young-sik: The actual patient is a female patient in her late teens. As he fell, he visited the hospital with a sudden pain in his knee and a locking phenomenon in which his legs could not bend and stretch, and an MRI scan showed that there was a bucket rupture in the inner meniscus cartilage plate, and the ruptured area moved inward, causing a locking phenomenon in which the joints were caught between the joints and could not move. If you look at the picture, you can see that the ruptured cartilage plate has spread inward, and it is a postoperative picture of the cartilage plate sutured using a medical thread after returning it to its original state.

<Degenerative cartilage plate rupture>
◆ Park Young-sik: In the case of a degenerative cartilage plate rupture, MRI scans show that more than 60% of cases with degenerative arthritis have cartilage plate rupture. In the absence of cartilage arthritis, cartilage plate rupture is accidentally detected in about 23%. What this means is that you shouldn't operate unconditionally just because an MRI found a cartilage plate rupture. This is because there were quite a few cases where they were found by accident even though they had no symptoms. This can remove the cushion and promote cartilage damage.

<∀}◆ Park Young-sik: One of the most important things for degenerative cartilage rupture is tearing the back of the base of the inner meniscus cartilage. When you run suddenly at a crossing or get off a bus and have a little shock, the back of your knee hurts as if someone kicked you, pulling your calf, and many people come to you thinking it was a disk at first, but it didn't work. So, when I diagnosed it, there was a rupture at the base of the posterior part of the medial meniscus cartilage plate. It is often diagnosed like this. In this case, until many years ago, we had a partial resection of the resection. I had a partial resection, and when I saw it later, degenerative arthritis suddenly came back. So I was thinking about what to do, and let's suture this area. That's how I sutured it, but when I see the results of the recent long-term release, there are quite a few reports that the progression to degenerative arthritis is prevented. Therefore, recently, suture surgery is recommended in the case of rupture of the base behind the medial meniscus cartilage plate, and the important thing in this case is whether there is a degenerative change in the rupture of the cartilage plate. To tell you the actual patient, he is a woman in her 50s, and while getting off the bus, he suddenly came to see that he had pain in the back of his knee. When you first came in, you couldn't walk well and came in in a wheelchair. Therefore, no abnormal findings were found on X-rays, and MRI was performed because the meniscus was suspected of rupture of the meniscus cartilage plate, and rupture of the meniscus cartilage plate base was confirmed inside. Since it had not been long since it ruptured, a cartilage plate suture was performed immediately in the meniscus using a joint endoscope.

<∀>
◆ Park Young-sik: It is inevitable that degenerative changes occur in the area during total resection of the meniscus, but treatments to prevent this have been limited. Usually, when we die, we donate our hearts, kidneys, corneas, and so on. In foreign countries, we also donate our knees. That's why we donate ligaments and cartilage plates. With this donated cartilage plate, you can have a transplant surgery on your knee that has been completely resected. Therefore, allogeneic meniscus cartilage plate transplantation is performed. When is it usually done? In the case of young people over 50 years of age, there are few degenerative changes, normal ligaments, and straight knees. However, if you have this symptom of pain and swelling in the area without enduring cartilage after surgery, you will have a meniscus cartilage plate transplant, and if you have a transplant, you will usually succeed in more than 85% of cases. But this is very lucky because when allogeneic cartilage plate transplantation is performed, there may usually be rejection of transplantation due to immune response, but there is very little rejection of transplantation in the knee. So you don't have to test for immune responses in advance, and if you just do the transplant, you can almost always succeed in the transplant without any major problems and rejection of the transplant. The picture I'm going to show you this time is a picture of a person who had an allogeneic meniscus cartilage plate transplant. If you look at the preoperative picture, all the meniscus cartilage plates have been resected, and if you look at the postoperative picture, it is a postoperative picture in which the cartilage plates are restored by implanting the cartilage plates.

<Conservative treatment of cartilage plate rupture>
◆ Park Young-sik: We've talked about surgery so far for meniscus cartilage plate rupture, but in fact, any treatment is supposed to be conservative at first. It was the first time I hurt my knee, so I did an examination, and there was a rupture of the cartilage plate, but the type that was very ruptured is very small, and it is less than about 5ml. In that case, no matter how symptomatic the cartilage plate rupture is, the cast is fixed for about four to six weeks. If you do that, the cartilage plate may bite again as the wound heals itself inside, so you don't have to operate right away. But of course, there is a rupture of the species or a rupture of the bucket, which is causing metastasis, and in this case, the right treatment is to do cartilage plate suture immediately. However, it is a little different in the case of a degenerative rupture. Even if there are symptoms, the cushion is very small when resected, and in the case of a degenerative rupture, there are degenerative changes in articular cartilage, so in this case, resecting the articular cartilage plate can reduce the cushion and cause cartilage damage very rapidly. Therefore, in the case of degenerative cartilage plate rupture, it is better to perform conservative treatment that preserves the cartilage plate more than resection.

<Surgical Treatment Considerations>
◆ Park Young-sik: Finally, when the meniscus cartilage plate is ruptured, resection is still considered if possible. If daily life is difficult due to knee locking or pain, a resection surgery is performed to selectively remove only the ruptured areas in this case. If suture is possible, I can tell you that it is much better to do it quickly without waiting. Next, it is very important to control your weight. If you gain 1kg, the pressure in your knees will increase by 3kg when you stand like this like me. So it's very important to control your weight.

<How to exercise to prevent diseases>
◆ Park Young-sik: It's better to exercise. The muscles in the front of the thigh are important, but the muscles in the back of the thigh and the calf are also very important. This is because calf muscles also contribute significantly to knee stability. So my recommended exercise is to sit and stand up in a chair, but when you sit down slowly and your hips reach the chair, don't flop down and get back up when you reach the chair. Don't speed up, but slowly touch it and then sit up when you feel it. If you feel like you're touching it, please repeat the exercise of standing up. Also, lifting your heels is very important, but don't do it too quickly. Slowly lift your heels and wait for 2-3 seconds while you're fully lifted. You can do a workout where you put it down and put it up again. However, there are often people who have difficulty exercising because their knees hurt and are swollen. In this case, you sit in a chair, straighten your knees, pull your toes toward your body, and lift your legs. You have to endure it for 10 seconds in that state. If you do this more than 10 times, it will be very helpful for muscle training in the front of the knee. And it is also very important to prevent further damage to the knee. There is an important change in the sport. It is important to avoid ball games and change to exercises such as walking, swimming, and cycling, and to change your lifestyle habits that do not include squatting or kneeling.

<Medical AI Q&A>
◆ Park Young-sik: Viewers have sent me a lot of questions regarding the treatment of meniscus cartilage disc rupture. Let's check it out together.

◇ Y-ON (AI Anchor): A woman in her 60s. He was diagnosed with a disk-shaped meniscus transverse cartilage rupture. One hospital wants to do surgery, and the other hospital wants to watch the situation. How shall I do it?

◆ Park Young-sik: If both sides have different treatment methods after seeing the same disease, it is recommended to check several more places. In this case, it would be much better not to operate if the effects of drug treatment, injection treatment, etc. were okay. This is because most of the surgery for the rupture of the disk-shaped cartilage plate is performed to remove all of the total resection.

◇ Y-GO (AI Anchor): A woman in her 30s. I was diagnosed with a meniscus cartilage rupture, and they told me to control my weight along with medication. I have pain while walking, is it better to endure the pain and start exercising?

◆ Park Young-sik : It may vary depending on the type of rupture. This is because the rupture can worsen while walking. In the early days, it's better to do exercise without bending your knees and lift your legs straight rather than walking, and if the pain disappears later, it doesn't matter to walk then. Please walk after the pain disappears at that time.

◇ Y-ON (AI Anchor): A woman in her 50s. He is undergoing injection and physical therapy for the internal rupture of the meniscus cartilage, and after two weeks, if the pain does not subside, let's have arthroscopic surgery. Would it be helpful to take joint nutritional supplements in this situation?

◆ Park Young-sik: If you look at the knee, there's articular cartilage covering the surface of the joint, and there's a cartilage plate that acts as a cushion between the joints. This joint nutritional supplement is usually aimed at articular cartilage. It's not a cartilage plate. So in the case of cartilage plate rupture, it doesn't help much to take it because it doesn't have much effect.

◇ Y-GO (AI Anchor): I had a meniscus ciliary suture 2 months ago. I'm trying to take away my assistants and my crutches, but I keep feeling something getting stuck in my knees. What's the reason?

◆ Park Young-sik: At the time of surgery, the joint membrane and synovial membrane can be injured a little, and you can get a scar on it and get caught when it moves. Or maybe it's because your knee still has some inflammation. Usually, it disappears if you wait, so if you don't have pain right now, you'd better wait a little longer.

<Let's remember this>
◆ Park Young-sik: Among those watching this broadcast today, I twisted my knee, but it still hurts, and then I sat down. If you feel pain in your knees when you wake up and when you walk, please suspect damage to the meniscus cartilage plate. If it is found in the early stages, it can be treated with drugs, injections, physical therapy, etc., not surgical treatment, so I would like to advise you to consult a specialist. I hope my story today helped you to have a happy life. Thank you.