The principal functions of the meniscus are load sharing and shock absorption.
Tears of the meniscus are possible at any age. For many years torn menisci have been removed. New techniques, and our improved understanding of the importance of the meniscus, have led to an increase in the repair of the meniscus by surgeons, like myself, trained in meniscal preservation.
How does the Meniscus get injured?
A torn meniscus can result from any activity that causes you to forcefully twist or rotate your knee, such as aggressive pivoting or sudden stops and turns. Even kneeling, deep squatting or lifting something heavy can sometimes lead to a torn meniscus. As a person ages, the meniscus becomes subject to degenerative change and becomes less pliable. A degenerate meniscus is prone to tearing, even with minimal trauma.
The symptoms of a Meniscal tear.
Acute tears are associated with a tearing or popping sensation at the time of injury, with swelling peaking some hours after the injury. Meniscal tears are frequently associated with pain in a well-localized region along the joint line, either on the outside or inside part of the knee. They are also associated with difficulty straightening your knee fully, feeling as though your knee is locked in place when you try to move it or the feeling of your knee giving way. The pain is often a sharp, sudden stabbing pain, which comes on and then disappears rapidly, particularly with deep bending or twisting activity.
There are 5 different types of meniscal tears.
- Radial Tear – a sharp split on the edge of the meniscus.
- Parrot Beak Tear – similar to radial tears, but more extensive. They can frequently catch and click.
- Bucket Handle Tear – commonly found in association with ACL injuries and instability episodes. They occur more commonly in young patients.
- Horizontal Cleavage Tear – occurs in menisci which are undergoing degenerate change.
- Degenerate Tear – complex, irregular tears in menisci which have undergone a degenerative change.
The diagnosis of a Meniscal tear.
Usually, a careful history and examination are sufficient to make a diagnosis. X-rays can help to exclude a fracture or knee arthritis as the cause of the pain. The diagnosis can be confirmed with an MRI scan, which can also identify the pattern of the tear, its exact location, and the presence of any other injuries. Untreated meniscus tears can increase in size and lead to complications, such as arthritis.
Treatment options for Meniscal tears
Initial treatment of meniscal tears is rest, ice, elevation, and compression (RICE). This is usually combined with anti-inflammatories and self-care. Some tears, particularly those near the outer rim, can heal naturally. Patients with ongoing meniscal symptoms can be treated with surgery. The surgical options are dependent on the pattern of the tear.
Will Meniscus tears heal by itself? Can it be repaired?
Tears which run along the periphery of the meniscus in the red zone can heal spontaneously. This is less likely in a knee with other injuries such as a torn anterior cruciate ligament. Due to the importance of the meniscus, I advocate surgical repair to increase the likelihood of healing.
Any stabilisation procedure such as ACL reconstruction is best performed at the same time and has been shown to increase the likelihood of healing. The capacity to heal diminishes with age. After around 40 years of age the success of meniscus repair is reduced, but in an active individual attempted repair may be worthwhile.
Post-op rehabilitation and care
It is so important to religiously follow rehabilitation post meniscus repair to secure a successful outcome. Patients who have a meniscus tear repaired under my care are either instructed not to weight bear for 6 weeks after surgery, or to walk in a straight-leg splint. Your health is ultimately in your hands.