Meniscus Tear
Meniscus Tear
The knee is the most complex joint in your body and uses a delicately balanced system of bones, ligaments, and other structures to allow you to run, jump, perform cutting movements, and other advanced activities. The knee is made up of three bones: the femur (thigh bone), the tibia (shin bone), and the patella (kneecap). The two joints of the knee are the tibiofemoral joint (between the femur and tibia bones, this is the main knee joint) and the patellofemoral joint (between the kneecap and the trochlea, a groove on the front of the femur). The fibula bone is a thin bone on the outside of your lower leg that does not contribute to the knee joint, but is important to ankle stability.
Due to the geometry of the knee joint, it is inherently unstable and relies on ligaments, tendons, and other soft tissue (non-bony) structures for stability.
Ligaments: The knee ligaments support the knee through range of motion.
Meniscus: The knee has two menisci that are located between the femur and tibia bones. The meniscus functions as a cushion between the bones and prevent bone-on-bone contact during activity. The meniscus plays an important role in knee health.
The meniscus is divided into a medial and lateral meniscus, one on each side of the knee joint
Each meniscus is divided into three zones, based on the amount of blood supply it receives. The outer zone receives the most, while the inner zone receives none.
Meniscus tears can occur in many different patterns, each with its own treatment plan
Injuries to the meniscus are the most common knee injury and can occur at any age. Many patients may have meniscus tears and have no symptoms from them. Acute meniscus tears can develop during a knee twisting injury while playing sports or a direct blow to the knee. Degenerative meniscus tear develop over time and are seen in patients over 40 years old. The meniscus becomes more brittle as we age and as the knee develops arthritis, the meniscus tears. This type of meniscus tear can occur from minimal trauma to the knee or with repetitive high impact activities, such as running, basketball, or high impact exercise classes.
Education
Symptoms & Diagnosis
Patients with a meniscus tear may feel knee pain that fluctuates based on activity. Locking or catching sensations in the knee can signify a meniscus tear. Patients may notice decreased knee range of motion or may feel that the knee gives way sometimes. Meniscus tears are diagnosed using physical examination and imaging studies to confirm the diagnosis. The physical examination is used to identify areas of pain, swelling, change in range of motion, and specific tests to examine the meniscus. X-rays are used to look at the bones of the knee. MRI (magnetic resonance imaging) is an important part of the diagnosis and will allow evaluation of all the knee ligaments, meniscus, cartilage, and any other structures that may have been injured.
Treatment
Meniscus tears can be treated with non-surgical and surgical means. Patients with degenerative-type meniscus tears can undergo non-surgical treatment with excellent results. Important non-surgical treatment measures can include:
Rest and activity modification: High impact activities should be stopped and activities should be modified for a period of time
Non-steroidal anti-inflammatory medications (NSAIDs) and use of ice can help decrease inflammation
Injections: Steroid injections can help decrease inflammation in the knee and may be appropriate for an acute flare of knee pain.
Physical therapy: This is an important tool to help you strengthen and retrain the muscles of the knee to work better together
Surgical treatment of meniscus tears is used in patients who participate in high level athletics, those who have a particular meniscus tear pattern, or those with a degenerative tear pattern who continue to have knee pain, catching, and inability to return to activities after extensive non-surgical treatment. Patients who have had a portion of their meniscus removed can develop arthritis over a few years due to the loss of cushion between the bones. Additionally, patients who have arthritis in their knee and undergo a meniscus trimming surgery may have worse pain after surgery due to the increased inflammation. Therefore, we are very careful in our examination of patients and evaluation of imaging before discussing and recommending trimming of a meniscus tear. Several types of meniscus surgery exist:
Meniscus debridement/partial meniscectomy: This procedure is used in patients with a tear of the inside portion of the meniscus that does not receive blood supply or those with a degenerative or irreparable tear pattern. This procedure is performed with arthroscopy and uses a camera and specialized instruments to remove the damaged part of the meniscus. The recovery after this procedure can be quick and patients are able to walk immediately after surgery. Patients are able to return to sports 6-8 weeks after surgery.
Meniscus repair: This procedure is used in patients who have a tear of the meniscus in the outer zone with blood supply. The meniscus is repaired using stitches to bring the pieces back together. The recovery after meniscus repair surgery involves a period of time on crutches with limited weight bearing and can take several months.
Disclaimer: The information presented on this page has been prepared by Dr. Kew and should not be taken as direct medical advice, merely education material to enhance a patient’s understanding of specific medical conditions. Each patient’s diagnosis is unique to the patient and requires a detailed examination and a discussion with Dr. Kew about potential treatment options. If you have specific questions about symptoms you are having and would like to discuss with Dr. Kew, please click below to contact our office to schedule a visit. We hope the information above allows our patients to more thoroughly understand their diagnosis and expands the lines of communication between Dr. Kew and her patients.