What is the meniscus?
The meniscus is a wedge-like rubbery cushion (cartilage) located between the thigh bone (femur) and shin bone (tibia) on the inside and outside of each knee. The meniscus helps the knee joint carry weight, glide and distribute forces. It also serves as a shock absorber between the bones and keeps the thighbone (femur) and shinbone (femur) from grinding against each other.
How does the meniscus tear?
Anyone can experience a meniscal tear. Most commonly, a tear occurs during an activity in which there has been a twisting (torque) of the knee as occurs with pivoting, cutting, rotation or decelerating. These injuries are prevalent in both contact and non-contact sports. A meniscal tear may be an isolated injury or can occur in combination with other knee injuries. A meniscal tear can also result as a part of the normal aging process. Over time, the meniscus softens and can weaken and may result in a degenerative tear. This type of tear may occur during a routine activity such as getting out of a chair or getting up from working in the garden.
What are the symptoms?
- Knee pain
- Swelling
- Possibly a “popping” sensation or clicking
- Tenderness when pressing on the meniscus
- Limited motion of the knee joint
How is a meniscal tear diagnosed?
Your physician will obtain a detailed history and do a thorough examination. If s/he suspects a meniscal tear, s/he may obtain x-rays and an MRI. These studies, along with clinical exam, will provide your physician the information s/he needs to formulate a plan of treatment.
Treatment options: Your treatment plan will be very individual, based on factors such as your age, symptoms and the type of tear.
Non-surgical treatment: Dependent on the meniscal changes noted on your evaluation, surgery may not be indicated. Further, not all individuals are good candidates for surgery. Your physician may recommend a regimen of rest, ice, compression and elevation and possibly the use of non-steroidal anti-inflammatory medication for swelling and pain. An exercise program and modification of activities on a short term basis may be recommended.
Surgical treatment: When a meniscus tear becomes symptomatic and interferes with activities, your physician may recommend surgery. There are generally two surgical options for treatment of a meniscal tear.
Meniscal Repair: As the name indicated, the meniscal tear is repaired during this surgical procedure. The advantage of a meniscal repair is that the normal anatomy of the knee can be restored, offering a better long-term prognosis. However, because of the limited blood supply to the meniscus, the location of the tear dictates if a repair is possible. Most tears do not occur in the vascular zone and therefore are not amenable to repair. Some tears are frayed and cannot be sutured together. A meniscal repair is a more involved surgery and has a longer recovery than a menisectomy.
Menisectomy: In this surgical procedure, the torn portion of the meniscus is removed. This procedure if far more common than a meniscal repair. There is a faster recovery following a menisectomy. However, the loss of meniscus places more stress on the cartilage surfaces of the joint and over time, patients may develop further damage. However, weight loss, low impact exercise and the avoidance of further trauma to the joint will all improve the long-term prognosis following a menisectomy.
Recovery following surgery: Your physician and his/her staff will review the surgical procedure that was performed at your post-op appointment and discuss a rehab plan. Following a menisectomy, most patients can return to desk work within a few days with a gradual return to exercise. Rehab can range from a self-directed exercise program to formal physical therapy, depending on your age, access to resources and the surgery that was performed. Following a meniscal repair, patients will be on crutches and will generally require a supervised physical therapy program
