Meniscus tears are among the most common knee injuries. Athletes, particularly those who play contact sports, are at risk for meniscus tears. However, anyone at any age can tear a meniscus, and by doing any activity. Here at CHAMPION, many of our meniscus patients injured theirs while running - felt a pop, the knee gave out - and they still finished the race. Many times, you'll know something's wrong but it's not like a quad tendon rupture or an achilles tendon rupture, where you won't be able to walk on that leg. You'll definitely have pain later on as the day continues and your body recognizes the injury, but many times, no one recognizes the severity of the injury that just occurred. When people talk about torn cartilage in the knee, they are usually referring to a torn meniscus.
The menisci are two wedge-shaped pieces of cartilage act as "shock absorbers" between your thighbone and shinbone. These are called meniscus. They are tough and rubbery to help cushion the joint and keep it stable.
Description
Menisci tear in different ways. Tears are noted by how they look, as well as where the tear occurs in the meniscus. Common tears include bucket handle, flap, and radial.
Sports-related meniscus tears often occur along with other knee injuries, such as anterior cruciate ligament tears.
Cause
Sudden meniscus tears often happen during sports. Players may squat and twist the knee, causing a tear. Direct contact, like a tackle, is sometimes involved.
Older people are more likely to have degenerative meniscus tears. Cartilage weakens and wears thin over time. Aged, worn tissue is more prone to tears. Just an awkward twist when getting up from a chair may be enough to cause a tear, if the menisci have weakened with age.
Symptoms
You might feel a "pop" when you tear a meniscus. Most people can still walk on their injured knee. Many athletes keep playing with a tear. Over 2 to 3 days, your knee will gradually become more stiff and swollen.
The most common symptoms of meniscus tear are:
- Pain
- Stiffness and swelling
- Catching or locking of your knee
- The sensation of your knee "giving way"
- You are not able to move your knee through its full range of motion
Without treatment, a piece of meniscus may come loose and drift into the joint. This can cause your knee to slip, pop, or lock.
Doctor Examination
Physical Examination and Patient History
After discussing your symptoms and medical history, your doctor will examine your knee. He or she will check for tenderness along the joint line where the meniscus sits. This often signals a tear.
One of the main tests for meniscus tears is the McMurray test. Your doctor will bend your knee, then straighten and rotate it. This puts tension on a torn meniscus. If you have a meniscus tear, this movement will cause a clicking sound. Your knee will click each time your doctor does the test.
Imaging Tests
Because other knee problems cause similar symptoms, your doctor may order imaging tests to help confirm the diagnosis.
X-rays: Although x-rays do not show meniscus tears, they may show other causes of knee pain, such as osteoarthritis.
Magnetic resonance imaging (MRI): This study can create better images of the soft tissues of your knee joint, like a meniscus.
Treatment
How your orthopaedic surgeon treats your tear will depend on the type of tear you have, its size, and location.
The outside one-third of the meniscus has a rich blood supply. A tear in this "red" zone may heal on its own, or can often be repaired with surgery. A longitudinal tear is an example of this kind of tear.
In contrast, the inner two-thirds of the meniscus lacks a blood supply. Without nutrients from blood, tears in this "white" zone cannot heal. These complex tears are often in thin, worn cartilage. Because the pieces cannot grow back together, tears in this zone are usually surgically trimmed away.
Along with the type of tear you have, your age, activity level, and any related injuries will factor into your treatment plan.
Nonsurgical Treatment
If your tear is small and on the outer edge of the meniscus, it may not require surgical repair. As long as your symptoms do not persist and your knee is stable, nonsurgical treatment may be all you need. Physical therapy may be necessary to strengthen the muscles around the joint to somewhat replicate the aspects of stability you lose when the meniscus is severely damaged so as to return to higher level activity. Immediately, however, the RICE protocol is going to manage swelling and pain until strengthening becomes an option.
RICE. The RICE protocol is effective for most sports-related injuries. RICE stands for Rest, Ice, Compression, and Elevation.
- Rest: Take a break from the activity that caused the injury. Your doctor may recommend that you use crutches to avoid putting weight on your leg.
- Ice: Use cold packs for 20 minutes at a time, several times a day. Do not apply ice directly to the skin.
- Compression: To prevent additional swelling and blood loss, wear an elastic compression bandage.
- Elevation: To reduce swelling, recline when you rest, and put your leg up higher than your heart.
- Non-steroidal anti-inflammatory medicines: Drugs like aspirin and ibuprofen reduce pain and swelling.
Surgical Treatment
If your symptoms persist with nonsurgical treatment, your doctor may suggest arthroscopic surgery.
Procedure
Knee arthroscopy is one of the most commonly performed surgical procedures. In it, a miniature camera is inserted through a small incision (portal). This provides a clear view of the inside of the knee. Your orthopaedic surgeon inserts miniature surgical instruments through other portals to trim or repair the tear.
Knee arthroscopy
- Partial meniscectomy. In this procedure, the damaged meniscus tissue is trimmed away.
- Meniscus repair. Some meniscus tears can be repaired by suturing (stitching) the torn pieces together. Whether a tear can be successfully treated with repair depends upon the type of tear, as well as the overall condition of the injured meniscus. Because the meniscus must heal back together, recovery time for a repair is much longer than from a meniscectomy.
Rehabilitation
After surgery, your doctor may put your knee in a cast or brace to keep it from moving. If you have had a meniscus repair procedure, you will need to use crutches for about a month to keep weight off of your knee. Meniscus tears can occur concurrently with another injury, such as an ACL rupture, or alone. An ACL rupture would not usually require weight-bearing limitations, but adding a meniscus repair in will require weight-bearing restrictions until the meniscus heals because of the pressure it endures from the joint.
Once the initial healing is complete, your doctor will prescribe rehabilitation exercises. Regular exercise to restore your knee mobility and strength is necessary. You will start with exercises to improve your range of motion. Strengthening exercises will gradually be added to your rehabilitation plan.
For the most part, rehabilitation is carried out at a physical therapy clinic. Rehabilitation time for a meniscus repair is about 3 months. A meniscectomy requires less time for healing — approximately 3 to 4 weeks.
