Introduction to a Meniscus Tear
The meniscus is a piece of fibrous cartilage in the knee joint between the weight bearing surfaces of the femur and the tibia. The meniscus functions as a shock absorber for the knee. Two menisci are in each knee, one on the inside of the knee (medial meniscus) and one on the outside of the knee (lateral meniscus). It also acts as a stabilizer of the knee joint. Tears in a meniscus can cause significant pain and decreased quality of life. Because the blood supply to the meniscus is poor, tears of the meniscus usually do not heal on their own.
Symptoms of a Meniscus Tear
A traumatic meniscus tear can occur with a twisting event during activities like sports or a trauma to the knee. A degenerative meniscus tear is more subtle in onset with gradual development of symptoms. Degenerative tears usually can occur because the quality of our meniscus tissue decreases with age. Meniscus tears are classified and treated based on their location within the knee, tear pattern, complexity of the tear, and quality of the tissue.
People with a meniscus tear will often complain of knee pain and swelling. The discomfort is often worse with deep knee bending, walking, twisting, and exercise. There can be a sensation of the knee giving way due to pain and mechanical symptoms such as locking, catching, or clicking.
Swelling in the knee and tenderness along the joint line are often present. In addition, loading the knee with specific maneuvers will cause pain in the compartment with the meniscus tear.
Diagnosing a Meniscus Tear
A thorough history and physical exam combined with appropriate imaging studies are usually sufficient to diagnose most meniscus tears. X-rays are important in the diagnosis of knee injuries to rule out fracture in the setting of acute knee injuries and to rule out arthritis in chronic knee pain. MRI has become an essential tool for knee surgeons. MRI is very sensitive for detecting injuries to the soft tissues of the knee including cartilage, meniscus, and ligaments. MRI is important to diagnose meniscus tears and to look for other pathology that can co-exist with meniscus pathology like cartilage lesion of the knee of ACL tears.
Treatment of a Meniscus Tear
While some meniscus tears can be managed non-operatively, most acute symptomatic meniscus tears require arthroscopic surgical treatment to repair the meniscus or remove the torn piece of meniscus. A degenerative tear is often given a chance to improve with time. Initial treatment is with R.I.C.E. (rest, ice, compression, and elevation), anti-inflammatory medications, injections, and physical therapy for a period of 4-6 weeks prior to making a decision for surgery.
Depending on the characteristics of the tear, the damaged meniscus will either be repaired or removed. As much meniscus as possible is preserved if removal is needed. Tears nearer the periphery of the meniscus are better suited to repair due to the better blood supply.
Rehabilitation after Meniscus Tear Surgery
Partial meniscectomy: In 1-3 weeks, you will likely be walking comfortably. Most people do not need formal therapy after a partial menisectomy. At the first visit, your doctor will decide whether you need formal physical therapy or a home exercise program. Knees tend to be swollen for a few weeks after arthroscopic surgery. The incisions in front of the knee tend to be sensitive after surgery.
Meniscal Repair: Meniscal repair rehabilitation is longer than a partial meniscectomy as the meniscus requires time to heal. You will be in a brace for six weeks after surgery and motion will be limited to 90 degrees of flexion for this period. Depending on the tear characteristics you may or may not be allowed to bear weight on the injured leg.
Final Thoughts on Meniscus Tear Surgery
Meniscus tear surgery is not to be undertaken lightly; however, if performed for the right reasons it can result in significant pain relief and an increased quality of life. If you have any further questions please don’t hesitate to schedule an appointment with Dr. Mazoch.