Meniscus Tears

A meniscus tear is a common injury, especially among athletes caused by a forceful twisting or rotating of the knee. Degenerative meniscus tears affect 6 out of 10 patients over age 65, due to aging that causes the cartilage to dry out and become brittle.

• Pain felt on the side of the knee where the tear occurred.
• Swelling that develops within the first 24-48 hours after the injury due to inflammation.
• Stiffness reduces range of motion and the ability to fully bend or straighten the leg.
• Sometimes, a piece of the torn meniscus can become lodged in the knee joint, causing the knee to “lock” or “catch,” making it difficult to move.
• The knee might feel unstable or give way, particularly when walking or bearing weight.

Dr. Ahsan will assess the knee for tenderness, swelling, and range of motion. Special maneuvers, like the McMurray test, can help determine the presence of a meniscus tear. While an X-ray can’t detect a meniscus tear because it is made of cartilage, but it can rule out a fracture.  Magnetic Resonance Imaging (MRI) is the most effective imaging test to visualize the meniscus and confirm the diagnosis of a tear.

• Radial Tear: Runs across the meniscus, starting from the inner edge and extending outward. Commonly found in the middle of the meniscus.
• Horizontal Tear: Runs parallel to the surface, creating a split within the meniscus. Often occurs in the outer portion where healing is more likely.
• Longitudinal Tear: Runs along the length of the meniscus, parallel to its C-shape. Can evolve into a more severe “bucket-handle” tear.
• Bucket-Handle Tear: A type of longitudinal tear where a portion of the meniscus is displaced, causing knee locking or catching.
• Flap Tear: A loose piece of the meniscus flips over, causing a flap that can catch in the knee joint.
• Complex Tear: Involves multiple tear patterns, making it more difficult to treat. Often seen in both traumatic and degenerative cases.
• Degenerative Tear: Common in older adults due to wear and tear, usually appears as fraying in the back portion of the meniscus.

The location of the tear is crucial for determining treatment because the meniscus has zones with different blood supplies, which affect healing potential. Other factors include the severity of the tear, the patient’s age, activity level, and any associated injuries.

Treatment options include:

1. Conservative (Non-Surgical) Treatment involves:
   • RICE, Rest, Icing, Compression and Elevation.
   • Physical therapy focused on exercises to improve range of motion, strengthen the muscles around the knee, and enhance overall knee stability.

• Nonsteroidal anti-inflammatory drugs (NSAIDs) to help reduce pain and inflammation.

2. Surgery:

• When conservative treatment fails, or the tear is severe, arthroscopic surgery may be recommended. During this minimally invasive procedure, Dr. Ahsan inserts a small camera (arthroscope) and surgical instruments into the knee to repair or remove the damaged portion of the meniscus.
• For tears that occur in the outer portion of the meniscus, where there is a better blood supply, surgical repair may be possible. This involves suturing the tear to allow it to heal naturally.
• A partial meniscectomy is often performed when the tear occurs in the inner portion of the meniscus, where there is less blood supply and a lower chance of healing. It involves surgically trimming the torn meniscus.
• If the meniscus must be removed, there are several options depending on your age and activity level and particularly if you have knee arthritis.

• Recovery time varies depending on the type of treatment and the patient’s overall health. Conservative treatment may lead to recovery within weeks to a few months, while surgical recovery can take several months, particularly if a meniscus repair was performed.
• Post-surgical rehabilitation is crucial for restoring full knee function. This often involves progressive physical therapy focused on regaining strength, flexibility, and balance.