Meniscus Tears 101

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.

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.

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.

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.

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, a 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.

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.

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.