Torn meniscus? Now what do I do?


So, one of your sports medicine orthopedic doctors at Orthopedics Rhode Island has just diagnosed you with a torn meniscus. What does that mean?

The meniscus is a specialized type of cartilage in the knee joint that acts as a cushion between your femur (thighbone) and your tibia (shinbone). The cushioning effect of the meniscus tissue is important to protect the cartilage on the ends of your bones in your knee joint. In fact, there are two meniscus cartilages in a normal knee joint: the medial meniscus on the inner aspect of your knee, and the lateral meniscus on the outer aspect of your knee. These sit snuggly between the two major bones in the knee joint.
These two menisci are important for absorbing the forces in your knee during ambulatory activities such as walking and running. Unfortunately, they are very prone to injury/tearing in certain circumstances.
A torn meniscus is the most common type of injury in the knee and is responsible for a vast majority of orthopedic surgical procedures on the knee.

There are two basic categories of a torn meniscus. The first category involves an acute injury to the knee that has an otherwise normal meniscus at the time of injury. This type of acute injury is common in sporting activities and generally occurs as a result of a twisting maneuver to the knee or a direct blow to the knee. This type of meniscal tear is much more common in the younger population.

The other category of meniscal tears, which are actually much more common, are tears that develop with age-related "wear and tear".  As the meniscus cartilage wears down over years of repetitive use, small tears may develop and then propagate gradually into larger and larger tears. This type of meniscus tear is more common in middle age or older people.

Not all meniscal tears require surgery to repair them. The reason for this is the fact that not all torn meniscus tissue is painful. Therefore, in the type of tear that occurs in older people, if the tear does not actually cause any pain, then the tear can be left alone and untreated. However, many people with a torn meniscus do in fact have pain and require further treatment. For a middle age or older person that has recurring pain or clicking or popping or locking sensations in his or her knee, then surgery may be the best option to eliminate those symptoms. In addition, in younger patients with a torn meniscus, such as athletes, it is generally best to proceed with surgery to fix the meniscus in this younger athletic population.

For patients whose injuries do not necessarily require surgery, symptoms can be managed initially with measures that help reduce the inflammation in the area of the tear. That would include resting the knee, icing the knee intermittently, and using anti-inflammatory medicine , such as Advil or Aleve. In many cases involving the middle age or older patient, these measures might result in relief of symptoms over the course of several weeks. Many people seem to benefit from a course of physical therapy as well, although the therapy itself does not directly affect the torn tissue.

For the younger patient with an acute injury to the meniscus or for an older patient whose torn meniscus causes persistent knee pain, treatment would involve arthroscopic knee surgery. Arthroscopic surgery involves a couple of very small incisions (done in an operating room with an anesthesia doctor) through which a small camera lens is inserted into the knee to inspect the meniscus and a small tool can be inserted into the knee to fix the meniscus. How the damaged meniscus is "fixed" depends on many factors. Your orthopedic sports medicine surgeon may consider stitching the meniscus together if the tissue is not too shredded and of good quality (generally in younger patients.). However, if the tissue is shredded and of poor quality and in an older patient, the only option at that point is to trim out the torn tissue, as opposed to stitching it together.

Fortunately, meniscus surgery is quite successful in terms of eliminating the knee pain associated with the tear. For patients who undergo arthroscopic knee surgery for a torn meniscus, many of them feel dramatic relief in the first couple of days and some patients require crutches only for the first day or two. However, it is not unusual for the soreness in the knee to persist for a few weeks and it may take 3 to 6 weeks for all symptoms to resolve.

Arthroscopic knee surgery for a torn meniscus is extremely safe, with complications being exceedingly rare. This procedure remains one of the most effective procedures for both injured athletes and older patients who have developed a torn meniscus.

Diagnosing a patient with a torn meniscus is usually quite straightforward. Your experienced orthopedic doctor or physician assistant can often conclude that a patient has a torn meniscus based on some very characteristic physical exam findings during your office visit. Subsequently, an MRI may be ordered to confirm the diagnosis of a torn meniscus if your symptoms persist. An MRI is generally at least 95% effective in terms of making the definitive diagnosis of the torn meniscus.   If you have any concerns or questions regarding this topic, please feel free to contact your orthopedic specialist at Orthopedics Rhode Island.   And, if you'd like, you can search images of the normal meniscus and torn meniscus tissues online (copyright restrictions prevent their inclusion here.)

Jon Gastel, MD