If you’ve watched football on TV, odds are you’ve seen a player tear his meniscus. It is one of the most common knee injuries caused when a person forcefully twists the knee when full weight is on it.
Sometimes conservative treatments can relieve the pain and allow a minor tear to heal. But in other cases, surgery may be necessary to repair the meniscus and return function. We handle diagnosis, treatment, and surgery, if necessary, for meniscus injuries at Advanced Orthopedics.
What is the meniscus?
Your knee has two menisci. These are C-shaped pieces of cartilage that provide a cushion between your shinbone and thighbone. The meniscus provides the cushion on the inside and outside of the knee, where the lateral condyle and the medial condyle (round knob-like ends of the femur) contact the same areas on the shinbone.
What is a torn meniscus?
When force is applied, usually in the form of twisting, the meniscus can tear. Often this occurs in the middle of the inner portion of the C. These tears can be minor and may not require surgery. There are different sorts of tears. Some can be sewn back together during surgery; others only can be cleaned up by cutting away torn areas during arthroscopic surgery.
What can cause a torn meniscus?
Any activity where a person forcefully twists and rotates their knee can tear the meniscus. Think of movements such as planting your foot to make a cut in football or to react to a shot away from you on the tennis court. When the knee is loaded with your body weight the odds of tearing the meniscus rise. Osteoarthritis, which is simply worn and tear over the years, can degrade the meniscus to the degree it is more easily torn. Sometimes, even something as innocuous as kneeling, deep squatting, or lifting a heavy object can result in a torn meniscus.
What are the symptoms that I have torn my meniscus?
You’ll usually know you’ve torn your meniscus. These are the signs and symptoms:
- A popping sensation
- Swelling or stiffness
- Pain, especially when twisting or rotating your knee
- Difficulty fully straightening your knee
- Feeling as though your knee is locked in place when you try to move it
INCLUDING AN ILLUSTRATION WITH THIS SECTION WOULD HELP
Are there different types of meniscus tears?
There are six common types of meniscus tears:
- Intrasubstance/Incomplete tear: These tears show up on an MRI, but are stable and usually don’t require surgery. By the time a person is in their 20s or 30s, they commonly have these minor tears.
- Radial tear: The most common type of meniscus tear, radial tears happen on the inside of the C of the meniscus. Unfortunately, there is no blood supply in this area, so these tears won’t heal. These are usually addressed in surgery by trimming out the damaged portion.
- Horizontal tear: Horizontal tears run lengthwise across the meniscus. These tears can be sewn together if they are near the outer back edge, the vascular portion of the meniscus.
- Flap tear: In this tear, a piece extends inward into the inside of the C shape. This often will catch when moving the knee. In surgery, this “flap” is removed.
- Complex tear: In a complex tear there is a combination of tear patterns. These are difficult to repair due to their complexity, but some of the torn areas may be able to be removed and other portions are sewn back together.
- Bucket handle tear: These are large horizontal tears through most of the center length of the meniscus. These tears often cause the knee to become stuck, blocking normal knee motion. Because of this, they require more urgent surgical attention.
How is a torn meniscus diagnosed at Advanced Orthopedics?
We can often identify a torn meniscus simply through a physical exam. We’ll move your knee and leg into different positions and watch you walk and squat.
If necessary, we’ll use magnetic resonance imaging (MRI), as these detail both hard and soft tissues.
We may use an arthroscope to examine your knee. We insert the device, which has a small camera on the end, and we can see inside your knee on an adjacent monitor. We’ll often perform arthroscopy at the same time, trimming or otherwise repairing the meniscus once we have an idea of the damage.
What are the non-surgical and surgical treatment options for a torn meniscus?
At Advanced Orthopedics, we begin all treatments, unless they involve serious trauma, from the most conservative treatment perspective. Tears associated with osteoarthritis can improve with time and rest. Other tears can be minor and not impinge knee movement, so the goal is to reduce the pain.
Conservative treatments will include rest. This involves avoiding any activities where you rotate or pivot the knee. Ice will be used for 15 minutes every four to six hours for the first day or two. Over-the-counter pain medications and anti-inflammatory medications will be used.
Physical therapy can be an option to strengthen the muscles around your knee and in your legs to provide stabilization and support to the knee joint.
Surgery may become necessary if your knee remains painful despite the conservative treatments used, or if your knee locks and function is impaired. As mentioned above, sometimes a tear can be sewn back together. This is especially true with children and young adults. For older patients, the meniscus more likely will be trimmed to remove the torn pieces. This can usually be done arthroscopically.
What will recovery be like after torn meniscus surgery?
Following your surgery, you’ll have an initial recovery time of up to two weeks. Most patients will be in either a knee brace or on crutches. Recovery will definitely include physical therapy in three phases. The first phase has the goal of regaining control of your leg muscles and weaning yourself off your crutches. The second phase has the goal of regaining full knee motion and strength. The last phase is returning to normal activity.
Is it possible to prevent meniscus tears?
It’s not possible to know when you may tear your meniscus. Obviously, avoiding sports such as football, tennis, soccer, and basketball would be preventative, but those sports also keep you healthier. Knee braces can help to prevent your knee from pivoting to the degree the meniscus tears.
There are various exercises that you can do to strengthen your quadriceps and hamstrings to strengthen bad knees. We’ll provide you with a list of great exercises at Advanced Orthopedics.
What are the risks/complications of torn meniscus surgery?
There are risks associated with having meniscus surgery and also risks associated with not undergoing surgery if that is recommended.
Risks of having surgery include infection, blood clots, joint damage, anesthesia risks, and damage to surrounding nerves and blood vessels. Some degree of joint pain and stiffness may also remain after the meniscus is repaired.
If surgery is not conducted, a meniscus tear may not heal and may worsen over time. This could prevent the full use of the knee and require more extensive surgery in the future.
Does a torn meniscus procedure hurt?
Surgical treatment for a meniscus tear is typically performed arthroscopically. This means that the surgeon inserts very small instruments through a few tiny incisions versus one large incision. Whether the meniscus is being sewn back together or tissue is being trimmed, surgical treatment is performed with some type of anesthesia. Patients may either undergo treatment with a local anesthetic that numbs the knee and tissues around it or their surgery is conducted under general anesthesia.
After surgery for a meniscus tear, patients temporarily rely on prescription pain medication to manage comfort. Within a week or two, most of the discomfort from surgery resolves and medication is no longer needed to conduct normal activities.
What are the benefits of having a torn meniscus procedure done?
Studies indicate that surgery to repair a torn meniscus is 85% successful. This means that 85 out of 100 patients achieve substantial relief from pain. In most cases, repair of the torn meniscus results in at least some degree of improvement in comfort and function. Repairing a meniscus tear may also reduce the risk of long-term joint problems in the knee.
How long until I can exercise again after a torn meniscus procedure?
How soon a person can resume physical exercise and sports after meniscus surgery is dependent on their healing and commitment to rehabilitation. After surgery, patients are often prescribed physical therapy to rehabilitate the joint and strengthen supporting muscles. Physical therapy is not a once-and-done session, nor is it something that is done only in the office. A physical therapist demonstrates effective exercises and stretches, which are then to be performed at home on a regular basis. The better one follows their rehab program, the sooner they can expect to resume physical activities. Typically, patients should expect this to take at least 4 to 6 weeks.
Can I drive after a meniscal tear procedure?
Driving should not resume until it is safely possible to do so. The first recommendation is to postpone driving until narcotic pain medication is no longer being taken. The next is to ensure that sufficient control over the knee has been restored before getting behind the wheel. Usually, this coincides with no longer needing crutches or a knee brace. Patients are typically able to drive 1 to 2 weeks after their meniscus procedure.