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Meniscus Tears

There are two menisci within the knee joint — a medial meniscus and a lateral meniscus.  The lateral meniscus sits more on the outside of the knee, the medial meniscus, sits more towards the inner aspect of the knee. Menisci act as shock absorbers within the knee and make the knee joint more stable. Before you start, it will be very helpful to review knee anatomy. You can always refer to this information later in the article.

Meniscal tears are common. A tear can occur in any age group. In young people, the meniscus is fairly tough, and tears usually happen from a very forceful twisting injury— e.g. sudden pivoting around a planted foot when playing tennis. Sports injuries aren’t the only causes of tears; tears can also happen with lifting. In older individuals, the meniscus is weaker, and tears of the meniscus can happen with smaller forces, such as the simple motion of squatting.

The pattern of meniscus tears can be quite variable. For example, the entire inner rim of the medial meniscus can be torn, called a bucket-handle tear because the torn area looks like a handle. Alternatively, there may just be a small tear of the inner meniscus or the meniscus may be completely frayed and torn in several directions.

Symptoms of a Meniscus Tear

Knee pain is the most common symptom of a meniscus tear.  Depending on where the tear is, it may be on the inner or outer aspect of the knee, or even towards the back of the knee. Sometimes, the pain may be more diffuse.  Sometimes the meniscus tear is associated with mechanical symptoms.  Mechanical symptoms are symptoms that affect the normal and fluid function of the knee: knee catching, clicking, or locking. If the torn portion of the meniscus is large enough, your knee may lock up.

You may momentarily feel like you are unable to fully bend or straighten out your knee. This happens because a torn part of the meniscus flaps into the joint and gets caught within, preventing the knee from functioning normally.  If the knee becomes permanently locked up, urgent surgery is required.  More frequently, however, these mechanical symptoms occur more intermittently.  These symptoms may additionally be associated with pain.

If the meniscus tear is large enough, it can cause long-term problems. Because the meniscus acts as a shock absorber, loss of the normal function of the meniscus may lead to increased wear on the cartilage leading to early onset osteoarthritis of the knee joint.

How to Diagnose a Torn Meniscus

The diagnosis of a torn meniscus begins with your doctor asking you questions about any injury that may have started your symptoms and the quality of your symptoms themselves. Your doctor will perform an examination of your knee to give him/her clues regarding your injury.

Regular X-rays do not show a torn meniscus, as the tissue of the meniscus is not dense enough to be seen on X-ray. X-rays are mainly useful to look at the bones. Depending on your symptoms, your doctor may order an MRI scan to get a better look at the menisci. An MRI is very good at evaluating the soft tissue structures around the knee, including the menisci.

Treatment for a Torn Meniscus

The size, location, chronicity of the meniscus tear as well the presence of any additional injuries will help to determine what treatment is needed. Oftentimes, meniscus tears that are not accompanied by mechanical symptoms (locking, catching) can be initially treated non-surgically with rest, ice, and anti-inflammatory medications.

If your pain continues despite non-surgical treatment or you are experiencing mechanical symptoms, you and your surgeon may decide that surgery is the next step for you. In this situation, treatment of meniscal tears typically includes either partial removal or repair. Whether the meniscus is repaired or removed will depend on many factors including your age, any additional injuries or associated arthritis within the knee, and the pattern, and location of the tear.

For instance, if the tear is located on the outer 1/3 of the meniscus, the tear is more likely to heal due to better blood supply, and a repair may help it to do so.  Tears of the inner 1/3 of the meniscus are unlikely to heal because of poor blood supply. Consequently, these tears are often simply removed.

Most meniscus surgery nowadays is done arthroscopically. The orthopedic surgeon makes small incisions around the knee to allow the insertion of a small camera and other special instruments into the knee joint to address your meniscus tear.

Ultimately, the final decision to repair or partially remove a meniscus is made by your surgeon at the time of surgery when the injury can be directly visualized with the arthroscopic camera. It is only then that the surgeon can truly understand if the tear is repairable. If the tear is repairable, sutures are used to sew up the tear.

It is important to remember that not all meniscal tears require surgery i.e. just because somebody says there is a meniscal tear on your MRI, doesn’t mean that you need surgery. Understanding when surgery is needed will depend on your symptoms, your age, any additional injuries or any underlying arthritis, and your ultimate functional goals. Only you and your orthopedic surgeon can make this decision together.

Knee arthroscopy

How long does the surgery take?

If you are only having meniscal surgery done, the surgery lasts approximately 30 minutes to an hour. If other problems within the knee need to also be addressed at the same time, it can take a bit longer.  Surgery is typically performed in an outpatient setting — meaning, you go home the same day as surgery. 

What kind of scar will I have?

Usually, only a few small incisions are made around the knee for this operation. Scarring is typically minimal. 

Recovery

physical therapy on kneeRecovery time will depend on the severity of the injury and if a repair was performed. Generally, only a couple weeks or so are needed for recovery after undergoing a partial menisectomy (removal).

However, in the setting of a repair, recovery time is expected to be longer. In some situations, it may be up to three months. 

Ultimately, this decision is made by your surgical team. Be sure to ask these questions at your pre-operative appointment.

Postoperative medications

Ask your surgeon what medications they recommend that you take during your recovery. Likely they will prescribe a pain medication and possibly an anti-inflammatory (to reduce swelling). Depending on what surgery was performed, they may also recommend the use of compression stockings or give you a medication to prevent blood clots.

Will I need to do physical or rehabilitation therapy?

Physical therapy is usually recommended after meniscus surgery. Consult with your surgeon or physical therapist before trying any exercises on your own. Some physicians will recommend non-weight bearing activities for a period of time (depending on the surgery performed) and others may want you to start trying weight-bearing activities sooner in your recovery. Always consult your surgeon first and follow their instructions.

Complications

Although complications are rare and arthroscopic surgery is considered low-risk, the following are possible complications of having meniscus surgery:

  • Damage to skin nerves
  • Infection
  • Knee pain and/or stiffness
  • Blood clots
  • Blood loss
  • Knee popping after surgery

Note that the information in this article is purely informative and should never be used in place of the advice of your treating physicians.

Comments

  1. Sharon Collins says

    I fell in Dec and ortho dr has had me I therapy for torn Medicaid. I’m still having pain still can’t straighten leg and still can’t bend knee or it gets locked up. He wants to “knock me out” and straighten leg then back to therapy again..does this sound “right”? Or should I get 2nd opinion. He won’t do another MRI which I ASKED for.

  2. Gary britton says

    My knee has been sore for a number of months. I believe I injured it running on a rubber track at the local high school. The pain was on both sides as well as in the back of the knee.i thought it was better and went for another run on track. Wrong! Same pain.

  3. my knee has been hurting since march. My mom and dad won’t belive me and I went to the nurse and its nothing. Its all swollen and painful and its numb and I really can’t bend it and put weight on it. I don’t know what to do.

  4. Shannon L Bomboy says

    I already had poor circulation in that leg for over 21 years. But when I went to bed Monday Night and waking up Tuesday morning and my knee is to painfull and feels locked at the knee I am horrified and worried. It was just my Birthday Sat. So a bunch of us co-workers went to the NYS Fair….walked about 5 hours. Was my normal tired in my knees and legs. We only live an hour away from it. Why would I wake up less than 10 hours later and have a sore and locked knee?? 😨 should I go to the Hospital?? Its about to be 3 days with this

  5. Cindy Schmidler says

    We are sorry to hear about your experience. We suggest you continue having conversations with your doctor to see what options (surgical or non-surgical) are best for you.

  6. I have had this since i was 9 and my brothers dislocated both knees during a neighborhood “tackle the man with the football” game where I was the only girl playing. They popped them back in, but I have never had any luck with doctors believing me.

    Now I am in my 50s and can hardly move, even in the pool.

    My ortho told me I was not a candidate for surgery and that I would likely lose my legs.

    Great. So now that I’m older they believe me and can’t do anything. But when it could have been fixed, they ignored me and called me a hypochondriac. Even though they eventually went in and pulled out bone chips after my knee locked up and I was on crutches for months.

    Still pretty bitter.

    I cannot lose weight because I can barely move. And they gripe about my weight and won’t do anything for my knees.

    I have zero cartilage left. And I am expected to shut up and deal with it.

  7. Lillian Schaeffer says

    Thanks for bringing to my attention that clicking and popping in the knee can be a sign of a meniscus tear. My daughter plays a lot of sports, and she hasn’t been able to recently because she’s been having some issues with knee pain. It’s been popping pretty frequently too, so maybe it would be a good idea to take her to a professional to see if it’s her meniscus.

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