What is the meniscus?
The meniscus is a C shaped piece of cartilage that sits between the thigh bone and the shin bone. It acts as a cushion the knee, absorb shock, distribute your weight equally for balance and stability, provide for smooth, controlled knee movements, and to prevent the bones from rubbing together; all of which minimize the risk of developing osteoarthritis of the knee. There are two menisci in the knee of each leg. Meniscus tears are common.
The integrity of the meniscus integrity is essential to prevent early osteoarthritis and treatment must be geared to preservation of the meniscus as a primary goal whenever possible. Therefore Dr. Cooper will always plan to try to repair the meniscus. However, in older patients, chronic tears, or certain tear patterns, repair is not possible. In this case the meniscus is shaved and re-shaped to preserve as much healthy tissue as possible and protect as much of the cartilage as possible.
What causes a meniscus tear?
A meniscus tear can be caused by trauma. However, meniscus tears rarely occur in isolation. Rather, 60-80% of the time a traumatic meniscus tear occurs in combination with a tear of the Anterior Cruciate Ligament (ACL). Traumatic tears are frequently the result of sports such as soccer, tennis and baseball that force the knee to violently twist or rotate when pivoting, kneeling and squatting.
In older patients, tears result from the slow degeneration of the meniscus tissues due to normal wear and tear. Degenerative tears are very common in adults over age 55. They result from over flexing the knee or twisting with every day activities like squatting with heavy lifting and climbing into and out of a car.
Types of meniscus tears
There are many different types of meniscus tears and some can cause instability, clicking and buckling. Many factors are examined to determine the ideal treatment for you based on your age, whether there is other knee damage and the specific type of tear. When quality of life is impaired, and there is no arthritis, meniscal repair or debridement may be recommended.
What are the symptoms of a meniscus tear?
The main symptom of a traumatic meniscus tear is a sudden onset of pain after a traumatic injury. Clicking, popping, locking and catching of the knee, and knee instability are commonly due to ligament damage. However, a degenerative meniscus tear is the result of a slow progression of tissue degeneration caused by repetitive microtrauma and often the patient has few or no symptoms.
How is a meniscus tear diagnosed?
Joint line tenderness and pain. In patients with knee OA, an x-ray can detect a degenerative tear. MRI is typically not indicated in the diagnosis of a meniscus tear; but may be indicated when other knee injuries are suspected.
Many degenerative tears are found incidentally on a knee MRI with no clear history of an acute knee injury and often without symptoms. A degenerative tear is commonly found in people with knee osteoarthritis.
Treatment of traumatic meniscus tears is geared to preserving the meniscus whenever possible because of the excellent outcomes in terms of a return to high levels of activity and prevention of osteoarthritis.
What are the treatment options for a meniscus tear?
The primary treatment options for a traumatic meniscus tear are arthroscopic partial meniscectomy and meniscus repair. Meniscus repair is favored because there is less chance of osteoporosis after surgery and patients can return to their preoperative level of activity after surgery. Young, healthy patients with a traumatic tear tend to do well without complications from surgical repair. The success rate of meniscus repair is 85%.
A majority of older patients with a degenerative tear of the meniscus find relief from symptoms and improve function without surgery. Degenerative meniscus tears are usually treated initially with conservative measures including activity modification, anti-inflammatory medications, ice, heat, and physical therapy to improve function and reduce pain, if present. Physical therapy helps to strengthen and stabilize the muscles around the knee. If arthritis is present, steroid injections may help. Surgery is rarely recommended for degenerative tears because research reports that physical therapy provides sufficient pain relief and improvement of function for most patients.
When you have knee pain it is important to see an orthopedic surgeon like Dr. Joe Cooper whose focus is on helping his patients return to the activities they love as quickly as possible.