The Meniscus is the cartilage that lives in the knee and acts as a cushion between the tibia and femur. It is a C-shaped structure that is located on both the outside and inside of the knee. The meniscus provides 50% of the weight bearing in the joint. If it is torn the femur and tibia start to carry the load, which can lead to joint degeneration and early arthritis, if not addressed.
There are two ways that people end up with a meniscus tear. First, they can experience an acute tear from a fall or an athletic injury. Sports with a lot of rotation or twisting, and deep knee bends can put individuals at greater risk. With the advent of an acute tear, people usually experience, swelling, pain and limited range of motion in the knee.
The second way that people can get a meniscus tear is that over time the tissue or cartilage can degenerate weaken. When it can no longer withstand the load of the joint, it breaks down. These tears often happen without an injury and are generally the product of wear and tear on the joint over time. Sometimes additional weight can cause increased stress across the meniscus and as people age it may put them at a higher risk of a meniscus tear because the tissue quality is poor or weak. This type of tear can develop over weeks or months and doesn’t get better with anti-inflammatory medication or rest. Often people complain of pain or swelling with activities
If you suspect a torn meniscus there are four symptoms that are commonly experienced in people with this injury:
- Individuals with a meniscus tear often complain of pain along the joint line
- They often have pain or weakness with bending the knee and sometimes they have a catching or locking sensation
- With an acute tear, individuals may notice a lot of swelling in the knee and often report that they heard or felt a pop.
- Individuals may experience pain going from a seated position to standing or when they are going up and down stairs
There are actually three different areas of meniscus that can be torn or injured:
- A Lateral tear – This type of tear happens along the outside edge of the knee
- A Medial tear – This type of tear is on the inside of the knee and it is often associated with deep knee flexion.
- A Meniscal Root tear – A tear at the root of the meniscus where it inserts into the bone – either in the front – the anterior root or the back of the knee – the posterior root. Not a lot was known about these tears in the past, but recently we’ve learned the importance of repairing these tears as they can lead to rapid joint wear
Treating a meniscus tear
The first step in diagnosing a meniscus tear is to get an x-ray of the knee to be sure there is no fracture or boney abnormalities. If there is a lot of swelling in the knee, we often will recommend getting an MRI to assess the meniscus. Once we know what the problem is we can offer treatment. For degenerative tears that are more chronic – we may start with a steroid injection. Patients usually get good relief. We can also treat these types of meniscus injuries with anti-inflammatories and physical therapy.
For acute tears, we may start with 6 – 8 weeks of physical therapy. If the symptoms do not resolve with physical therapy, we often will recommend surgery in younger patients, especially those who have an athletic tear. The reason for that is that in athletes, the tear pattern is usually larger, and it may involve more of the structural integrity. Another reason we treat these tears surgically in younger patients is that the tissue quality is good, it is easier to fix and the surgical outcomes are better than in an older patient.
Today, we try to fix most meniscus tears, if they can be repaired. Years ago, the approach was taking the meniscus out which was sometimes referred to as “cleaning the joint out”. With this approach, we now know that increases the load on the tibia and femur and the expectation is that it will lead to arthritis over time and a knee replacement may be necessary in 15 – 20 years. In fact, recent research has shown that people who had their meniscus removed 15 – 20 years ago today, many of those patients have knee pain.
If you have pain in your knee or joint – get it checked out by an orthopedic doctor. It’s always better to be safe than sorry. Dr John Arvesen is an orthopedic surgeon and sports medicine specialist at OrthoTexas in Carrollton.