This post was written by Michael Rosen, DO, PPG – Orthopedics, Angola, Indiana.
Meniscus tears are one of the most common injuries that can affect anyone from younger athletes to older adults. This post serves as an overview for common causes, course of treatment and prevention.
Causes
The meniscus is a piece of tissue inside the knee that cushions the cartilage through shock, absorption and force dissipation. Meniscus tears can come from a variety of injuries, such as a twisting mechanism, which can cause the meniscus to become pinched and torn, or normal wear and tear, which leads to the tissue becoming degraded.
Patients often complain of symptoms such as locking, catching or clicking in the knee, and this can be associated with a meniscus tear.
Diagnosis
Meniscus tears can often be diagnosed from a thorough history and physical exam. There are certain types of tears that can be more severe, including those that block full knee range of motion, or those that are associated with additional ligamentous or cartilage injury. To diagnose a meniscus tear, you can sometimes see findings on X-rays, such as calcifications or joint space narrowing that may make you suspicious of the potential for a meniscus tear. An MRI is needed to confirm the diagnosis.
Treatment
Often meniscus tears can be treated without surgery. A meniscus tear is not a dangerous condition, and if there are minimal to no symptoms, it can sometimes be reasonable to continue to observe. Initial treatments may include rest, ice and activity modification. Physical therapy is often helpful as an initial conservative treatment for patients that have been diagnosed with a tear.
In patients who have a mechanical block to motion or have failed conservative treatment, surgery is an option to treat meniscus tears. These can often be treated with arthroscopy, which is a minimally evasive surgical technique that utilizes very small incisions and a camera to go inside of the knee joint and adequately treat the tear.
Meniscus tears can be treated with meniscectomy, sometimes referred to as “cleanup.” In the surgery, the torn part of the meniscus is removed using very small instruments. We can remove the torn part of the meniscus and contour the remaining meniscus to smooth, stable borders, which can effectively eliminate the mechanical symptoms that patients often experience.
There are certain types of tears that can be treated with a repair of the meniscus. There are a variety of factors that go into this decision, such as age, activity, level, body habitus (a person’s physical build) and most importantly, the location of the tear. The outer part of the meniscus has better blood flow, which promotes healing. A repair is a good option to restore the native anatomy without removing any tissue.
Recovery
The recovery from these surgical options does vary based on what type of procedure was performed. After a meniscectomy, physical therapy can help restore normal motion and limit swelling. You may begin to place weight on your leg immediately after surgery, but most patients find it more comfortable to use crutches for a few days. After that, they are able to progress as tolerated.
Recovery from a repair may take several months with restrictions and physical therapy playing a crucial role while the meniscus has a chance to heal.
As with any surgical option, there are certain risks, including persistent knee pain, swelling, bleeding, stiffness, infection, blood clots, as well as anesthetic complications. These risks are all very rare due to minimally invasive methods.
Prevention
To limit potential injury, it is recommended to practice a healthy diet and lifestyle, as well as engage in low impact aerobic exercise. If you have been experiencing symptoms that raise concern for a possible meniscus tear, you may initially attempt to modify the aggravating activities, take over-the-counter anti-inflammatory medications, ice and elevate the knee. These initial conservative tactics might lead to the symptoms resolving. If symptoms persist, you may require further treatment.
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