What is a Meniscus Tear?
There are two cartilage structures in the knee known as the medial and the lateral meniscus. These are made of a different type of cartilage than that found on the surface of the femur and tibia; meniscal cartilage is like a hard rubber shock absorber and serves to allow the flat tibial surface to conform to the rounder femoral surface. Essentially, the medial and lateral meniscus “cup” the rounded femoral surface. Tears in the meniscus occur most commonly with twisting injuries or with injuries to the knee ligaments.
How do I know I have a Meniscus Tear?
When a meniscus tears, it can become unstable and frequently catches or gets pinched as the femur glides back and forth on the tibia. Pain is therefore not necessarily constant with these injuries and, in fact, it is more common to have “episodes” of pain or certain movements that consistently elicit a painful catch. In some cases, the meniscus can “lock” the knee and prevent the ability to fully straighten. With a meniscus tear, it is common to have pain on either the inside or the outside of the knee rather than directly in front or behind the knee. However, many other things cause similar pain and therefore an examination, xray and often MRI are needed to make the diagnosis of meniscus tear.
Does a Meniscus Tear always require surgery?
However, it is important to realize that meniscus “tears” also occur as arthritis begins to affect the knee joint. While these are called tears, frequently this just represents a natural breakdown of the meniscal cartilage as the arthritis begins to erode the cartilage in general. These types of tears frequently do not need surgery as management of arthritic symptoms will generally minimize any symptoms due to the meniscus. It is important for your surgeon to determine which type of tear you have as degenerative tears may not respond as dramatically to surgery as a traumatic tear. This is why we review your MRI films rather than just rely on the reports–often the type of tear can be determined by the MRI.
Further, these degenerative tears are not dangerous nor do they cause further damage to the knee. Occasionally, when degenerative tears of the meniscus do not respond to symptomatic treatment and cause prominent mechanical symptoms, surgery may be a consideration.
Rarely is a true mechanical meniscus tear in an area where it can spontaneously heal, therefore, non-degenerative meniscus tears frequently require surgery to eliminate the pain and dysfunction they cause.
What kind of surgery is performed for a Meniscus Tear?
Surgical treatment involves an outpatient procedure called knee arthroscopy. Your surgeon will make 2-3 small incisions the size of a pencil on your knee and insert a camera to view the tear. Special micro instruments are then used to either remove the damaged part of the meniscus or place stitches into it. Most tears do not occur in the region where the meniscus has adequate blood supply. What this means is that the tear does not have healing capacity and therefore an attempt at repair may not be successful; in these situations, removal of the damaged segment of meniscus is performed and symptoms typically rapidly improve. If the tear occurs in the vascular zone, a repair may be performed. In some cases this can be done through the same tiny incisions. In certain tears, a larger incision on the side of the knee may be necessary to complete the repair.
How long is the recovery after meniscus surgery?
The recovery depends heavily on whether a repair or partial removal is performed. In a repair, the repair needs to be protected so often a period of minimal walking/crutch use is recommended and it may be several months before the knee is ready for vigorous activity and sports. On the other hand, if a partial removal is performed, usually you will be allowed to walk on it immediately and, depending on the activity, return to sports and normal activities may occur within 2-6 weeks.
Drs. Bak, Frush and Silas are highly experienced with injuries to the meniscus and determination whether your particular injury will do better with surgical or non-operative management. Furthermore, the surgeons at MCO are aggressive about joint preservation and repair of the meniscus whenever possible. In fact, successful meniscus repair (as opposed to meniscus removal) is performed by MCO surgeons with a far greater frequency than most centers in the Midwest.