The meniscus is a semi-circular wedge of cartilage that acts as a shock absorbing buffer between the thigh bone and shin bone. Without this cartilage, the two bones would rub and any activity involving the knee joint would be extremely painful. The meniscus acts as a stabilizing and joint preserving cushion.
However, whether due to sports, vigorous activity or degeneration of over time, the meniscus can tear. While just about anyone, at any age, can tear their meniscus, it is more likely in people who engage in contact sports or elderly people whose cartilage has degenerated over time, rendering it weaker and more prone to injury. The degeneration of cartilage can weaken the meniscus to such a degree that even slight, awkward movements can cause a tear.
The Symptoms and Diagnosis of a Torn Meniscus
The knee is a complex structure and a number of different injuries share the signs and symptoms of a torn meniscus. However, with a medical history and full evaluation by a qualified orthopedic surgeon, a meniscus tear can be diagnosed accurately. The most common signs and symptoms of a meniscus tear include:
- Popping or clicking
- Instability of the knee
- Locking of the knee
- A feeling that the knee is catching
- Limited range of motion
When we first evaluate you for a potential meniscus tear, we want to understand the circumstances that caused you to make the appointment. You may have heard a pop in the knee followed by discomfort, limited range of motion, swelling and stiffness. These are classic signs of a meniscus tear.
We will also perform some range of motion and movement tests to confirm the presence of a tear. First by bending the knee back-and-forth while rotating it, we can accurately detect whether the meniscus is compromised. Simply checking for tenderness along the joint where the meniscus lies can also confirm that a tear exists.
Occasionally, additional diagnostic imaging may be required to confirm the diagnosis or eliminate the possibility of another knee condition. It is not uncommon for another injury to occur alongside a meniscus tear. Most commonly this is an anterior cruciate ligament or ACL tear, but a number of other knee problems can occur concurrently. If diagnostic imaging is required, it is in the form of X-ray and/or magnetic resonance imaging or MRI, or many times we can get an immediate answer by performing a state of the art in office arthroscopy.
Treatment for a Meniscus Tear
Your orthopedic surgeon will discuss the options for treatment of your meniscus tear depending on the size, severity, location and type of tear that is found. There are four types of meniscus tear including bucket handle, flap, radial and degenerative tears. Each of these is treated uniquely, depending on its presentation.
Treating Red Zone Tears
The outer third of the meniscus is known as the red zone as it has excellent blood supply. This may allow for the meniscus to heal on its own. Even if it does not heal with conservative treatment, surgical repair to the meniscus may be possible. Therefore, if your orthopedic surgeon finds a tear in this area, the first course of action will be non-surgical, including Rest, Ice, Compression and Elevation (RICE). If after a few weeks, no improvement has been seen, further treatment and surgery may be considered.
Treating White Zone Tears
The inner 2/3 of the meniscus, known as the white zone, has no blood supply, so healing and repair of the meniscus is less possible. In this case, surgery is the most likely course of action. During surgery, a portion of damaged meniscus is trimmed to reduce pain, increase range of motion and allow for a normalization of the patient’s lifestyle and activities.
Most commonly, meniscus repairs and partial meniscectomies are performed using a minimally invasive technique known as arthroscopy. During arthroscopy, a miniature camera and small medical devices are used to visualize the inside of the knee and perform the procedure. This minimally invasive technique reduces pain and recovery time after the procedure, while maintaining excellent results and safety.
Treating Degeneration of the Meniscus
Treatment for a degenerated meniscus varies, but usually include surgery. For severe cases causing exceptional knee pain and lifestyle impediment, a total knee replacement may be considered. A total knee replacement is more common in elderly patients with a great deal of arthritic degeneration and athletes who have had multiple injuries to the knee.
Repair and/or correction of a meniscus tear is a straightforward, safe and effective method to reduce pain and increase range of motion. Tears in the red zone have an excellent prognosis whether corrected non-surgically or surgically and patients are usually able to return to their former activities after several weeks of rest and rehabilitation. Tears in the white zone that require cutting away or trimming part of the meniscus also have an excellent outcome. However, due to the reduction of cartilage, longer-term arthritis to the joint is a concern. Degeneration can also be treated effectively, but outcomes are highly dependent on the degree of degeneration.
For more information and to schedule a knee pain/meniscus tear consultation, contact us.