Meniscus tears - A common source of knee pain
Did you hurt your knee recently? There are some easy ways to figure out if you have a meniscus tear. Learn how to get this problem fixed.
The knee is an important joint for movement. Each component of the knee protects the joint during motion. One important component, the menisci, are prone to injury. A meniscal injury can cause pain, hinder everyday activities, and may even cause long-lasting damage. Orthopedic surgeons can offer different treatment options based on the extent of the injury and the patient’s goals.
Knee Anatomy - Menisci are crucial to your knees
The knee is a joint composed of bones, cartilage, and ligaments. The thigh bone, also referred to as the femur, sits atop the two shin bones, the tibia and fibula. These bones are coated in a layer of cartilage to allow smooth, painless movement.
Two additional pieces of cartilage, the menisci, are vital to healthy knee function. Each meniscus is a crescent-shaped piece of cartilage that lies between the tibia and the femur. One meniscus is referred to as the lateral meniscus as it is closer to the outer knee. The other is referred to as the medial meniscus as it resides on the inner knee. In addition to facilitating smoother movement, the menisci absorb and dissipate some of the forces placed on the knee during movement. Importantly, they also stabilize the knee during rotation.
Acute versus Degenerative Meniscus Tears - Understanding their differences helps with figuring out your prognosis
Because the menisci bear a large proportion of stress during movement, they are prone to injury. Acute tears most often occur during a twisting motion, specifically when someone has planted their foot, flexed their knee, and then rotated. This type of motion causes a shearing force on the meniscus that results in a tear. Acute injuries commonly occur in sports, such as soccer, football, and basketball.
Symptoms associated with acute menisci tears depend on the extent of the injury. Generally, people are able to walk immediately after the injury and feel a variable degree of pain. Over the next 24 hours, they may experience swelling and an increase in pain. People with larger acute tears may experience more significant pain and have more limited knee motion. Acute, untreated meniscus tears are associated with developing osteoarthritis, a degenerative condition.
Degenerative meniscus tears often occur in older and middle-aged people. These may not be associated with an acute injury but rather repetitive forces on a weakened meniscus over time. Degenerative meniscus tears can also be associated with osteoarthritis. Osteoarthritis is caused by overuse of joints resulting in degeneration of that joint. It can cause weak menisci that are prone to tears.
The symptoms of both degenerative tears and osteoarthritis are also similar. People with degenerative meniscus tears or osteoarthritis may experience pain, stiff knees, and intermittent swelling. Degenerative meniscus tears are often part of the disease process the occurs with osteoarthritis. As arthritis develops, your meniscus often becomes damaged and frayed. There are some symptoms such as catching or locking which can be improved with arthroscopic surgery. Pain alone is more likely to be coming from the osteoarthritis and may not be easily be treated with arthroscopy.
Tear Patterns in Meniscus Injuries - Can you heal your meniscus tear?
Meniscus tears are described by the type of tear.
These descriptions help surgeons plan their treatment approach and predict success.
Tears can be described as vertical longitudinal, transverse, oblique, horizontal, meniscal root, bucket-handle, or complex.
They are also described by the avascular (white) or vascular (red) zone. The vascular zone refers to the blood vessels that supply that area of the meniscus and thus the healing potential. Generally, better blood supply corresponds with better healing. The red zone has the best blood supply while the white zone has a poor blood supply. Repair of a meniscus in the setting of an ACL reconstruction also tends to lead to a more successful repair.
Dr. Morton will decide how to treat your tear during surgery based on the potential for your tear to heal. Tears on the outside of the knee are less likely to heal. If he does not feel that it will heal, he will remove it. If there is a possibility of repair, he will offer this option to you.
Meniscus Injury Treatment - Repair or meniscectomy?
For acute meniscus tears, the treatment is rest, ice, and elevation. Patients should avoid positions and activities that put stress on the joint. They should also apply ice for 15 minutes every 4 to 6 hours until swelling resolves. Elevation will help reduce swelling. After adequate rest with the reduction of pain and swelling, patients should slowly strengthen their quadriceps to compensate for the loss of stability.
The further management of meniscus tears depends on the type and extent of the tear. If patients have large tears or are symptomatic, orthopedists may recommend surgical intervention. Meniscus repairs and meniscus removal, also referred to as a meniscectomy, can be done arthroscopically. Choosing the right surgery depends on the patient’s needs.
Meniscus Repair vs Meniscectomy
A meniscus repair involves suturing the tear and anchoring it to keep the meniscus in place. A meniscectomy removes the meniscus or the damaged part of the meniscus. For acute tears, surgeons choose one intervention over the other depending on the zone and type of tear. Acute tears (not degenerative) treated surgically generally have favorable outcomes. Regardless of repair or meniscectomy, roughly 90% of patients will return to sport or have a satisfaction rate of 90%.
Degenerative tears are harder to treat. Because there is no acute tear, meniscectomies are often more appropriate than meniscus repairs. However, meniscectomies are not 100% successful either. For example, only 20% of patients in one study with degenerative tears who underwent meniscectomy had satisfactory results. Therefore, managing degenerative tears is often a multi-prong strategy, often including physical therapy and pain management.
The menisci are important components of the knee. They absorb stress, stabilize the joint, and facilitate smooth movement. Meniscus injuries are common and can be acute or chronic. Treatment can range from conservative to surgical, and the best option depends on the patient and the extent of the injury. Meniscus repairs and meniscectomies are two surgical options. Surgeons will recommend the best option depending on the zone and type of tear. Ask Dr. Morton about your options in regards to meniscus injuries.
Frequently Asked Questions about Meniscus Injuries
Can a meniscus tear heal on its own?
This depends on the size or location of the tear. A large tear causing impingement like a bucket-handle tear is less likely to heal on its own and is likely to need surgery. Small degenerative tears often will stop being symptomatic after a short period of conservative treatment.
What happens if you leave a torn meniscus untreated?
A large repairable tear untreated may go on to develop arthritis years later. Arthritis can be a serious problem and a source of debilitating pain. For patients who already have a degenerative tear, a torn meniscus may eventually become asymptomatic. If you continue to have symptoms, Dr. Morton can offer to remove the offending meniscus.
How long does it take to heal a meniscus without surgery?
This is variable. Dr. Morton may offer you a steroid shot and a course of physical therapy. This is designed to help you improve your strength and reduce your inflammation. Usually the pain can improve over the course of 1 to 2 months.
Can you walk with a torn meniscus?
Yes. Walking is unlikely to cause further damage to your knee. A bucket-handle meniscus tear that is impinged may limit your ability to walk.
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Meet Dr. Paul N. Morton, MD
Dr. Paul N. Morton, MD is a fellowship-trained orthopedic surgeon in hip and knee surgery, specializing in robotic joint replacements, complex joint reconstruction, sports injuries, and trauma. Reach out to him to learn more about treatment options for your problem.
Written By: Dr. Paul N. Morton, MD
Post Published on April 13, 2020