What is a torn meniscus?

A torn meniscus is damage to the cartilage that sits on top of the tibia and allows the femur to glide when the knee joint moves. Tears are usually described by where they are located and their appearance (for example, "bucket handle" tear, longitudinal, parrot beak, and transverse). While physical examination may predict whether it is the medial or lateral meniscus that is damaged, a diagnostic procedure, like an MRI or kneearthroscopy, can locate the specific part of the cartilage that is torn and how it appears. Because there is different blood supply to each part of the meniscus, knowing where the tear is located may help decide how easily an injury might heal (with or without surgery). The better the blood supply, the better the potential for recovery. The outside rim of cartilage has better blood supply than the central part of the "C." Blood supply to knee cartilage also decreases with age, and up to 20% of normal blood supply is lost by age 40.

What causes a meniscus to tear?

A forceful twist or sudden stop can cause the end of the femur to grind into the top of the tibia, pinching and potentially tearing the cartilage of the meniscus. This injury can also occur with a deep squatting or kneeling, especially when lifting a heavy weight. Meniscus tear injuries often occur during athletic activities, especially in contact sports like football and hockey. Motions that require pivoting and sudden stops, such as tennis, basketball, and golf, can also cause meniscus damage. The risk of developing a torn meniscus increases with age because cartilage begins to gradually wear, lose its blood supply and its resilience. Increasing body weight also puts more stress on the meniscus. Routine daily activities like walking and climbing stairs increase the potential for wear, degeneration, and tearing. Because some of the fibers of the cartilage are interconnected with those of the ligaments that surround the knee, meniscus injuries may be associated with tears of the collateral and cruciate ligaments, depending upon the mechanism of injury.

What are symptoms and signs of a torn meniscus?

Comment on thisRead 47 CommentsShare Your Story Some people with a torn meniscus know exactly when they hurt their knee. There may be acute onset of pain and the patient may actually hear or feel a pop in their knee. As with any injury, there is an inflammatory response, including pain and swelling. The swelling within the knee joint from a torn meniscus usually takes a few hours to develop. Depending upon

the amount of pain and fluid accumulation, the knee may become difficult to move. When fluid accumulates, it may be difficult and painful to fully extend or straighten the knee. In some situations, the amount of swelling may not necessarily be enough to notice. Sometimes, the patient isn't aware of the initial injury but starts complaining of symptoms that develop later. After the injury, the knee joint irritation may gradually settle down and feel relatively normal as the initial inflammatory response resolves. However, other symptoms may develop over time, including any or all of the following:

Pain with running or walking longer distances Intermittent swelling of the knee joint: Many times, the knee with a torn meniscus feels "tight." Popping, especially when climbing up or down stairs Giving way or buckling (the sensation that the knee is unstable and a sense that the knee will give way): Less commonly, the knee actually will give way and cause the patient to fall. Locking (a mechanical block where the knee cannot be fully extended or straightened): This occurs when a piece of torn meniscus folds on itself and blocks full range of motion of the knee joint. The knee gets "stuck," usually flexed between 15 and 30 degrees and cannot bend or straighten from that position.

How is a meniscus tear diagnosed?

The diagnosis of a knee injury begins with the history and physical examination. The health care professional will want to hear about the mechanism of injury to help understand the stresses that were placed on the knee. With chronic knee complaints, the initial injury may not be remembered, but many patients who participate in athletic events or training can pinpoint the specific timing and details of the injury. There is a true art to the physical examination of the knee. From inspecting (looking), palpating (feeling), and applying specific diagnostic maneuvers, the health care professional can often make the diagnosis of a torn meniscus.

Physical examination often includes palpating the joint for warmth and areas of tenderness, assessing the stability of the ligaments, and testing the range of motion of the knee joint and the power of the quadriceps and hamstring muscles. There have been many tests described to assess the internal structures of the knee. The McMurray test, named after a British orthopedic surgeon, has been used for more than 100 years to make the clinical diagnosis of a torn meniscus. The health care professional flexes the knee and rotates the tibia while feeling along the joint. The test is positive for a potential tear if a click is felt. Magnetic resonance imaging (MRI) is the test of choice to confirm the diagnosis of torn meniscus. It is a noninvasive test that can visualize the inner structures of the knee, including the cartilage and ligaments, the surface of the bones, and the muscles and tendons that surround the knee joint. One additional benefit of the MRI before surgery is that by knowing the anatomy the surgeon can plan a potential operation and discuss alternatives with the patient. Plain X-rays cannot be used to identify meniscal tears but may be helpful in looking for bony changes, including fractures, arthritis, and loose bony fragments within the joint. In older patients, X-rays may be taken of both knees while the patient is standing. This allows the joint spaces to be compared to assess the degree of cartilage wear. Prior to the widespread use of MRI, knee arthroscopy was used to confirm the diagnosis of a torn meniscus. In arthroscopy, the orthopedic surgeon inserts a small scope into the knee and looks directly at the structures within the joint. The added benefit of arthroscopy is that the injury may be repaired at the same time using additional tools that are inserted into the joint. The disadvantage of arthroscopy is that it is a surgical procedure with all the potential risks that are associated with surgery.

What is the treatment for a torn meniscus?

Comment on thisRead 3 CommentsShare Your Story The treatment of a meniscus tear depends on its severity, location, and underlying disease within the knee joint. Patient circumstances also may affect the treatment options. Some meniscus tears can be treated conservatively without an operation using anti-inflammatory medications and rehabilitation to strengthen muscles around the knee to prevent joint instability. Patients involved in athletics or whose work is demanding may opt for immediate surgery. Most patients fall in between and the decision to treat the injury conservatively or operative needs to be individualized.

Torn meniscus due to injury The first steps in treatment after the acute injury usually include rest, ice, compression, and elevation (RICE). This may be helpful in easing the inflammation that occurs with a torn meniscus. Anti-inflammatory medications, such as ibuprofen (Advil), may help relieve pain and inflammation. It is important to remember that over-the-counter medications can have side effects and interactions with prescription medications. It is reasonable to ask a health care professional or pharmacist for directions as to which over-the-counter medication might be best. Rest and elevation may require the use of crutches. Many patients choose initial conservative or nonsurgical treatment for a meniscus tear. Once the initial injury symptoms have calmed, exerciseprograms may be recommended to strengthen the muscles surrounding the knee and add to the stability of the joint. Maintaining an ideal body weight will also help lessen the forces that can stress the knee joint. Orthotics may be useful to distribute the forces generated by walking and running. If conservative therapy fails, surgery may be a consideration. Knee arthroscopy allows the orthopedic surgeon to assess the tear within the meniscus and repair it. Options include sewing the torn edges together or trimming the torn area and smoothing the injury site. Degenerative joint disease In older patients with degenerative joint disease (also known asosteoarthritis), where the cartilage wears out, treatment options may be considered over a longer timetable. Exercise and muscle strengthening may be an option to protect the joint and maintain range of motion. As well, anti-inflammatory medications may be considered to decrease swelling and pain arising from the knee joint. Cortisone medication injections into the knee joint may be used to decrease joint inflammation and to bring temporary symptom relief that can last weeks or months. A variety of hyaluronan preparations are approved for mild to moderate knee arthritis and include hylan G-F 20 (Synvisc) and hyaluronan (Orthovisc). The use of dietary supplements, including chondroitin and glucosamine, have yet to have their effectiveness proven, but many people find relief with their use.

As a last resort, joint replacement may be an option with substantial degeneration of the knee if conservative measures fail and symptoms of pain and decreasing joint range of motion affect quality of life and prevent the patient from performing routine daily activities.

Can a meniscus tear heal without surgery?

Comment on thisRead 6 CommentsShare Your Story If the tear is small and located on the outer edge of the meniscus, it is possible that rehabilitation without surgery is all that is needed for recovery. The location of the meniscal injury is also an important consideration. Injuries that occur in parts of the cartilage that have better blood supply have a better chance to heal than those where there is little blood supply. With other meniscal injuries, if the knee is stable and if the symptoms do not persist and do not limit lifestyle, nonsurgical treatments remain an option. However, the decision to defer surgery depends upon whether the knee joint remains functional and allows the patient to participate in their preferred activities.

What is rehabilitation and recovery like for a patient with a meniscus tear?
If a conservative, nonsurgical approach is taken, the pain and swelling of a torn meniscus should resolve within a few days. Recovery and rehabilitation becomes a long-term commitment, making certain that the muscles surrounding the knee are kept strong to promote joint stability, maintaining an ideal body weight and avoiding activities that cause pain. If knee arthroscopy is performed, the rehabilitation process balances swelling and healing. The goal is to return range of motion to the knee as soon as possible. Physical therapy is a common part of rehabilitation, and most therapists work with the orthopedic surgeon to return the patient to full function as soon as possible. Since the procedure is planned in advance, some health care professionals advocate pre-hab. With rehabilitation prior to the procedure, the patient begins strengthening exercises for the quadriceps and hamstring muscles before surgery to prevent the routine muscle weakness that can occur after an operation. Once the swelling in the knee joint resolves, the goal of therapy is to increase the strength of muscles surrounding the knee and to promote and preserve stability of the joint.

Elite athletes return to practice within one to two weeks after surgery, but they are a motivated group of people who spend hours each day in rehabilitation. For most other patients, return to mild routine activity occurs in less than six weeks. Most patients do well after surgery. The prognosis for return to normal activity is good but depends upon the motivation of the patient to work hard with their physical therapist and to continue that work after formal therapy has been completed.

What are recommended exercises once a torn meniscus has been repaired?
Rehabilitation after an operation depends upon the individual patient and the response to surgery. Specific recommendations regarding weight-bearing and exercises will be customized for the patient by the surgeon and therapist. Usually the goal is to return the knee to normal function within four to six weeks.