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.
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.
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, and others can only be cleaned up by cutting away torn areas during arthroscopic surgery.
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 wear 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.
You’ll usually know you’ve torn your meniscus. These are the signs and symptoms:
There are six common types of meniscus tears:
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.
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.
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 of your crutches. The second phase has the goal of regaining full knee motion and strength. The last phase is returning to normal activity.
“Dr. DeNoble has a rare knack for making his patients feel right at home in his office. He took the time and patience to answer any and all questions I had…” -Helen C.
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 to perform.
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.
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.
Studies indicate that surgery to repair a torn meniscus is 85 percent 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 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 four to six weeks.
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 one to two weeks after their meniscus procedure.
As our patient, you will have an in-depth consultation with one of our doctors. We will create an individualized treatment plan together, tailored to your problem and lifestyle. Our doctors prefer non-invasive treatments whenever possible, including physical therapy and/or injections. If your problem ultimately does require surgery, our doctors prefer the least invasive surgical techniques possible. Our goals are the same as yours: to get you back to living your best life, pain free.