Meniscus Tears

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Meniscus Tears

Meniscus tears are among the most common knee injuries. Athletes, particularly those who play contact sports, are at risk for meniscus tears. However, anyone at any age can tear a meniscus. When people talk about torn cartilage in the knee, they are usually referring to a torn meniscus.

Anatomy
Three bones meet to form your knee joint: your thighbone (femur), shinbone (tibia), and kneecap (patella).
Two wedge-shaped pieces of cartilage act as "shock absorbers" between your thighbone and shinbone. These are called meniscus. They are tough and rubbery to help cushion the joint and keep it stable.

Normal anatomy of the knee. The menisci are two rubbery disks that helps cushion the knee joint.

Description
Menisci tear in different ways. Tears are noted by how they look, as well as where the tear occurs in the meniscus. Common tears include bucket handle, flap, and radial.  Sports-related meniscus tears often occur along with other knee injuries, such as anterior cruciate ligament tears.

Types of meniscus tears:  (Left) Bucket handle tear. (Right) Flap tear.
Types of meniscus tears:  (Left) Radial tear. (Right) Complex / Degenerative tear.

Cause

Sudden meniscus tears often happen during sports. Players may squat and twist the knee, causing a tear. Direct contact, like a tackle, is sometimes involved.

Older people are more likely to have degenerative meniscus tears. Cartilage weakens and wears thin over time. Aged, worn tissue is more prone to tears. Just an awkward twist when getting up from a chair may be enough to cause a tear, if the menisci have weakened with age.

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 2 to 3 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.

Physical Examination and Patient History

After discussing your symptoms and medical history, your knee will be examined, and checked for tenderness along the joint line where the meniscus sits. This often signals a tear.  One of the main tests for meniscus tears is performed by bending your knee, then straighten and rotate it. This puts tension on a torn meniscus. If you have a meniscus tear, this movement may cause increased sharp pain.

Imaging Tests

Because other knee problems cause similar symptoms, imaging tests may be done 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

Treatment options 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.

RICE. 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. In some cases crutches are used 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, ibuprofen and naproxen reduce pain and swelling.

Injections. Corticosteroids (also known as cortisone) are powerful anti-inflammatory agents that can be injected into the joint. These injections provide pain relief and reduce inflammation

Surgical Treatment

If your symptoms persist with nonsurgical treatment, arthroscopic surgery may be an effective option.Procedure. Knee arthroscopy is one of the most commonly performed surgical procedures. In it, a miniature fiberoptic camera is inserted through a small incision (portal). This provides a clear view of the inside of the knee. Thin instruments are passed through small incisions to address the tear and treat any additional problems noted.

Illustration and photo show a camera and instruments inserted through portals in a knee.

  • 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.

(Left): Close-up of partial meniscectomy. (Right): A torn meniscus repaired with sutures.

Once the initial healing is complete, rehabilitation exercises can help with recovery. Regular exercise to restore your knee mobility and strength can be beneficial. For the most part, rehabilitation can be carried out at home, although at times we may recommend physical therapy. Rehabilitation time for a meniscus repair is about 3 months. A meniscectomy requires less time for healing — approximately 2 to 4 weeks.

Recovery

Meniscus tears are extremely common knee injuries. With proper diagnosis, treatment, and rehabilitation, patients often return to their pre-injury abilities.

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