Meniscal tears are one of the most common knee injuries. If knee cartilage is torn, the injury is most likely a meniscus tear. These tears can occur in anyone, but athletes playing contact sports are particularly at risk.
ANATOMY
Normal knee anatomy
Your knee joint is made from three joining bones: 1) the femur, or thighbone, 2) the tibia, or shinbone, and 3) the patella, or the kneecap. Each meniscus is a “shock absorber,” which is a piece of cartilage between the thighbone and shinbone. The two menisci in each knee cushions and stabilizes the joint.
DESCRIPTION
There are different ways that menisci can tear, and the tears are classified by both where the tear is and how the tear looks. Some of the common tears are: longitudinal, flap, bucket handle, parrot-beak, and mixed/complex (pictured below). When the meniscus tears during sports, there are often accompanying injuries, such as anterior cruciate ligament (ACL) tears.
Common types of tears
CAUSE
While playing sports, the meniscus can tear suddenly. This often occurs if players twist their knee while squatting. Getting tackled or enduring other direct contact can also tear the meniscus.
When these tears occur in elderly patients, tears are more likely to be degenerative. As tissue ages it becomes more prone to tears because the cartilage thins and weakens. Thus, a much smaller twist can result in a tear in older people with worn tissue.
SYMPTOMS
At the time of the tear, it is likely that you will hear a pop. It can take a few days before the knee is stiff, painful, and swollen, so it is likely that you will be able to stay active in the interim. However, you may feel a sensation of your knee weakening or notice that it does not have a full range of motion. If you do not have your knee repaired, a piece of the meniscus can shift to the joint, which can cause your knee to lock or pop.
IMAGING TESTS
To confirm that your injury is in fact a torn meniscus, your doctor will likely order imaging tests. You could experience similar symptoms with a different injury.
X-rays cannot detect menisci tears, but if you have other problems, such as arthritis, causing your symptoms, X-rays may pick up on these and eliminate the possibility that your injury is a torn meniscus.
Magnetic resonance imaging (MRI) allows doctors to visualize soft tissues in the knee and can thus provide clear evidence for tears in the tissue. MRI can therefore allow doctors to make a diagnosis of a meniscus or ACL tear.
TREATMENT
The specific treatment that will be recommended will depend on the specific type of tear you have endured. If the outside portion of the meniscus is torn, it may heal on its own or may require knee surgery. This part of the meniscus is known as the “red” zone because it is rich in blood. Longitudinal tears often occur on the outside part of the meniscus. If the outer portion of the meniscus is torn, surgery is usually required. This “white” zone lacks blood and is tears due to worn cartilage.
Other factors, including the size and location of the injury and your age and activity level will also be considered when determining a treatment plan.
Nonsurgical Treatment
If your symptoms are short lived, you may not require surgery. In this case, you can employ the Rest, Ice, Compress, Elevate (RICE) strategy, which is particularly effective for most sports-related injuries. Specifically, RICE requires that you refrain from the activity that caused the injury, ice the knee at 20 minute intervals, several times each day, compress the leg to prevent swelling and blood loss (which can be done with a bandage), and raise the leg above the level of the heart (to reduce swelling).
Swelling can also be reduced with non-steroidal anti-inflammatory medicines like aspirin and ibuprofen. These medications can also be used to manage pain associated with your injury.
Physical therapy is another rehabilitative strategy that can reduce symptoms and prevent further injury.
Surgical Treatment
You will likely need to undergo arthroscopic surgery if your symptoms persist. Dr. Samimi specializes in treating meniscus tears with this minimally invasive technique that allows for a quick recovery.
What Happens during the procedure?
If you undergo knee arthroscopy, Dr. Samimi will evaluate your injury and repair or remove damaged tissue.
After an initial examination, Dr. Samimi will insert the arthroscope into your knee. The arthroscope will be connected to a video monitor in the operating room so that Dr. Samimi has superior visibility of the components of your knee.
After determining the extent of damage, Dr. Samimi will use small surgical tools to remove or repair damaged tissue. Dr. Samimi will likely only need to make 2 or 3 incisions during the procedure, which generally lasts less than an hour. After the orthopedic surgery, your incisions will be closed and covered, and you should be able to return home the same day. After a couple of days, you can remove the bandaging.
REHABILITATION
Dr. Samimi will recommend that you engage in rehabilitation exercises after your initial healing period. Restoring mobility and strength in your knee will require that you exercise your leg regularly. You can build up strength by increasing the vigor of exercises over time.
