Meniscus Tear & Injury Repair
Meniscus Tears and Repair
The knee is one of the most important and functional parts of the body. It flexes and extends to allow us to carry out activities like running, squatting and climbing. There are structures within and around the knee which facilitate movement and protect the knee joints.
The hamstring and quadriceps muscles, for example, help move the joint. They also help with the stabilisation of the knee. Four ligaments help stabilize the knee as we walk and run. They are the medial and lateral collateral ligaments and the posterior and anterior cruciate ligaments. Without these ligaments, the knee will not be unstable and normal function will be affected.
There are 2 menisci in a knee. The medial and lateral meniscus are found in the inside and outside compartments of the knee. They help to support, stabilise and cushion the cartilage of the knee.
What Causes a Meniscus to Tear?
Injury to the meniscus often occurs after a sudden stop or a forceful twist. When this happens, the femur grinds into the tibia and tears the meniscus which lies between them. People who participate in strenuous physical activities like weight lifting are prone to this injury. Also, certain sports like golf, tennis, and basketball that require pivoting can result in a meniscus tearing.
Symptoms of a Torn Meniscus
For some patients, a meniscal tear doesn’t cause them much pain. For others, they experience excruciating pain in their knee which may be swollen. Excessive swelling may result in stiffness of the knee.
Note that the swelling may not be obvious or visible. At times, a person with this injury may not be aware of it especially with minor tears.
Below are some symptoms you may experience when you have the injury:
- You hear a popping sound when climbing up or down the stairs
- You experience pain after walking or running for a long distance
- Swollen knee joint
- The knee gives way and makes you fall or make you feel unstable
- When you can’t fully extend or flex your knee
Where Can You Go to Treat Your Torn Meniscus?
Diagnosis and treatment of a torn meniscus is usually done by an orthopaedic surgeon. Of course, other caregivers and health professionals can diagnose the injury if they have been trained and are working in a professional medical facility, clinic or hospital.
However, when it comes to performing arthroscopic surgery, only a trained orthopaedic surgeon is able to do so. Surgery is required when the tear is significant or when the symptoms are impeding daily activities.
As we age, the meniscus slowly weakens and this can increase the risk of developing a torn meniscus. People above 50 are prone to this injury. Simple daily activities like climbing stairs or walking can put stress on the meniscus and may result in a degenerative tear.
What Treatment Options are Available to Treat a Torn Meniscus?
While there are a few ways to treat a torn meniscus, the one that will eventually be advised by your doctor will be determined by the following factors:
- The severity of your injury
- Pre-existing diseases within the knee area
Most of the time, a meniscus tear is treated with arthroscopic surgical repair or a partial meniscectomy. A surgical procedure is usually the best treatment option for active patients. Below are some approaches your doctor might take during the surgery :
- Arthroscopic Repair
During the surgical procedure, your doctor will make a few incisions in your knee and insert an arthroscope to get a clear picture of the extent of the tear. Next, he will use arthroscopic stitches and fixation devices to stitch the torn area. Activity can be resumed in 4 to 6 weeks with the knee able to bear weight a week after surgery. Physical therapy is useful to regain full function of the knee which will be on average 4 months after surgery.
- Arthroscopic Partial Meniscectomy
Your doctor will carefully remove only the damaged fragments of meniscus that interferes with joint movement and flexibility so that your knee can function properly.
- Arthroscopic Total Meniscectomy
This procedure is rarely performed as meniscus tears can be usually treated with one of the 2 methods above. In this case, your doctor will remove the entire torn meniscus. This occurs in the unusual circumstance whereby the whole meniscus is torn and irreparable.
After the surgery, you will have to wear a brace for 3 weeks to help keep your knee stable. You will also have to use crutches. On the average, it will take about 4 months for your injury to heal completely.
How is a meniscus tear diagnosed?
Physical Examination and Patient History
After discussing your symptoms and medical history, your doctor will examine your knee. He or she will check for tenderness along the joint line where the meniscus sits. This often signals a tear.
One of the main tests for meniscal tears is the McMurray test. Your doctor will bend your knee, then straighten and rotate it. This puts tension on a torn meniscus. If you have a meniscal tear, this movement will cause a clicking sound. Your knee will click each time your doctor does the test.
Because other knee problems cause similar symptoms, your doctor may order imaging tests to help confirm the diagnosis.
X-rays. Although x-rays do not show meniscal tears, they may show other causes of knee pain, such as osteoarthritis.
Magnetic resonance imaging (MRI). This study can create better images of the soft tissues of your knee joint, like a meniscus.
Treatment of meniscal tears
How your orthopaedic surgeon treats your tear will depend on the type of tear you have, its size, and location.
The outside one-third of the meniscus has a rich blood supply. A tear in this “red” zone may heal on its own, or can often be repaired with surgery. A longitudinal tear is an example of this kind of tear.
In contrast, the inner two-thirds of the meniscus lacks a blood supply. Without nutrients from blood, tears in this “white” zone cannot heal. These complex tears are often in thin, worn cartilage. Because the pieces cannot grow back together, tears in this zone are usually surgically trimmed away.
Along with the type of tear you have, your age, activity level, and any related injuries will factor into your treatment plan.
If the knee is stable and if the symptoms do not persist and do not limit your lifestyle, nonsurgical treatments remain an option. However, the decision to defer surgery depends upon whether the knee joint remains functional and allows the patient to participate in their preferred activities (e.g. sports).
RICE. The RICE protocol is effective for most sports-related injuries. RICE stands for Rest, Ice, Compression, and Elevation.
- Rest. Take a break from the activity that caused the injury. Your doctor may recommend that you use crutches to avoid putting weight on your leg.
- Ice. Use cold packs for 20 minutes at a time, several times a day. Do not apply ice directly to the skin.
- Compression. To prevent additional swelling and blood loss, wear an elastic compression bandage.
- Elevation. To reduce swelling, recline when you rest, and put your leg up higher than your heart.
Non-steroidal anti-inflammatory medicines. Drugs like aspirin and ibuprofen reduce pain and swelling.
Do meniscal tears predispose patients to develop osteoarthritis?
Several studies have concluded that meniscal damage not treated surgically remains a significant risk factor for the development of knee osteoarthritis.
If your symptoms persist with nonsurgical treatment, your doctor may suggest arthroscopic surgery.
Procedure. Knee arthroscopy is one of the most commonly performed surgical procedures. In it, a miniature camera is inserted through a small incision. This provides a clear view of the inside of the knee. Your orthopaedic surgeon inserts miniature surgical instruments through other small incisions to trim or repair the tear.
- Meniscectomy. In this procedure, the damaged meniscal tissue is trimmed away.
- Meniscus repair. Some meniscal tears can be repaired by suturing (stitching) the torn pieces together. Whether a tear can be successfully treated with repair depends upon the type of tear, as well as the overall condition of the injured meniscus. Because the meniscus must heal back together, recovery time for a repair is much longer than from a meniscectomy.
Once the initial healing is complete, your doctor will prescribe rehabilitation exercises. Regular exercise to restore your knee mobility and strength is necessary. You will start with exercises to improve your range of motion. Strengthening exercises will gradually be added to your rehabilitation plan.
For the most part, rehabilitation can be carried out at home, although your doctor may recommend physical therapy. Rehabilitation time for a meniscus repair is about 3 months. A meniscectomy requires less time for healing — approximately 3 to 4 weeks.
Meniscus Repair – Animation Video
Animation video “FAST-FIX* 360 Meniscal Repair” obtained from this link
Our doctor provide consultation, treatment and surgery for sports injuries of the shoulder, elbow, wrist, hip, knee and ankle.
- Same-day admission
- Wheelchair accessible
- X-Ray, CT/MRI scan available
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Knee Treatments & Surgery
- Joint lubrication injection (Viscosupplementation)
- Knee arthroscopy
- Meniscus repair
- Osteoarticular transfer system (OATS)
- Anterior cruciate ligament (ACL) Recontruction
- Posterior cruciate ligament (PCL) Reconstruction
- Fixation of fractures (plates and screws)
- Osteotomy of the knee
- Partial knee replacement (MAKOplasty)
- Partial knee replacement (conventional)
- Total knee replacement
- Osteoarthritis of the knee
Conditions of the Knee
- Meniscus injury/tear
- Anterior cruciate ligament (ACL) sprain/strain
- Posterior cruciate ligament (PCL) sprain/strain
- Medial collateral ligament (MCL) sprain/strain
- Lateral collateral ligament (LCL) sprain/strain
- Jumper’s knee
- Housemaid’s knee
- Infra-patellar bursitis
- Patella dislocation
- Patella tendon rupture
- Quadripceps tendon rupture
- Articular cartilage injury
- Acute fat pad impingement
- Biceps femoris avulsion
- Tibiofibular joint dislocation
- Tibial plateau fracture
- Osteochondritis dissecans