Dr Frame’s Crucial Case Notes – Torn meniscus
Ex-racer and orthopaedic knee surgeon Mark Frame warns of the dangers of over-exuberance in sun and slush. The ski injury case: Torn meniscus
As spring sets in, we need to hurry to make the most of the snow. The deck chairs become busier and the voice in your head chants, “Take your goggles off!” so you don’t go back to work with a comedy suntan.
This time of year, although a fantastic chapter in the ski season, is one with its own challenges for our poor beaten ski bodies… Mornings can bring freeze-thaw ‘powder’ that’s more like skiing on a crème brûlée and afternoons herald a rush back to the chalet on a slush puppy.
This, however, is a great time for families and kids. It’s skiing without being frozen stiff. It’s fun in the sun. So without wanting to sound like Dr Party Pooper (honestly, I’m not!), let me tell you another wee story…
Let’s call our victi… – I mean patient – James. James is 13. He had a great morning in ski school and after a steak haché and frites he was poised to show his family his awesome new moves.
The only problem was that James didn’t bank on the heavy snow when doing nice little jump off the edge of the piste. He caught an edge landing in slush… twist, pop, ouch!
Fast forward the reverse chairlift down and an expensive swipe of the Amex, hoping the insurance will cover the world’s most expensive crutches and knee brace. James had torn his meniscus (disc of cartilage in the knee joint).
Now a 13-year-old knee is not the same as mine (cough… 40)! The younger you are the more healing potential you have and the longer you need your knees to be working. James had what’s called a bucket handle tear. This is where the cartilage flips like the handle of a bucket and sits in the wrong place, locking the knee and preventing it from straightening out. It is a bit of an emergency and the sooner we can put it back, the better.
Your meniscus is vital and if left may be unrepairable and result in it being removed. In fact in the past (and even now) the routine was simply to remove the damaged cartilage. This solved the immediate problem, but we now know this almost universally sets you on a path to osteoarthritis.
Thankfully, through a small keyhole operation using a 4mm camera, we can relocate the displaced meniscus and secure it with tiny, very strong loops of suture. This stabilises it and allows your amazing body to heal it back together.
Anyway, James was in and out in a morning and with an op that lasted less than half an hour. I would say that’s worth it to stave off arthritis and keep him skiing another day! Vivre la menisc, et bon ski!
Mr Mark Frame MBChB MRCS FRSC is a trauma and knee surgeon at the University Hospital Southampton/Spire Hospital Southampton.
