Meniscus

The knee is the largest joint in the body and contains two important large pieces of cartilage – the medial and the lateral menisci – which are positioned between the femur and tibial bones. The meniscus can tear as a result of forceful twisting or hyper-flexing of the knee joint.

A meniscus tear is one of the most common knee injuries. This type of injury can happen to people of all ages and can occur whenever there is too much stress placed on the knee joint. Athletes who participate in contact sports, such as football and wrestling, are most commonly affected by a torn meniscus.

As we age, the meniscus becomes more brittle and can tear with less force.

Meniscus Tear Symptoms

The symptoms of a torn meniscus vary, and can include one or more of the following:

  • Pain in the knee when walking
  • The feeling of a ‘pop’ or a ‘click’ when the injury occurs
  • Swelling in the knee
  • Reduced range of motion of the knee
  • Locking of the joint, which can occur when the torn cartilage gets stuck between the femur and the tibia, preventing the knee from straightening
  • Symptoms may be masked by more serious injuries such as an anterior cruciate ligament (ACL) tear

Causes and Risk Factors

Meniscal tears usually occur in one of two ways:

  1. While participating in sports, the meniscus can tear. This can happen as a result of sudden squatting or twisting, or when there is a blunt blow to the knee, such as a tackle in football or sliding in soccer or baseball.
  2. Meniscus tears can occur as a result of degeneration of the cartilage. This happens when the cartilage of the knee weakens as part of the normal aging process. The tissue is more prone to being torn, and as a result, something as simple as standing up from a sitting position and twisting the knee can cause the meniscus to tear.

Diagnosis

In order to diagnose a torn meniscus, your doctor first takes a thorough medical history and conducts a physical examination of the knee. During the physical exam, your doctor will bend the knee, straighten it and rotate it in and out. Doing so creates pressure on the torn meniscus, which will allow the doctor to better understand the condition of the meniscus. If you experience pain or a click during this test, this is an indication of a tear in the meniscus.

Your doctor may also order imaging tests of the knee joint to get a clearer picture of the meniscus. These imaging tests may include an X-ray, and MRI, or both.

Treatments and Procedures

Surgical and non-surgical treatments may be used for a torn meniscus.

Non-surgical treatment can include:

  • The RICE protocol. RICE stands for:
    • Rest – Not participating in the activity that caused the injury. Crutches may be recommended to avoid putting weight on the knee.
    • Ice – The application of cold packs for 20 minutes at a time, several times a day, for several days.
    • Compression – An elastic compression bandage will prevent additional swelling and blood loss.
    • Elevation – Place the knee higher than the heart while resting.

Non-steroidal anti-inflammatory medicines can also be used to reduce pain and swelling, and occasionally a steroid injection into the knee will be used to dramatically reduce pain and swelling.

If surgery is necessary, arthroscopy is highly effective and is now the gold standard in treating meniscal tears. Knee arthroscopy performed by an orthopaedic surgeon can include:

  • Partial meniscectomy – The torn, non-viable fragment is removed and the remaining healthy meniscus remains
  • Meniscus repair – The torn meniscus is sutured, allowing it to heal

Recovery

Physical therapy and exercises that encourage movement of the knee are highly encouraged and effective during recovery. The recovery time varies from person to person, but return to most activities occurs within a week or two after surgery. Some physically demanding jobs and sports activities will require more time. Most importantly, listen to the instructions provided by your surgeon during the recovery period.

Frequently Asked Questions

Is every torn meniscus treated the same way?

Different treatments may be necessary depending on the severity of the injury. Non-surgical options for treatment include the RICE protocol, which stands for rest, ice, compression (to prevent swelling and blood loss), and elevation (so that it is higher than the heart when you are at rest).

Your doctor may also prescribe the use of non-steroidal anti-inflammatory medications (NSAIDs) for your swelling and pain. If your pain and swelling are severe, he or she may also recommend a steroid injection placed into the knee for more dramatic results.

If your orthopaedic surgeon feels surgery is necessary, you will either have a partial meniscectomy, which is a minimally invasive option that trims away the damaged tissue, or meniscus repair that sutures the torn pieces together. Recovery time for the latter option is much longer, up to three months, than for the partial meniscectomy, which requires only four to six weeks for recovery.

Can a torn meniscus cause arthritis?

While the tears themselves may not be the cause of arthritis, the instability caused by the tears and the extra wear they place on the knee joint may result in arthritis over time.

When does a torn meniscus require surgery?

Surgery isn’t always necessary for a torn meniscus, but your orthopaedic surgeon may recommend surgery if your pain persists after following non-surgical treatment options. You may also find it necessary to have surgery if your tear is complete or the pain and weakness caused by the tear are significant.

Can a torn meniscus heal itself?

In some cases, your knee will repair itself from a partial tear with the RICE protocol mentioned above; you may also want to take an anti-inflammatory for the swelling and pain. Dr. O’Grady and his staff may recommend that you consider surgical options for relief and to aid your recovery if there is no improvement after a few weeks of conservative treatment. Severe injuries and complete tears will likely require surgery to repair.

Will an X-ray or MRI detect a meniscus tear?

An X-ray will not show a meniscus tear, but it may be used to rule out the potential for other causes of knee pain. MRIs may provide better images of soft tissue, but most physicians will use the McMurray test and listen for clicking sounds as they manipulate your knee before diagnosing a meniscus tear.

Infographic Resource:

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