Meniscal Tear

Meniscal Tear Illustrated

A meniscal tear looks like this.

One of the most commonly injured parts of the knee, the meniscus is a wedge-like rubbery cushion where the major bones of your leg connect. Meniscal cartilage curves like the letter “C” at the inside and outside of each knee. A strong stabilizing tissue, the meniscus helps the knee joint carry weight, glide and turn in many directions. It also keeps your femur (thighbone) and tibia (shinbone) from grinding against each other.

Football players and others in contact sports may tear the meniscus by twisting the knee, pivoting, cutting or decelerating. In athletes, meniscal tears often happen in combination with other injuries such as a torn ACL (anterior cruciate ligament). Older people can injure the meniscus without any trauma as the cartilage weakens and wears thin over time, setting the stage for a degenerative tear.

Without treatment, a fragment of the meniscus may loosen and drift into the joint, causing it to slip, pop or lock; your knee gets stuck, often at a 45-degree angle, until you manually move or otherwise manipulate it. If you think you have a meniscal tear, see your physician right away for diagnosis and individualized treatment.

Meniscal Tear (Snowboarder)Menisci tear in a number of different ways:

  • Young athletes often get longitudinal or “bucket handle” tears if the femur and tibia trap the meniscus when the knee turns.
  • Less commonly, young athletes get a combination of tears called radial or “parrot beak” in which the meniscus splits in two directions due to repetitive stress activities such as running.
  • In older people, cartilage degeneration that starts at the inner edge causes a horizontal tear as it works its way back.

Signs and Symptoms

You might experience a “popping” sensation when you tear the meniscus. Most people can still walk on the injured knee and many athletes keep playing. When symptoms of inflammation set in, your knee feels painful and tight. For several days you have:

  • Stiffness and swelling
  • Tenderness in the joint line
  • Collection of fluid (“water on the knee”)

Treatment Options

Non-operative Approach

Initial treatment of a meniscal tear follows the basic RICE formula: rest, ice, compression and elevation, combined with nonsteroidal anti-inflammatory medications for pain. If your knee is stable and does not lock, this conservative treatment may be all you need. Blood vessels feed the outer edges of the meniscus, giving that part the potential to heal on its own. Small tears on the outer edges often heal themselves with rest.

Surgical Repair

If your meniscal tear does not heal on its own and your knee becomes painful, stiff or locked you may need surgical repair. Depending upon the type of tear, whether you also have an injured ACL, your age and other factors, your surgeon may recommend surgery with use an arthroscope to either place sutures to repair the meniscus or to use small instruments to trim off damaged pieces of cartilage.

Surgical Techniques

Dr. Peter Gambacorta has spent many years developing highly specialized arthroscopic techniques to treat tears in the meniscus. This experience has enabled us to repair not only small “simple” tears, but also complex multi-component tears.

In some cases, the torn part of the meniscus is either so small it would be impractical to repair, or so damaged that the repair would have a high likelihood of failure. In these cases, this tissue is simply trimmed out to leave a stable rim of meniscus and to minimize further damage within the knee.

Risks of Surgery

Risks of surgery include bleeding, infection (around 1%), nerve or vessel injury (most commonly an area of numbness on the skin adjacent to the incision), retear of the meniscus, knee stiffness (5 to 25%) and need for further procedures.

Rare risks include bleeding from acute injury to the popliteal artery (overall incidence is 0.01 %), weakness or paralysis of the leg or foot and a blood clot in the veins of the calf (0.12%). The goal of meniscal surgery is to obtain a stable, smooth rim of meniscal tissue that does not rub abnormally on the cartilage surfaces of the knee. Patients may still have an increased risk of arthritis in the knee after a meniscal tear, even if surgery is performed.

Alternatives to Surgery

Surgical treatment is usually advised for patients with symptoms of unstable meniscal tears, including pain, locking, giving way or catching in the knee. However, deciding against surgery is reasonable for select patients.

Nonoperative management of isolated meniscal tears is likely to be successful or may be indicated in patients:

  • With small, stable tears located in the outer third of the meniscus
  • With low demand lifestyles
  • With no effusion or swelling of the knee and no symptoms of locking or catching in the knee

You must complete a course of rehabilitation exercises before gradually resuming your activity.

Pre-operative Care

If you decide to have arthroscopic surgery to treat your meniscal tear, you may be asked to have a complete physical with your family physician before surgery to assess your health and to rule out any conditions that could interfere with your surgery.

Prior to surgery, tell your doctor about any medications that you are taking. You will be informed which medications you should stop taking before surgery. This typically includes aspirin and anti-inflammatory medications such as Advil®, ibuprofen, Motrin®, Naprosyn® or Aleve®, all of which should be stopped 10 days before surgery. Tylenol® can be taken in the week preceding your surgery, but be sure not to exceed the recommended daily dose.

Tests, such as blood samples or a cardiogram, may be ordered by your doctor to help prepare for your procedure.

Postoperative Care

After surgery you will be given written instruction sheets, pictures of your surgery, a prescription for therapy and a copy of rehabilitation guidelines. This information will answer most of the questions you may have during your recovery.

You will be going to physical therapy (PT) after your surgery. At the initial evaluation you will meet with the physical therapist or athletic trainer (ATC) who will be responsible for your rehabilitation. During this visit, you will be instructed in exercises, wound care and how much weight you should place on your operated leg. In addition, your therapist will ask you to help set your goals for rehabilitation. If you have a mensical repair, you will be partial weight bearing with crutches for four to six weeks.

The entire rehabilitation process will take two to six months. During the early phase of your rehabilitation you will be closely monitored. As you progress, you will be able to do more exercises on your own. If you have any questions concerning your rehabilitation process, they should be directed to your rehabilitation team.

This information is intended for education of the reader about medical conditions and current treatments. It is not a substitute for examination, diagnosis and care provided by your physician or a licensed healthcare provider. If you believe that you, your child, or someone you know has the condition described above, please see your healthcare provider. Do not attempt to treat yourself or anyone else without proper medical attention.