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A meniscus is a c-shaped rubbery structure that sits between
the end of the femur and the top of the tibia.
There are two minisci in each joint and they function as shock
absorbers to sort of protect the surface of the joint.
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Meniscus tears occur in a variety of different ways.
In the youngest patients, it usually takes a major trauma,
a twisting injury to the knee, for example.
In older patients, the meniscal tissue is not nearly as sturdy.
So minor little injuries such as squatting down to pick something
up can cause the meniscus to tear or sometimes,
there isn't even any specific injury at all.
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The most common symptom of a meniscus tear is pain at
the site of the tear.
Sometimes patients describe pain exacerbated by squatting or
going up and down the stairs.
Sometimes patients have a catching feeling in their knee.
And that would usually be on the same side of the knee as
the meniscus.
They can get swelling or in the most severe cases,
the knee can actually get stuck.
And interestingly, sometimes, patients don't have any pain or
any symptoms at all.
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Meniscus surgery doesn't cause, treat, or prevent arthritis.
Some patients have meniscus tears independent of arthritis,
an otherwise normal knee, the meniscus tears.
But other patients have meniscus tears as
part of the degenerative process that also can include arthritis.
So doing surgery to treat the meniscus tear is independent of
the arthritis process.
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The appropriate treatment for meniscus tears is based strictly
on the symptoms that the patient's experiencing.
Some meniscus tears cause no trouble at all and
therefore don't need any type of intervention.
If you have minor pain, then sometimes things as simple as
modifying your activities or using some ice, or taking some
over the counter medications can be very effective.
In more severe cases where there is swelling or the patient is
limping or they're unable to do their normal activities.
Then form of physical therapy or bracing or
even surgery might be necessary.
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No, not every meniscus tear needs surgery.
In fact, there are quite a few meniscus tears that
are asymptomatic.
They maybe picked up on an MRI when looking for
something else, or the tear may cause just minimal symptoms that
respond well to nonsurgical modalities.
Things like medication or activity modification,
or icing, or even bracing.
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There are different types of meniscal surgery.
The most common type of meniscus surgery is a partial
menisectomy.
And that's what most people consider a knee scope.
For partial meniscectomy,
we trim out the torn part of the meniscus, and
leave behind as much normal meniscus tissue as possible.
Those patients are usually on crutches for one or
two days, usually back to driving within a week, and
light sports activity within four to six weeks.
The more extensive and
less common meniscus repair surgery has a longer recovery.
People would usually be on crutches for two weeks or so and
in a brace for up to six weeks.
And it may be six months or
longer before they're back to cutting and pivoting sports.
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Articular cartilage is the smooth, white,
shiny layer on the surface of the bone that occurs,
that's found on both sides of a joint.
It's the tissue that prevents the surface of the joint from
wearing away.
It's a very, very durable, special kind of tissue
that can last for 100 years, a patient's lifetime.
But unfortunately, once it gets injured,
it has a really limited capacity to heal.
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Most patients have difficulty returning to sports with a torn
meniscus.
That would really be limited by the symptoms that the patient
is experiencing.
And you'd need to have advice from your physician
it was actually safe to try to return to sports.
If you require surgery,
then it depends on which surgery you have.
If it's a partial meniscectomy, a trim job,
then generally patients can return to sports in six weeks or
so after that surgery.
The more extensive surgery, meniscus repair, where we
actually sew the meniscus back together again, it could be six
months or even longer in some cases before patients are able
to return to the high level of cutting and pivoting sports.
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It is possible for a meniscus to get torn a second time.
After partial meniscectomy, it happens perhaps 5% of the time.
It's more common in a patient who's undergone a meniscus
repair.
And after repair, the chance of a re-tear is closer to 25%.
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If surgery is deemed necessary,
the appropriate surgical procedure is based on the size,
the location, and the type of meniscus tear.
In younger patients who sustain a traumatic injury,
we try very hard to sew that tissue back together again.
Unfortunately, meniscus tissue has a very limited capacity to
heal.
So it's not common, particularly in older patients,
to be able to sew a meniscus back together again.
Because usually in the older patients the tear is more
complex and there are more fragments present.
And in that case it's much more appropriate
to simply remove the torn part of the meniscus and
leave behind as much normal meniscus tissue as possible.
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