Meniscus Repair

What is the meniscus?

The meniscus is a C shaped shock-absorbing pad of cartilage in the knee that lubricates, supports and protects the bones in the knee joint. There are two menisci in each knee, one on the inner edge and the other on the outer edge of the knee. They function to stabilize the knee, equally distribute one’s weight on the knee bones for balance and allow for smooth movement in many directions.

What is a Meniscus tear?

A meniscus tear is when there is damage to this pad of tough of cartilage.  A tear can lead to catching and locking of the knee during movement.  In addition, the forces in a knee joint may be altered and lead to arthritis. Meniscus tears are common knee injuries.

Types of Meniscus tears

• Traumatic tears may be large or unstable which can cause ongoing discomfort if not surgically repaired. Unstable tears include radial tears, flap tears and bucket handle tears.
• Degenerative tears are caused by wear and tear over time. Aging causes the cartilage to dry out and become brittle. These tears may result in pain which eventually improves or disappears, allowing one to return to an active lifestyle without the need for surgery.

What cause a traumatic meniscus tear?

Traumatic meniscus tears most often result from an athletic injury, usually as a direct result of twisting or over flexing the knee joint. A tear can also result from kneeling, squatting and heavy lifting.

What are the symptoms of a meniscus tear?

• A popping sound may be heard when the meniscus is torn.
• Knee pain. Depending on the type of tear, its size and location, a patient may be able to walk, but have pain when seated or going up or down stairs. Many athletes continue to play with a meniscus tear, only realizing the injury when the knee stiffens and swells.
• Swelling and stiffness
• Limited motion
• A sensation that the knee is giving way. If the tear is large, the knee may buckle.
• A sense of the knee catching, or locking may indicate that a piece of the meniscus has become loose causing the knee to slip, pop or lock. The knee is unstable.

How is a meniscus tear diagnosed?

During your consultation with Dr. Tom Hackett, a sports medicine expert and orthopedic knee specialist he will ask about your symptoms, any injuries and your symptoms.  During the physical exam, he will check for tenderness which helps diagnose a tear. The McMurray test is often used to diagnose meniscus tears. During this test the doctor will bend and straighten the knee and rotate it. If a tear exists, these movements will cause a clicking sound.

Imaging tests may be ordered to confirm the diagnosis since the symptoms of a meniscus tear are also symptoms of other common knee problems. X-rays can show other causes of knee pain, while an MRI will show soft tissue damage and can confirm the diagnosis.

How is a meniscus tear treated?

Treatment depends on the type of tear, its size and location. When a tear is in the inner two thirds of the meniscus, there is no blood supply, and the tear must be treated with surgery.  If the tear is in the red zone, the outer one third of the meniscus, where the blood supply is good, it may be able to heal on its own. If left untreated it can enlarge cause arthritis or can break loose and slide into the joint necessitating surgery.

Nonsurgical treatment

The initial use of the RICE treatment method is effective for many meniscus tears.  The RICE method consists of: Rest, Ice, Compression, and Elevation. Aspirin and NSAIDs will also help reduce pain.

If the symptoms resolve and the knee is stable, nonsurgical treatment may be sufficient. However, if symptoms persist a cortisone injection to reduce inflammation may improve pain.  This may be especially helpful for degenerative tears in arthritic patients. If symptoms persist after conservative management arthroscopic surgery will recommended.

Minimally invasive knee arthroscopy

This is a commonly performed procedure to repair a tear, trim and remove the torn and loose pieces in the joint, or remove the entire meniscus. Often a meniscus tear occurs with an injury to the ACL ligament. In this case, the surgery will repair the ligament and the meniscus.

Meniscus repair involves suturing the tear and anchoring it in place.  Recovery from this procedure is longer than in a meniscectomy. A meniscectomy is an arthroscopic procedure that removes the meniscus or trims the damaged meniscus tissue (also called a debridement). Removal of the entire meniscus is called a total meniscectomy. Removal of damaged parts is called a partial meniscectomy.

Outpatient minimally invasive surgery uses an arthroscope, a small, thin tube that contains a camera which is inserted into the knee joint through a tiny incision. It is used to examine and repair the meniscus. Small tools are inserted into small incisions for repair. This less invasive surgery will limit damage from the procedure and provide a faster recovery. Physical therapy will be recommended. Most patients are able to fully recover and return to normal activity within 2-4 weeks.

Dr. Tom Hackett is a sports medicine physician and an expert knee surgeon who has cared for hundreds of athletes and active individuals, getting them back to play and back to their pre-injury activities.