Meniscus tears & repairs

Overview

Both the inside and outside of the knee have a meniscus. The meniscus is a firm, elastic, shock absorber that helps stabilize the knee and is important for normal function of the knee joint. It also provides protection of healthy cartilage in the knee.

A meniscus can become damaged due to sudden trauma. This can occur with turning, twisting, or pivoting activities or sports. It can also occur while bending the knee deeply. Sometimes the meniscus damage occurs more gradually as part of degeneration. This is commonly due to “wear and tear” of the knee and the gradual decline in tissue quality that occurs with aging.

Meniscus damage is most frequently seen between the ages of 15 and 30 or between the ages of 45 and 70.

Damaging or losing part of the meniscus can lead to short-term symptoms related to the meniscus damage and/or longer-term symptoms of arthritis due to the lack of the knee’s normal shock absorber.

A meniscus tear can occur suddenly when turning or bending the knee deeply. In this situation, the patient may feel a pop or tearing sensation accompanied by a sharp stabbing pain on the inside or outside of the knee. This is usually followed by swelling of the knee and is aggravated by walking, standing, rising from a chair, or climbing stairs. Alternatively the meniscus can also slowly lose its elasticity (cushioning function) over time and result in gradually worsening pain.

A meniscus injury is characterized by:

  • Pain and tenderness. Each knee has a meniscus on the inside and the outside at the level of the joint line, and this is where the pain typically occurs. The meniscus tear can also cause pain more deeply in the center or back of the knee.
  • Locking. If a piece of the torn meniscus gets stuck between the moving parts of the knee, the knee can “lock up” and not move properly. This is typically a very sudden phenomenon that occurs and may quick resolve or persist.
  • Instability. Because the meniscus contributes to the stability of the knee, a tear in the meniscus can give a sense that the knee is unstable or slipping around. This can be very problematic when walking and turning.
  • Swelling. Damage to the meniscus can irritate the knee causing inflammation and swelling.  

Consult your doctor if rest, ice, and over-the-counter pain relievers don’t ease your knee pain. Similarly, you should see a physician if you are developing mechanical symptoms (such as locking or catching) that prevent you from normally bending and straightening the knee. Seek immediate care if:

  • Your knee is hot and inflamed, and you have a fever
  • You can’t bend or extend your knee because of mechanical obstruction

A meniscus injury can typically be diagnosed by your doctor based on the patient’s history and a physical examination. An X-ray can help the doctor rule out other causes of knee pain, such as a fracture or arthritis. To properly visualize the meniscus and adjacent cartilage, an MRI scan may be indicated for some patients.

Treatment begins with avoiding the activity that causes pain. Many patients may need crutches to take weight off of the affected knee. It is important to keep the knee moving to avoid stiffness and locking. Regularly applying ice to the knee may help with the pain and swelling.

Medication

You can take an over-the-counter pain reliever such as ibuprofen, naproxen sodium, or acetaminophen.

In the absence of arthritis, corticosteroid injections are not typically given because they haven’t been shown to be effective in the long-term treatment of meniscal injuries.

Therapy

Try the following:

  • Rest. Be sure to rest the knee, and limit activities that aggravate your symptoms. Try to take the weight off the knee until the pain is gone.  If you have mechanical catching or locking that prevents normal motion of the knee joint, you should see a doctor.
  • Ice the affected area. Apply ice packs to your knee for 15 to 20 minutes at a time, three to four times a day for several days. To protect your skin, wrap the ice packs in a thin towel.
  • Use a brace. The use of a brace for meniscus damage is not often necessary; however, sometimes it may be indicated if there is any abnormal alignment of your knee.
  • Stretch and strengthen the affected area. Your doctor might suggest exercises for stretching and strengthening. Other physical or occupational therapy practices can be helpful, too.

Gradually return to your usual activities. When the above-mentioned therapy and medication alleviates your pain, generally there is no further need for treatment or additional steps. If your symptoms do not improve, you should seek medical attention.

Surgery

Surgery can be indicated for many types of meniscus injuries. If you are young and have a sudden injury that results in a painful knee, this can be a reason to urgently see an orthopedic surgeon. This is especially true if you cannot bend and straighten the knee fully. This may be the result of a displaced meniscus tear, which is better treated earlier rather than later.

In older patients with degenerative type meniscus injuries (those that occur slowly over time due to wear and tear), surgical intervention is not typically indicated. There are certain situations where it may be considered such as the development of clicking, catching,. or locking of your knee.

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