Meniscal tears are among the most common knee injuries. Athletes, particularly those who play contact sports are at risk for meniscal tears. However, anyone at any age can tear a meniscus. When people talk about torn cartilage in the knee, they are usually referring to the meniscus.
- Meniscal tears are among the most common knee injuries.
- Many people have meniscus tears and don’t know they do.
- The majority of meniscal tears in older patients will get better without surgery.
- Knee arthroscopy to remove torn meniscus may make symptoms worse if there is significant arthritic change (cartilage wear).
Anatomy and Function
- Each knee has two C-shaped structures sandwiched between the femur (thighbone) and tibia (shinbone) called menisci. One of these menisci is on the inside of the knee (medial) and the other is on the outside (lateral) part of the knee.
- Menisci look and act somewhat like bumpers on a pool table and are natural “shock absorbers” that cushion high-impact forces and protect from bone-on-bone grinding.
- The outside one-third of the meniscus has a rich blood supply. A tear in this “red” zone may heal on its own, or can often be repaired with surgery. A longitudinal tear is an example of this kind of tear.
- The inner two-thirds of the meniscus lacks a blood supply. Without nutrients from blood, tears in this “white” zone cannot heal. These complex tears are often in thin, poor quality tissue. Because “white” zone tears do not heal the surgical treatment is to trim away what is torn.
- Meniscus tears occur in a number of different patterns and locations. Common tear patterns include longitudinal, parrot-beak, flap, bucket handle, and complex.
- Meniscal tears can occur suddenly during high-demand activities and involve squatting, twisting the knee, or a direct blow to the knee.
- Meniscal tears that develop over time, called “degenerative meniscal tears” usually occur in patients over 40 years old and those with with pre-existing articular cartilage wear (arthritis). Over time our meniscal tissue becomes more brittle and prone to tears. Sometimes it only takes very minor trauma (getting up from a chair or a gentle twist of the knee) to cause a tear.
- Catching or locking within the knee
- Sense of instability or giving way
- Physical examination is an important diagnostic tool. Dr. Taylor will evaluate your knee for alignment, areas of tenderness, amount of swelling, range of motion, evidence of abnormal laxity, and for co-existing injury of other structures in and around the knee
- X-ray is important to look for fractures, arthritis, and other bony abnormalities.
- MRI may be ordered to help aide in diagnosis and/or better evaluate some of the soft tissue structures in the knee that may have been injured as well
- Rest, ice, Compression, and Elevation (RICE)
- Activity modification to avoid activities (high impact) that produce symptoms
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) such as aspirin, ibuprofen, etc. may be helpful for reducing pain and swelling
- Steroid (cortisone) injection is a powerful anti-inflammatory medication that may be appropriate for some patients to calm down the acute inflammation.
- Physical therapy and rehabilitation can be used to strengthen the muscles around the knee to alleviate the forces transmitted to cartilage.
- Surgical treatment is typically reserved for patients with particular meniscal tear patterns, high demand patients, and those who have had recurrent knee pain and mechanical symptoms after attempted non-operative treatment.
- The surgery is usually performed arthroscopically through small poke-holes in the skin and a camera to allow maximal visualization of the knee’s internal structures. Depending on the type and location of injury, the meniscus will be either repaired or removed. Dr. Taylor will discuss options during the office visit.
- Partial Meniscectomy – is removal or trimming away of the torn/damaged part of the meniscus so that it does continually irritate the knee. This procedure is performed when the meniscus is more common than repair. Because the torn tissue is removed, full recovery can be expected relatively quickly.
- Meniscal Repair – is performed when the location and pattern of tear are favorable for healing. Repairable tears are fixed by by suturing (stitching) the torn pieces back together. This represents the minority of meniscal tears. Because the meniscus must heal back together, recovery time for repair is much longer than from a meniscectomy.
- The type and duration of rehabilitation following surgery depends on whether the meniscal tear was removed or repaired. Dr. Taylor will review expectations during your office visit.