What is a meniscal tear? The meniscus is a C-shaped cartilage structure in the knee that sits on top of the tibia. Each knee has two menisci, and inner (medial) and outer (lateral) meniscus. The meniscus functions like a cushion between the femur and tibia. It functions to help distribute the forces between the surfaces of the two bones, helps supply nutrition to the cartilage that lines the bones (articular cartilage), and helps to stabilize the knee. The meniscus is a rubbery tissue and can lose its elasticity with age. Each individual meniscus can be torn. Meniscus tears are very common, the medial meniscus is torn the most often. How does a tear occur? A meniscal tear can occur when the knee is forcefully twisted, a direct blow to the knee, or occasionally with minimal or no trauma, such as when you are squatting/kneeling. Without injury is usually due to aging. The meniscus can thin and become degenerative over time increasing its risk to a degenerative tear. What are the symptoms? You may experience pain, especially with standing on the affected leg, squatting, and tenderness along the joint of the knee. You may have immediate swelling with fluid in the joint, called an effusion. You may experience locking, getting stuck in one position, or catching, causing an inability to straighten the knee completely. You may hear or feel a pop at the time of injury and experience giving away. A chronic (old) meniscal tear may give you pain on and off during activities. You may or may not experience swelling. Your knee may occasionally lock or “stiffen up”. How is it diagnosis? Your doctor will examine your knee and find that you have tenderness along the joint line. Your doctor will move your knee in several ways that may cause pain along the injured meniscal surface. Your doctor may order x-rays to see if there are injuries or degenerative changes to the bones in the joint, but a meniscal tear will not show up on an x-ray. An MRI is sometimes useful in diagnosing a meniscus tear. Expected outcomes Some meniscal injuries can heal on their own, and some do not heal but may not cause any symptoms. However, the only definitive treatment for meniscus tears requires surgery. Surgery may provide complete healing in six weeks. Treatment Initial treatment: Initial treatment for acute injuries includes applying a cold compress to the knee for 20-30 minutes every 3-4 hours for 2-3 days or until the pain and swelling are gone. Elevating your knee raising it above your heart. Wrapping an elastic bandage around the joint will help with support and swelling. Using crutches to support yourself while weight bearing can prevent further injury. Finally, taking anti-inflammatory prescribed by your doctor can help decrease symptoms such as pain and swelling. It is recommended a physician evaluates you as soon as possible. Nonoperative treatment: Conservative treatment of meniscal tears is based on diagnostic testing, symptoms, and limitations that the patient is experiencing. If the symptoms are mild and the patient is able to perform activities of daily living (ADL’s), then anti-inflammatory drugs, and a simple knee rehabilitation program to restore full range of motion and strengthen the knee flexors and extensors may be initiated. Operative treatment: Operative indications for arthroscopy (surgery) when a meniscus tear is diagnosised include a locked knee, pain and inability to perform ADL’s following an acute injury after joint effusion has subsided, and pain that lasts longer than 3-4 months despite a conservative treatment program. Repair of the meniscal tear is based on five factors: tear pattern, quality of meniscal tissue, location of the tear, ability to reduce the tear, and the patient’s age. The quality of the meniscal tissue is an important consideration. Menisci that have marked tissue degeneration may not be able to hold the sutures and thus are not amendable to repair. Tears that are within the peripheral one-third of the meniscus are vascular and have been shown to have the highest rates of healing and are most successful to heal following a repair. The meniscal tissue must be strong enough to support the sutures needed for a repair. If the meniscus is degenerative or displaced the surgeon may need to trim any portion of the meniscus that cannot heal. This procedure is called a partial menisectomy. Postoperative care: Following surgery your physician may recommend a rehabilitation program. A physical therapist can help you reach your goal to return to sport and activity through stretching and strengthening the muscles surrounding the joint. If you return too soon you may worsen your injury, which could lead to permanent damage. A therapist can assist in teaching the proper exercises techniques and agilities needed to help you safely to return to your sport or activity. Preventive measures Preventive measures include appropriately warming up and stretching before exercise, maintaining conditioning, strength, flexibility, and endurance. Wear protective equipment and ensure correct fit. For jumping sports (volleyball, basketball) or contact sports, protect vulnerable joints with supportive devices. Risk increases There is increased risk of meniscal injury with contact sports, sports in which cleats are used for pivoting, or sports in which good shoe grip and sudden change in direction are required. A previous knee injury predisposes a person to increased risk, particularly ligament injuries. Lastly, poor physical condition including strength and flexibility. Complications If the condition goes untreated several complications may arise. Repeated knee injury, particularly if sports are resumed too soon following injury or surgery. Frequent reoccurrence of symptoms, this can result in a chronic problem. Progression of a tear can occur with a lack of treatment. Arthritis of the knee in later years regardless of treatment can occur. Complications of surgery include infection, bleeding, injury to nerves, continued pain, giving away, locking, non healing of meniscus (if repaired), need for further surgery, knee stiffness (loss of motion), and deep vein thrombosis (DVT).
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