The meniscus is a fibro-cartilaginous pad within the knee that sits between the femur and tibia. There is both a medial and lateral meniscus within each knee. The role of the meniscus pads is to help transmit weight-bearing forces through the knee, protect the articular cartilage within the knee, and secondarily to stabilize the knee. The meniscus is a commonly injured knee structure, and it is prone to degeneration throughout a lifetime.
Patients may sustain meniscus injuries through sporting and other everyday activities. It is also possible to sustain damage or degeneration of the meniscus because of aging and wear-and-tear. A common cause of traumatic meniscus tears is an unsupported twisting of the knee with the foot planted. Soccer, football, skiing, wrestling, and basketball are the most common sports associated with meniscal tears. People who experience a traumatic meniscus tear often feel a ‘pop’ followed by swelling and pain in the knee.
The most common symptom of a meniscus tear is pain within the knee. Other symptoms include:
- Locking or catching with knee movement
- Knee swelling
- Difficulty resuming impact activities such as running
- Loss of knee motion
- Losing the ability to fully straighten the knee could be a result of a flipped bucket handle meniscus tear
- Pain in the back of the knee with deeper flexion of the knee could signify and meniscus root tear
- Pain on the lateral side of the knee with figure-four position raises suspicion for a lateral meniscus tear
- Medial sided pain could be from a medial meniscus tear
To determine if you have a meniscus tear it is important to generate a proper history of your symptoms and mechanism of injury. A physical exam including assessment of your knee’s stability is also vital. X-rays determine the mechanical alignment of the knee, look for the presence of any fractures, and evaluate if there is any arthritis in the knee. An MRI is important to evaluate the meniscus if there is sufficient evidence of a tear. The MRI can look at all of the structures within your knee including the ligaments, cartilage, bone, and meniscus.
The exact type of treatment for a meniscus tear depends on the type, location, and size of the tear. Other factors that must be appreciated include your age, activity level, presence of other injuries, and amount of any arthritis. In general, due to the poor blood supply of the meniscus, they have little ability of heal on their own.
For some types of meniscus tears a brief course of physical therapy may be reasonable. The goals of exercise therapy are to improve the muscular supports around the knee, reduce swelling, and improve movement patterns. Some patients with meniscal tears will also choose to limit certain types of twisting, bending, and impact activities to reduce their knee pain and swelling.
Both cortisone and PRP injections are widely used to treat the pain and swelling of a meniscus tear. These types of injections have no ability to heal a tear on their own and are strictly used to reduce the symptoms of a tear. For degenerative meniscus tears, and those tears associated with any knee arthritis, injections are used to help alleviate the pain of a tear.
The only way to heal a meniscus tear is with a surgical procedure. Surgery is indicated as a first-line treatment for patients with flipped bucket handle tears and meniscus root tears. Those who are active without knee arthritis as also typically candidates for meniscus surgery.
Arthroscopic Meniscus Repair. Repairing the torn meniscus is generally favored over resection if possible. Knees that have a meniscus removed (meniscectomy) develop arthritis at a higher rate. The goal of a meniscus repair is to reconstitute the form and function of the torn tissue. This is done by placing sutures across the tear arthroscopically. First, we assess the type of tear, associated damage in the knee, and the quality of your tissue. When possible, we then place sutures to mend the tear. After surgery, patients typically wear a knee brace and have some weight bearing restrictions for the first month. Return to full sporting participation can take 4-6 months depending on the type of repair.
Meniscus Root Repair. A meniscus root tear is a specific type of tear that occurs at or near the posterior attachment site of the meniscus. When the meniscus rips near its attachment to the tibia it essentially loses its ability to cushion the knee and we can see rapid progression of arthritis. Because of this, I typically recommend a meniscus root repair for eligible individuals. Those that are obese, have significant arthritis, or who continue to smoke cigarettes are generally not candidates for a repair. This procedure is done arthroscopically, where sutures are placed through the stump of the meniscus and then anchored into the tibia through a bone tunnel. Meniscus root repair can effectively slow the progression of arthritis within the knee and return patients to their pre-injury activity level. Full recovery typically takes 4-6 months, with 4-6 weeks of initial non-weight bearing on the repaired knee.
Meniscus Transplantation. For patients with meniscus deficiency and pain within the knee attributed to this a meniscus transplantation may be performed. This involves sourcing a meniscus that is size matched to the patient from a deceased donor and implanting it into the knee. A meniscus transplantation is considered a salvage procedure when attempts at meniscus preservation have failed. You may be a candidate for a meniscus transplantation if you have had a previous meniscectomy, have normal or correctable leg alignment, have a stable knee, are not overweight, are able to abide by the post-operative restrictions, and have minimal cartilage wear (typically it is possible to restore some cartilage defects at the same time). Patients are typically advised not to return to any high impact activities after a transplantation.
Partial Meniscectomy. This arthroscopic procedure is performed when a meniscus tear causes significant symptoms and cannot be repaired. The goal is to trim the frayed and torn ends of the meniscus and sculpt the remaining tissue to prevent further tearing. We attempt to leave as much of the meniscus as possible so as not to hasten the progression of degenerative changes. Patients who undergo a partial meniscectomy can typically get back to their pre-injury activities with decreased pain and swelling.
Dr. Daniel Elkin is a leading Orthopedic Surgeon performing Meniscus Surgery in the Willamette Valley. He specializes in complex knee reconstruction and knee arthroscopy and is conveniently located in Salem, Oregon