By Dr. Mason Platt, MultiCare Health System
Meniscus tears are extremely common knee injuries. With proper diagnosis, treatment and rehabilitation, patients often return to their pre-injury abilities.
The meniscus is a rubbery, C-shaped disk that acts as a “shock absorber” between the thighbone and shinbone. It helps cushion and stabilize the knee joint. Each knee has two menisci — one on the outside of the knee and one on the inside.
A meniscus tear is often caused by a single acute injury such as a sudden twist or quick turn during sports activity. Because the menisci weaken and wear thin over time, older people are more likely to experience a degenerative meniscus tear.
Symptoms
You might feel a “pop” when you tear a meniscus. Most people can still walk on their injured knee. Many athletes keep playing with a tear. Over two to three days, your knee will gradually become more stiff and swollen.
The most common symptoms of meniscus tear are:
• Pain
• Stiffness and swelling
• Catching or locking of your knee
• The sensation of your knee “giving way”
• You are not able to move your knee through its full range of motion
Without treatment, a piece of meniscus may come loose and drift into the joint. This can cause your knee to slip, pop or lock.
Diagnosis
Because other knee problems cause similar symptoms, your doctor may order imaging tests to help confirm the diagnosis.
X-rays. Although X-rays do not show meniscus tears, they may show other causes of knee pain, such as osteoarthritis.
Magnetic resonance imaging (MRI). This study can create better images of the soft tissues of your knee joint, like a meniscus.
Treatment
How your orthopedic surgeon treats your tear will depend on the type of tear you have, its size and location.
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.
In contrast, 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, worn cartilage. Because the pieces cannot grow back together, tears in this zone are usually surgically trimmed away.
Along with the type of tear you have, your age, activity level and any related injuries will factor into your treatment plan.
Nonsurgical treatment
If your tear is small and on the outer edge of the meniscus, it may not require surgical repair. As long as your symptoms do not persist and your knee is stable, nonsurgical treatment may be all you need.
The RICE protocol is effective for most sports-related injuries. RICE stands for rest, ice, compression and elevation.
Rest. Take a break from the activity that caused the injury. Your doctor may recommend that you use crutches to avoid putting weight on your leg.
Ice. Use cold packs for 20 minutes at a time, several times a day. Do not apply ice directly to the skin.
Compression. To prevent additional swelling and blood loss, wear an elastic compression bandage.
Elevation. To reduce swelling, recline when you rest, and put your leg up higher than your heart.
Non-steroidal anti-inflammatory medicines. Drugs like aspirin and ibuprofen reduce pain and swelling.
Surgical treatment
If your symptoms persist with nonsurgical treatment, your doctor may suggest arthroscopic surgery.
Knee arthroscopy is one of the most commonly performed surgical procedures. In it, a miniature camera is inserted through a small incision (portal). This provides a clear view of the inside of the knee. Your orthopedic surgeon inserts miniature surgical instruments through other portals to trim or repair the tear.
Partial meniscectomy. In this procedure, the damaged meniscus tissue is trimmed away.
Meniscus repair. Some meniscus tears can be repaired by suturing (stitching) the torn pieces together. Whether a tear can be successfully treated with repair depends upon the type of tear, as well as the overall condition of the injured meniscus. Because the meniscus must heal back together, recovery time for a repair is much longer than from a meniscectomy.
Once the initial healing is complete, your doctor will prescribe rehabilitation exercises. Regular exercise to restore your knee mobility and strength is necessary. You will start with exercises to improve your range of motion. Strengthening exercises will gradually be added to your rehabilitation plan.
For the most part, rehabilitation can be carried out at home, although your doctor may recommend physical therapy. Rehabilitation time for a meniscus repair is about three months. A meniscectomy requires less time for healing – approximately three to four weeks.
Mason Platt, DO, is an orthopedic surgeon for MultiCare Orthopedics & Sports Medicine.
