Knee Surgery, Orthopedic Surgery
June 29, 2020
Symptoms & Solutions: Meniscus Tears
Meniscus tears can occur when you twist or wrench your knee. Learn more about these painful injuries and the various ways they can be treated.
What is the Meniscus?
The meniscus is the cartilage between the tibia (shin bone) and femur (thigh bone) in the knee. There are two menisci in each knee. They cushion the joint to prevent wear and tear to the upper and lower bones of the leg.
What Causes a Meniscus Tear?
A meniscus tear can happen to anyone, but because cartilage naturally wears down with age and use, the chances increase as you get older. Making a sudden shift in direction or jumping during sports are some of the most common causes of meniscus tears. Twisting or hyper-extending the knee during a stumble or fall can also tear the meniscus. If the damage is severe, a loose piece of cartilage may lodge in the joint and cause the knee to seize up.
Symptoms of Meniscus Tears
Depending on the severity of a tear in the meniscus, you may feel only minor discomfort at first. However, the symptoms and problems associated with the tear will increase over time.
Symptoms of a torn meniscus may include:
- A sudden popping sound when the injury occurs
- Pain in the knee joint
- Inflammation of the knee
- Difficulty straightening or bending the knee
- Locking or “sticking” of the knee
Some people can “play through the pain” when the meniscus is torn, but over several hours or days, swelling and pain can increase dramatically.
Diagnosing a Meniscus Tear
If you have pain and swelling in your knee, see a doctor as soon as possible. After a physical examination of the injury, he or she may order x-rays to determine whether any bones are broken. An MRI scan will also be needed for a precise picture of the menisci and to determine the location of any tears.
Treating a Torn Meniscus
There are a variety of treatment options for meniscus tears, depending on the location and severity of the damage. Your health, activity level, and age are also factors.
The outer ring of the meniscus, called the red zone, can heal successfully on its own if the tear is small. This is because there is an abundant blood supply in this area. In contrast, the inner part of the meniscus, known as the white zone, is more difficult to heal because there are fewer blood vessels.
Non-Surgical Treatments for Meniscus Tears
If the meniscus tear is minor and/or in the red zone, it may be possible to treat the injury without surgery. As long as your knee isn’t locking up and the pain isn’t severe, you may be able to use topical treatment and physical therapy to aid in the healing process. This could include:
- Exercises and stretches recommended by your doctor
- Limiting activities, including walking, whenever you feel pain
- Walking on crutches for one to two weeks
- Elevating your knee when resting
- NSAIDs (non-steroidal anti-inflammatory drugs)
- Icing the area periodically during the first two or three days after the injury or until the swelling is alleviated (your doctor can recommend a schedule for this)
- Compression bandages around the joint to minimize swelling
- Avoiding any sports or activities that involve impact, twisting, or extension of the knee joint
If these modalities don’t work, or if the tear is unstable or significant, you may need surgery. For example, if your knee periodically locks up or freezes, surgery is warranted to repair the damage and remove any uneven or unstable edges of the meniscus.
Surgery for Meniscus Tears
If the damage to the meniscus is severe enough, surgery may be required. This is more likely if the damage is in the white zone or if there is loose cartilage that has torn free. The goal in any surgery for meniscus tears is to preserve as much of the menisci as possible.
Surgery for a torn meniscus is almost always effective. In most cases, it is a relatively simple laparoscopic procedure that does not require overnight hospitalization. Arthroscopic surgery is the most common approach and is usually an outpatient procedure performed under either general or spinal anesthesia. In most cases, you can go home the same day.
There are a few different surgery options for repairing meniscus tears:
Arthroscopic Repair or Trimming
In this minimally invasive procedure, the surgeon makes two or three small cuts in the knee and inserts an arthroscope to inspect the damage. Using dissolving sutures, the tear in the meniscus is repaired and any rough edges are smoothed. In some cases, if the tear is along the edge of the meniscus, the affected area may be trimmed away rather than sutured.
In a partial meniscectomy, the surgeon removes the damaged part of the meniscus and smooths the area to restore normal function to the knee. In a total meniscectomy, the damaged meniscus is completely removed. This is usually done only when the damage is so extensive that normal function cannot be restored through less extreme means.
Open Meniscus Surgery
In rare instances, a surgeon may need to expose the entire knee joint via a large incision. This is done under general anesthesia and is usually reserved for significant damage or if there are loose fragments of cartilage that must be removed from the joint. In most cases, the entire meniscus is removed. The incision is then closed with sutures or staples.
What to Expect After Surgery
Meniscus repair and meniscectomy are low-risk surgeries with few complications. The most common complications are joint stiffness, infection, or minor damage to nerves in the area. Some surgeons may suggest wearing compression socks or bandages to minimize the chance of blood clots.
You may receive a local anesthetic injection before going home. For the first few days after surgery, you will control the pain with prescription medication. After three or four days, over-the-counter NSAIDs may be used to relieve pain and minimize swelling.
Recovering from Meniscus Surgery
Recovery depends on how severe your meniscus tear is, how well the surgery goes, your age, your general health, and how well you stick to the guidelines your doctor provides. For most patients, it takes four to six weeks to fully recover from meniscus surgery.
You may need to wear a knee brace after surgery to protect the area while it is healing. Physical therapy helps the recovery process and can minimize complications. In the long-term, some patients may develop arthritis in the joint. In the short-term, however, you should be able to return to all or most of your activities once you have completely recovered.
When Are Meniscus Tears Considered Fully Healed?
You should not return to your pre-treatment or pre-surgery activities without your doctor’s approval. At the least, he or she will expect that:
- You can walk, jog, jump, and move side-to-side without pain
- You can straighten and bend your knee without pain
- Your injured knee is as healthy as it was before treatment or surgery
- There is no swelling in the area
Do You Have a Torn Meniscus?
If you have a knee injury, our orthopedic surgeons will evaluate you to determine how severe your injury is and whether you have a torn meniscus. From there, you can discuss both surgical and non-surgical options to determine the best course of action. Contact Arkansas Surgical Hospital at (866) 273-1271 to schedule an appointment.