Meniscus tears are one of the most common knee injuries in orthopedics. People sometimes refer to this as “torn cartilage”. Meniscus tears can develop over time and are known as degenerative meniscus tears. Athletes in particular are at risk for meniscus tears.
The knee joint is made up of three bones, the femur, tibia, and patella. Between the femur (thigh bone) and tibia (leg bone), there are two menisci. These two C-shaped pieces of cartilage act as shock absorbers between the two bones. The two meniscus distribute the body weight uniformly across the joint, helping to increase the stability of the knee and avoid pressure on any one part of the knee joint.
Sudden or acute meniscus tears are common in athletes or active individuals. Athletes may squat, twist or pivot causing a meniscus tear. Direct injury to the knee in contact sports may also cause a tear. It is common for meniscus tears to occur with other knee injuries such as ACL tears.
The meniscus is also prone to wear and tear or degeneration over time as it is in the weight bearing part of the knee joint. Older individuals may be at risk for degenerative meniscus tears.
Menisci tear in different ways. They are often named by their patterns. Common types of tears include flap, radial, and bucket handle tears. Some tears cause immediate pain and symptoms while others are more stable and do not cause symptoms.
Symptoms and Diagnosis
People often report a “pop” when they tear their meniscus. The knee may become stiff or swollen. The most common symptoms associated with a meniscus tear are:
- Stiffness or swelling
- Catching or locking
- Weakness or sense that the knee is going to give out
Diagnosis is made through a thorough history and physical examination. Xrays are ordered to rule out any underlying conditions such as arthritis or other bony abnormalities. MRIs are helpful in evaluating the menisci and other soft tissue structures of the knee.
Treatment of meniscus tears will depend on the type, size, and location of the tear. Generally, initial treatment for meniscus tears is the R.I.C.E (Rest, Ice, Compression, and Elevation) and use of nonsteroidal anti-inflammatory medications. Physical therapy may be helpful to improve strength and increase range of motion and function.
If the meniscus tear is large, located in an area with poor healing, or is causing significant symptoms, it may need to be treated surgically. A torn meniscus can lead to articular cartilage injury over time if it is unstable and catches in between the femur and tibia. Additionally, a piece of the torn meniscus can break away and become loose in the joint causing pain and locking or catching.
- Procedure: Most surgeries for a meniscus tear are done via a knee arthroscopy. Two small incisions (portals) are made for the arthroscope (camera) and small surgical instruments. Depending on the type of tear, you may have additional incisions.
- Partial Meniscectomy: during a partial meniscectomy, the damaged or torn meniscus is removed or trimmed away. This procedure may not be ideal for younger individuals or athletes. Depending on the size of the tear, the damaged meniscus that is removed may leave less cushion for the knee.
- Meniscus repair: during this procedure, the torn meniscus is sutured or brought back together using permanent sutures. This leaves the best chance for persevering the entire meniscus. This may not be a suitable option for people with significant arthritis in the knee joint.
- Meniscus transplant: for patients with severely damaged meniscus or who have previously undergone a meniscectomy and have lost the shock absorbing function of the meniscus, a meniscus transplant may be an option. The damaged meniscus is removed and a meniscus from a donor is transplanted in its place with the goal of reducing pain and preventing arthritis. This is generally not recommended for older individuals or those with significant knee arthritis.
Recovery from a meniscus surgery depends on the type of tear and surgery. Generally, the recovery is much shorter for a partial meniscectomy. For meniscus repairs and meniscus transplants, you will likely not be able to place weight on the leg for 6 weeks to allow the repair to heal. You will need crutches and to wear a knee brace at all times for the first 6 weeks. Significant physical therapy is required following surgery to help regain range of motion and strength after surgery. Most patients are able to return to their normal activity following proper treatment and rehabilitation.