Could repair "new" type of meniscus damage: – Like a new knee

A new method that enables the detection and repair of knee injuries that have so far resulted in a whole host of outcomes, ranging from permanent pain to the need for prosthetics. One in six people who sustain a meniscus injury also have this “new” type of damage.

Meniscus injuries can cause lasting ailments, but DePhillipo's findings make it possible to discover, operate, and recover on the legs many more injured than so far. Ill. photo: Shutterstock

“Making a damaged knee as good as new is a pretty revolutionary thing,”

PORTRAIT: Nicholas DePhillipo
Nicholas DePhillipo is a doctoral research fellow at the Centre for Sports Injury Research at the NIH.
  • Nicholas DePhillipo defended his doctoral thesis about meniscus ramp lesions at the NIH on 24 March.

says Nicholas DePhillipo at the Centre for Sports Injuries at the Norwegian School of Sports Sciences (NIH). He has discovered that so-called meniscus-attachment injuries – or “meniscus ramp lesions» – are very common.

Newly discovered injury

This type of injury has not previously been known, but one in six people who injures their meniscus also have this type of ramp injury, sometimes accompanied by other types of injuries to the knee.

He has also discovered how to both identify and repair them and thus get people on their feet again.

  • Nicholas N. DePhillipo is affiliated to the Centre for Sports Injury Research (OSTRC) at NIH and has studied the anatomical, biometric and clinical aspects of meniscus ramp injuries.

    • A meniscus ramp lesion means that the edge of the meniscus is torn away from its attachment in the joint capsule. This usually occurs when the knee is twisted violently. It is quite common to sustain damage to the cruciate ligament at the same time.
    • Injuries of this type cause instability in the meniscus and thus the knee, something which results in pain, swelling in the joint and possible locking of the knee.
    • The damage can become worse over time so that ultimately the patient may need to have a prosthetic inserted.
  • He is a qualified physiotherapist and has a background in elite sports training, kinesiology and rehabilitation.

Because this type of meniscus ramp injury has not previously been known, it has obviously also been extremely difficult to diagnose and treat. Even when looking inside the knee, typically in connection with a keyhole procedure or using MRI (magnet resonance imaging), it has been difficult to identify this type of injury with any degree of certainty.

Quick and cheap

DePhillipo’s findings mean that we now know about this type of injury and that we can identify and treat it.

“Using this knowledge we can carry out and interpret MRI scans much better,” explains DePhillipo. In order to find the damage in such cases, a special camera (an arthroscope) will be placed in a position that is not normally used. He says that even an MRI scan will not necessarily show everything, but that this is possible with keyhole surgery - now that they are aware of this type of injury.

“One bonus is that both the examination and the procedure can be performed at a day clinic. So it is also cheap.”

Nicholas DePhillipo has published a number of articles about his doctoral studies...

This is what a “ramp lesion” looks like: the meniscus is torn away from its attachment in the joint capsule.
Meniscus injury
A ramp lesion injury is repaired using keyhole surgery

Discovered through peephole

It was precisely during a Arthroscopic surgery that one discovered this "new" type of injury. One patient experienced pain and swelling in the knee after an injury, but during surgery one couldn’t see anything wrong with the meniscus. After some more searching around the bone structure, the very joint revealed something, though: There was a tear in the affixion between the meniscus and the joint capsule.

Why this type of injury has not been found before is probably due to two factors: The peephole instruments have not been good enough and to the surgeons have not searched enough to detect it.

Quickly back on one’s feet

“If injuries of this type are not quickly diagnosed and treated, the patient could suffer from pain for years, instead of being fully mobile,” states Nicholas DePhillipo.

Injuries of this type are treated by performing a keyhole procedure during which the meniscus and the capsule are sewn together. After the operation the injury will heal within a few weeks, and the patient can use his/her knee as normal after just three-four months.

- How good will the knee be afterwards?
- When the knee is healed, the knee will function normally.

  • There are no exact figures showing how many people incur meniscus injuries, but around 4,000 people suffer from injuries to the cruciate ligament on an annual basis. This the most serious type of knee injury one can have.
  • Approx. 70% suffer from a meniscus injury at the same time. One sixth of these injuries also involve damage to the meniscus ramp.
  • In this group there are around 460 meniscus ramp injuries in Norway each year. Added to this are all those who sustain this type of injury without damaging the cruciate ligament at the same time.

Serious for both the old and the young

The two sets of meniscus cartilage in each knee act as shock absorbers, but they are also important for keeping the knee stable. While damage to the actual meniscus is common in young people, poorly functioning worn meniscus in middle-aged people and the elderly is common, particularly after one has passed the age of 50.

The two sets of meniscus cartilage in each knee act as shock absorbers, but they are also important for keeping the knee stable. While damage to the actual meniscus is common in young people, poorly functioning worn meniscus in middle-aged people and the elderly is common, particularly after one has passed the age of 50.

Useful for surgeons and physiotherapists

During the study DePhillipo not only anatomically identified and described this injury, he also created such injuries on models and showed that they lead to increased pressure on the cartilage on both the greater trochanter and the fibular head.

Dephillipo’s thesis provides surgeons with new knowledge which will result in better treatment of meniscus injuries. It will also provide physiotherapists with a better understanding of the limitations which affect re-training after such procedures.

This new method can make knees like new again. I would say that this new knowledge is fairly revolutionary for knee surgeons and for everyone who can now regain their mobility.

Nicholas DePhillipo