Is A Meniscus Tear
Causing Your Knee Pain?

Meniscus tears of the knee are a common knee injury. How can you tell if you might have a tear? And if you do, is surgery always necessary? What can you do to reduce your knee joint pain? Learn what you need to know to take control of your knee condition.




What is a Meniscus Tear?

The menisci of the knee are two crescent shaped pieces of cartilage that rest on the top of the tibia. The medial meniscus is located on the inside aspect of the knee and the lateral meniscus on the outside. They are avascular in that they do not receive a blood supply (except for the most outer portion of the medical meniscus). This is problematic in that when the meniscus becomes torn, without a blood supply, it cannot heal.

The menisci function to provide cushioning between the tibia below and the femur above, provide for equal distribution of weight on the knee joint, and allow for increased range of motion of the knee.


knee meniscus tear


The only way to diagnose a cartilage tear is via MRI. X-rays only show bone and thus cannot be used to diagnose meniscus injuries.

A meniscus tear is obviously an injury to the meniscus. Tears can be large, allowing the edges to get caught in the joint or be small and simply cause joint irritation. Medial meniscus tears are far more common than lateral tears. A common type of tear is called a bucket handle tear. This type of tear runs along the middle of the meniscus but does not tear thru the inner ring.


Causes of Meniscus Tears

There are two basic reasons why the cartilage in the knee can tear: trauma and degenerative changes. A traumatic tear occurs with some type of twisting motion while the knee is slightly bent and in a weight bearing position. Micro tears can also occur from degenerative changes within the knee joint as we age.


Typical Symptoms

Typical complaints with cartilage tears involve knee joint pain, swelling, catching or locking of the knee, or a feeling of the knee giving way. In some cases the knee can become ‘stuck’ with the knee unable to fully straighten. Most of these symptoms occur along the inside aspect of the knee as the medial meniscus is injured much more frequently then the lateral meniscus.


Typical Treatment Protocol

It is important to note that even if a cartilage tear is diagnosed via an MRI, it is not an indication that surgery is a must. A study reported in the New England Journal of Medicine, researchers found that physical therapy was as effective in treating meniscus tears as surgery. Depending upon the size and location of the tear and your activity level, surgery can be avoided. Strengthening supporting muscles around the knee can help minimize the sheer stress directed to the knee and help to possibly avoid surgery.

As with all joint related injuries the three main goals of treatment are to reduce inflammation, restore range of motion, and restore strength. Inflammation and swelling of the knee can be minimized by both ice therapy and elevation of the knee. At times an anti-inflammatory medication or in more extreme cases a cortisone injection can help to reduce the inflammation (consult your doctor regarding medication).

As swelling can limit both knee ROM and strength, reducing swelling is an important aspect to recovery. Swelling increases the pressure within the joint, limiting the joint’s mobility. Swelling also inhibits normal muscle activity, thus in the presence of even a small amount of swelling, muscles around the joint are unable to contract fully.

Depending on the severity of the injury and swelling, you may or may not have limited range of motion. The use of a stationary bike can be greatly helpful in restoring normal knee mobility. Repetitive motion has been shown to help increase circulation, increase knee lubrication, and help to reduce swelling.

Strengthening exercises are vital to help restore the knee to normal function. Although the quadriceps, the group of muscles on the front of the thigh, is considered to be most important, it is also important to maintain muscle balance.

The following is a typical range of motion and strengthening program for the treatment of knee cartilage tears: meniscus tear exercises.


Surgery

In cases in which a tear is present and persistent symptoms occur, surgery is the treatment of choice. Because of a lack of blood supply, most tears will not heal. Thus, the goal of surgery is to trim or remove the damaged area. This surgery is done via an arthroscopic procedure. The good news is with meniscus surgery, the procedure is rather simple. The goal is to simply trim away the portion of the cartilage that is torn.


In less common situations involving the outer edge of the medial meniscus, a repair of the cartilage may be warranted. Recovery from this surgery involves keeping weight off of the knee for an extended period to allow healing to occur. Although the recovery process is longer, it is of great benefit to preserve meniscus tissue.

Recovery from meniscus arthroscopic procedure is faster than other more involved knee surgeries. Generally the need for crutches will be only a day or two. Physical therapy following surgery will focus on reducing swelling, restoring normal knee range of motion (specifically extension), and restoring strength.

Controlling postoperative swelling is a key component to a positive outcome. Swelling will increase pain, decrease knee range of motion, and will inhibit normal muscle activity. Even though the ability to walk can occur quickly following surgery, monitor knee swelling and if swelling is persistent, limit weight bearing activity.

Following surgery, the use of a stationary bike is helpful in restoring knee range of motion. Quadriceps strengthening exercises are also utilized early in the recovery process.


Summary

• Meniscus tears can be either large or small injuries to the cartilage of the knee.

• Injuries occur generally from some type of twisting motion.

• An MRI indicating a tear does not always mean surgery is imminent.

• When conservative treatment has failed, arthroscopic surgery is performed to trim the torn cartilage.

• Range of motion and strengthening exercises are important whether trying to avoid surgery or as part of the recovery process: meniscus tear exercises.

Whether you chose to have surgery for your meniscus tear is up to you and your doctor. Even if you need surgery, following these recommendations will help to limit knee joint pain, reduce swelling, improve knee mobility and strength and get you back to your desired activity more quickly.



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References

Herrlin S, Hallander M, Wange P, Weidenhielm L, Werner S. Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomised trial. Knee Surg Sports Traumatol Arthrosc 2007;15:393-401

Herrlin SV, Wange PO, Lapidus G, Hallander M, Werner S, Weidenhielm L. Is arthroscopic surgery beneficial in treating non-traumatic, degenerative medial meniscal tears? A five year follow-up. Knee Surg Sports Traumatol Arthrosc 2013;21:358-364

Fransen M, McConnell S. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev 2008;4:CD004376-CD004376

Jeffrey N. Katz, M.D., Robert H. Brophy, M.D., Christine E. Chaisson, M.P.H.,March 19, 2013DOI: 10.1056/NEJMoa1301408