The meniscus is a semi-circular disk of cartilage, shaped much like a wedge, that prevents the thighbone and shinbone from rubbing together. This cartilage is critical for the proper movement of the knee joint, keeping it stable and pain-free.
A meniscus tear is one of the most common patient concerns seen by an orthopedic surgeon- it is tear in the aforementioned cartilage of the knee. A meniscus tear is more common in athletes, especially those who engage in contact sports and elderly people with arthritic degeneration in their knee joint. However, just about anyone can tear their meniscus, regardless of their level of activity or athleticism.
What Causes the Meniscus to Tear?
There are two common ways that a meniscus tears. Sudden tears are due to significant, even traumatic activity including sports, a sudden movement or blow to the knee. An unexpected twist, poor warm-up or a tackle are all contributory causes to a higher risk of a torn meniscus.
Secondly, over time, cartilage wears down and weakens. As the cartilage ages it can thin and start to degenerate. This is true for any joint in the body. This weakened cartilage can tear more easily with even slight movements, potentially causing a degenerative tear.
How Does the Meniscus Tear?
There are several main classifications of meniscus tear including:
- Bucket handle
- Torn Horn and
The difference between these tears is simply the way they look and where they occur. The meniscus tear can be an isolated injury, or in more severe cases can tear alongside another orthopedic injury such as an anterior cruciate ligament or ACL tear. How the meniscus tears and how it will be repaired will be determined during consultation with your orthopedic surgeon.
Signs and Symptoms of a Torn Meniscus
Common signs and symptoms of a torn meniscus include:
- A feeling that your knee is catching or locking
- Limited range of motion.
It is important to remember that other knee injuries can share some of these symptoms, so an evaluation from a qualified orthopedic specialist is important if knee pain occurs.
When the meniscus first tears, many patients hear a pop. There may be some discomfort in the knee and somewhat limited range of motion, however most patients will continue to use their knee as before. However, over the next few days, the injury will become more obvious with stiffness and swelling including pain becoming more pronounced.
Over the longer-term, a piece of cartilage may dislodge and wind up in the joint, causing instability, pain, a popping sensation or the feeling that the knee is locked.
How We Diagnose a Meniscus Tear
The first and most important part of the diagnostic process is to visit a qualified orthopedic specialist. During this visit, we will learn more about the circumstances surrounding the injury, check for tenderness within the joint and perform stretches and other movement tests to check for a meniscus tear. Sometimes it is very clear that the meniscus is torn, but we may occasionally need to send you for imaging.
Sometimes it is very clear that the meniscus is torn, but we may occasionally need to send you for imaging. These Tess may serve to both confirm the diagnosis of a meniscus tear and rule out the possibility of other knee injuries. Most commonly, an x-ray or MRI will be performed.
Treatment for a Meniscus Tear
Treatment for a meniscus tear will vary depending on the severity of the tear, where it is located and the type of tear. One significant determinant of the treatment protocol is whether the minute tear is on the outer ½ or inner 2/3 of the meniscus. Known as the red zone, the outside third of the meniscus has an excellent blood supply and may heal on its own with rest and proper care. Your orthopedic surgeon will likely start you on a course of RICE – Rest, Ice, Compression and Elevation. This is critical to maximizing the chances of the meniscus healing. Continue continuing strenuous activity will have the opposite effect. A meniscus repair is typically limited to tears in the red zone that do not heal completely with nonsurgical treatments.
However, the inner 2/3 of the meniscus does not have the blood supply and therefore cannot heal on its own. This is known as the white zone. White zone tears usually require surgical intervention.
Surgical treatment for white zone tears comes in the form of trimming away the torn portion of the meniscus to improve range of motion and reduce pain. This is known as a partial meniscectomy. We most often performed this procedure using minimally invasive arthroscopy. During the procedure a miniature camera and minimally invasive devices are used to minimize recovery while still offering excellent results. A partial meniscectomy – trimming away the damaged meniscus and a meniscus repair – suturing the torn pieces of meniscus together, can both be performed using arthroscopy.