Meniscal Tears

Each knee has two C-shaped, tough and rubbery discs of type I/II collagen which lie between the shinbone and the thighbone. They act as shock absorbers to help cushion and keep the joint stable. These are your menisci (plural of meniscus). A fun fact is that menisci are very commonly and incorrectly called a “cartilage”, but this has become ingrained in the popular vernacular and will likely stay that way. A torn meniscus can cause pain, swelling, a wobbly feeling, and will prevent your knee from functioning correctly.

CAUSES

A meniscal tear is a common sports injury, as it is usually caused by twisting or turning quickly, often with the knee bent while the foot is planted. These types of moves are frequently used in soccer, football, and basketball, so the injury is more common in those sports. The meniscus can also tear if you lift something heavy and turn the wrong way. As we age, the meniscus slowly wears out and weakens, which makes it more susceptible to tear.  Many patients report they can’t recall an injury which caused the pain, commonly happening as the meniscus deteriorates over a lifetime.

SYMPTOMS

If you suspect you have a meniscal tear, you should know that the symptoms vary, depending on the type of tear you have. There are three types of meniscus tears and each has its own symptoms.  They are as follows:

•    Minor – A minor tear will likely become asymptomatic after 2 or 3 weeks. You may have swelling and slight discomfort which will go away.
•    Moderate – If a moderate tear goes untreated, your pain may come and go for years. You may feel pain if you twist or overuse your knee, and the pain is usually at the center or side of your knee.  Swelling will get worse over a few days and might limit how you bend your knee. You will still be able to walk, but activity is limited. You might also feel a jarring pain when you squat, stand up, or go down stairs.
•    Severe – If you have a severe tear, you will not be able to straighten your knee. It might give way without warning or feel very wobbly. After the injury, it might swell and become stiff right away, or it may take 2 or 3 days.  A piece of meniscus may come loose and move into the joint space, which can cause your knee to crack, lock, or catch.

DIAGNOSIS

If you suspect you have a meniscal tear, see an orthopaedic physician at OSC right away.  A physical exam will be performed to check your range of motion and stability. You will be asked  questions about past injuries, activity level, and what you were doing when your knee started to hurt.  The physician will also assess tenderness along the joint where the meniscus sits, which can signify a tear. Depending on what the exam shows, you may need to have a Magnetic Resonance Imaging (MRI) study to examine the knee and surrounding tissue. This will help confirm the diagnosis.

TREATMENT

Non-surgical – If the tear is not severe, it may not require surgery. Small tears typically become asymptomatic with rest and physical therapy. If your knee is stable and your symptoms do not persist, you may see good results from non-surgical care. In this case, treatment will be the PRICE protocol, which is common for most sports-related injuries. PRICE means Protection, Rest, Ice, Compression, and Elevation.  You may also need to do physical therapy.

Protection — Give your leg a time out from any activities causing pain.  Sometimes, the use of a brace will give you extra support.
Rest – Enjoy some time off from the activity that caused the injury, and try to avoid any new activity that would aggravate the injury.
Ice – Do not apply ice directly to skin. Use cold packs several times per day for about 30 minutes at a time. This will help with inflammation.
Compression– Wear an elastic compression bandage around your knee. This will help prevent additional swelling.
Elevation – This is also to reduce swelling. Recline when you rest, and make sure your leg is elevated higher than your heart.

Your OSC specialist may recommend that you take non-steroidal anti-inflammatory medications such as naproxen or ibuprofen. These medications help reduce pain and swelling.

Surgical – If your symptoms persist after trying non-surgical treatment, surgical treatment may be recommended. Tears at the inner edge of the meniscus often need surgery because they may not respond well to conservative treatment. The inner edge of the meniscus is further from its blood supply and nutrients, so it may not be able to heal as well.

Meniscal tears are repaired using knee arthroscopy, which is a very common outpatient surgical procedure. A miniature camera is inserted into the knee through a small incision. The camera allows a very clear view of the inside of the knee.  One additional small incision is made for inserting miniature surgical instruments to repair the tear. The repair is usually a shaving of the torn meniscus to create a smooth surface.  Only certain type tears can actually be repaired.

REHAB AND RECOVERY

After a few days of rest at home, icing and keeping your knee elevated, You will be release to do activities as you normally would.

You will begin rehabilitation exercises shortly after surgery. The importance of these exercises cannot overemphasized! They will help restore your knee strength, mobility, and range of motion. It is very important to be able to fully straighten your knee joint, as well as bend it.  If needed,  Physical Therapy will be ordered to help with any lingering stiffness or motion issues.

Meniscal tears are common injuries. With proper diagnosis, treatment and rehabilitation, patients often return to their previous level of activity in a few weeks, with minimal interruption to their lives.