This study investigated the outcomes of meniscectomies performed for medial meniscus lesions in elite tennis players (1st and 2nd series) under 30 years of age. The menisci perform several important functions in the knee: shock absorption, division of the pressure and of the fluid of the joint, and joint stabilisation. Only the peripheral third and a large part of the anterior and posterior horn contain blood vessels and nerves. The lateral menisci are larger, rounder, and more mobile. They are separated from the articular capsule by the popliteal tendon at the posterior-external aspect. The force transmitted by the knee is approximately 2 to 4 times the body weight. The menisci transmit between 50% and 100% of this weight. Lesions therefore occur as a result of compression or tearing during rotation, semi-flexion or gliding. Clinical symptoms The clinical symptoms of medial meniscus lesions are mechanical pain, sometimes blocking or snapping, and moderate effusion. The appearance of swelling immediately after a trauma more often indicates a ligament rupture or an osteochondral fracture. During physical examination, pain is provoked by the meniscus tests. Usually, flexion of the joint is restricted. When there is real blocking, due to a 'bucket handle' tear, the loss of flexion is 20 to 30 degrees. The amount of swelling varies, and is often delayed. The stability of the ligaments and patello-femoral symptoms should be carefully tested. MRI is indispensable for players of over 40 (Figure 1), but diagnosis can usually be confirmed in younger players with arthrography alone. Arthroscopy enables partial meniscectomies to be performed and offers the best post-operative recovery and long term results. Training should not be resumed for at least three weeks. The criteria for a return to play are the absence of swelling, recovery of muscle volume and recovery of muscle strength. It is important to respect these requirements. In our experience, a return to tennis is possible within one to three months. Case reports We found nine cases of elite players aged under 30 with three years of follow-up. All players had stable ligaments. There were 2 females and 7 males, with a mean age of 26.5 (16-30). Eight medial and one lateral meniscectomy were performed. Excellent results were realised with the eight medial meniscectomies. All patients were able to resume play at their previous level. One player complained of intermittent pain after matches of long duration on hard courts. Another had a genu varum of more than 4°, but his results were excellent. The outcome of the lateral meniscectomy was poor. This lesion was a large tear from the posterior horn and middle section of a partially discoid meniscus. The player presented after the operation with chronic effusions, although these were not painful after resumption of play. Despite various medical treatments, another arthroscopy five months later revealed a Stage 2 chondropathy covering most of the posterior aspect of the lateral condyle of the knee, with numerous loose bodies in the joint. The cartilage of the tibia plateau was normal. This player did not resume tennis, but did have normal knee function in daily life and during sports two months after the second intervention. X-rays of 5 knees in which a meniscectomy was performed were normal three years after the operation. X-ray of the knee in which the lateral meniscectomy was performed showed a slight narrowing of the lateral femoral-tibial joint line. Discussion Before every meniscectomy, the patello-femoral joint should be X-rayed and the morphology of the meniscus should be determined. Absence of pain and effusion, recovery of good muscle volume and good muscle strength are required before resumption of play. The results of meniscectomies have improved with the introduction of the arthroscope. Certain parameters can predict the outcome: the duration of symptoms before the operation, the morphotype, the presence of chondropathy, the age of the patient, whether the lateral or the medial meniscus is involved, and failure to respect the criteria for return to play. In a significant number of cases, long term follow-up demonstrates degenerative changes in the knee. These do not appear to be influenced by playing sports. The appearance of clinical and radiological signs varies according to the post-operative follow-up and the age of the patient at the time of the meniscectomy. The literature suggests that after five to ten years, 10% to 20% of the knees become symptomatic again, and that 20 to 50% shows signs of degeneration. These numbers increase with time. The results of meniscectomy are consistent with the mean in the long term. The meniscus must be protected to preserve the future of the knee. Patients must respect the natural recovery process and avoid any over-hasty return to sport.
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