Meniscal tears are one of the most common injuries that can occur to the knee. A sudden twist or trauma to the knee joint and cause the tissue to tear. As we age, the meniscus can tear without significant trauma and can occur with simple activities such as squatting or getting out of a chair.
The knee joint is comprised of the thigh bone or femur, the leg bone or tibia, and the knee cap or patella bone. Articular cartilage covers these bones and allows for smooth and pain free motion of the knee joint. The meniscus is a rubbery like tissue that cushions and protects the knee joint and provides a shock absorber effect to decrease the risk of articular cartilage damage.
TYPES OF TEARS
The meniscus can tear in different patterns depending on the mechanism of injury. The type of treatment of meniscus tears typically depends on the type of tear and the age of the patient.
Acute meniscal tears often occur during sporting events. Twisting injuries to the knee can cause a tear, however, direct contact to the knee can also damage the meniscus. As we age, the internal properties of the meniscus change and make the meniscus more susceptible to tears. Older people are more likely to develop degenerative meniscus tears without any noticeable injury.
Acute meniscus tears in younger individuals will often result in a sharp stabbing pain when the meniscus tears. Many patients will describe the sensation of feeling a “pop”. After the injury, the patient will frequently describe an on and off feeling of the knee “giving way.”
Most meniscus tears can be walked on immediately and frequently will improve in a short period of time. Symptoms will typically subside over the next several days following the injury. As the patient returns to normal activity, the symptoms frequently will recur.
Continued activity on a meniscus tear may result in increased swelling or stiffness.
Common symptoms of meniscal tears include:
- Stiffness and swelling
- Catching or locking of the knee
- The inability to regain full range of motion
Treatment of meniscal tears can depend on the type of tear, the patient’s age, activity level, and other related injuries to the knee. A low percentage of meniscal tears can heal on their own. A tear which occurs at the outer edge of the meniscus in a younger patient has the potential for healing. Most meniscal tears will not heal and may require surgical treatment.
Nonsurgical treatment consists of (RICE):
Nonsteroidal anti-inflammatory medications can help decrease pain and swelling associated with meniscal tears.
Surgical treatment of meniscal tears is performed through the use of a small camera called an arthroscope. The surgery is performed at a hospital or surgical center as an outpatient procedure. Two small incisions are made in front of the knee and the arthroscope is placed into one of the incisions to allowing direct visualization of the injured knee structures. Through the second incision, instruments can be brought into the knee joint to treat the meniscus tear.
A repair of the meniscus is performed with sutures. Some tears are amenable to repair and the decision to repair the meniscus is made during the time of surgery.
Other tears are not amenable to repair and result in removal of the torn tissue using special instruments while leaving the healthy non-injured remaining meniscus tissue intact.
Following the treatment of the meniscus tear, the incisions are sutured and a bandage is placed on the knee. The patient is discharged home and will follow up with the doctor within a few days for the first postoperative visit.
Rehabilitation following surgery is an important component of regaining full recovery. Physical therapy is implemented for the purpose of restoring knee range of motion and strength over several weeks following the procedure.
Depending on whether the meniscus was repaired or removed, return to sports will vary depending on the magnitude of injury and treatment.