Tears of the Meniscus
What is the Meniscus?
The meniscus is a crescent shaped fibrocartilage shock absorber. There are two in each knee:
- Inner side (medial meniscus)
- Outer side (lateral meniscus)
The menisci have the following important functions:
- Reduce wear
- Protect against arthritis
- Assist with stability of the knee joint, and
- Help disperse synovial fluid around the knee joint effectively, thereby assisting with lubrication
What is a Meniscal Tear?
Meniscal tears are very common injuries, and are a common cause of knee pain and dysfunction. The meniscus can tear as a result of trauma, age related wear, or a combination of both factors.
Causes of Meniscal Tears
Meniscal tears can be:
Degenerative – occur as part of the aging process due to progressive wear or as a result of habitual, prolonged activities such as squatting, kneeling twisting etc.
Sometimes no trauma is required as the meniscus stiffens and weakens with age.
Meniscus tears are a special risk for older athletes.
Traumatic – occur in the athletic setting.
The meniscus is at risk of tearing due to constant exposure by repetitive loading as we walk, run and perform other activities.
When the knee is partially bent under load or involved in twisting motions (pivoting during sports, squatting, heavy lifting and changing direction) the meniscus can deform under pressure.
Higher risk sports include:
Meniscal tears can also occur in combination with tears of ligaments around the knee (e.g. ACL tear).
Symptoms of a Torn Meniscus?
Meniscal tears may cause some or all of the following symptoms:
- Knee pain
- Difficulty walking
- Loss of full range of motion
- Inability to either bend or fully straighten the knee
- Pain with walking
- Tenderness along the joint line
- A tendency for your knee to get “stuck” or lock up
Painful functional instability may be present and this can be difficult to distinguish from true instability resulting from an ACL rupture.
Meniscal Tear Diagnosis
Meniscal tears are diagnosed by the following
- History of injury
- Nature of knee pain and other symptoms
- Physical examination
- Imaging tests
X-rays are useful in the diagnosis of fractures and osteoarthritis
MRI scans are useful for imaging meniscal tears, cartilage injuries and bony abnormalities such as bone bruising and insufficiency fractures
Arthroscopy is a surgical procedure in which the inside of a joint is viewed by insertion of a fibreoptic telescope (arthroscope)
The arthroscope contains a camera that allows direct visualization of all the structures in the knee joint.
Small operating instruments can be inserted into the knee through a second small incision
The benefits of arthroscopy include
- Small incisions
- Fast healing
- Rapid recovery, and
- Little scarring
Arthroscopic surgical procedures can be performed on an outpatient basis. This means patients can return home on the same day as the procedure.
Risks With Knee Arthroscopy?
Complications are not common but can occur.
Prior to making any decision to have surgery, it is important that you understand the potential risks so that you can make an informed decision regarding the advantages and disadvantages of surgery.
The following list is by no means exhaustive, so it is important to discuss your concerns with me.
General surgical risks include:
- Risk of infection,
- Postoperative bleeding
- Blood clots in the leg (deep vein thrombosis – DVT) or lung.
Apart from surgical risks, medical (including allergies) and anaesthetic complications can occur, and these can affect your general health and well-being.
Treatment for a Meniscal Tear?
Unfortunately, meniscal tears do not heal without surgery.
Not everyone requires surgery and treatment is tailored to the patient’s individual needs. The less active patient may be able to return to a quieter lifestyle without surgery.
At arthroscopy, the torn meniscus will be repaired with sutures or partly resected and reshaped to a stable configuration, depending on the site and nature of the tear.
Arthroscopy is very effective in treating the symptoms of meniscal tears.
Surgery is recommended where patients endure ongoing episodes of
- Swelling and
Certain types of meniscal tears can cause damage to the articular cartilage if left untreated. This can contribute to the development of premature osteoarthritis.
Non-surgical treatment involves physical therapy and rehabilitation to strengthen the quadriceps and hamstrings muscles to stabilise the knee and maintain range of movement.
Patients will usually require surgery to restore function and stability if they wish to return to:
- Sports involving cutting or pivoting movements e.g. soccer, football and netball, etc, or
- Physical jobs e.g. policeman, fireman, builders, etc).
The procedure for meniscal repair is performed via knee arthroscopy (ie. keyhole surgery) with 2 small cuts (5-7mm) on each side of the knee cap.
Risks with Meniscal Surgery
Complications are not common but can occur. Prior to making any decision to have surgery, it is important that you understand the potential risks so that you can make an informed decision regarding the advantages and disadvantages of surgery.
The following list is by no means exhaustive, so it is important to discuss any concerns you may have with me or my staff prior to surgery.
- Joint stiffness
- Local nerve or blood vessel damage
- Bleeding into the knee
- Infection (extremely rare)
- Blood clots and DVT
- Other rare complicatins, e.g. reflex sympathetic dystrophy, also known as complex regional pain syndrome. This rare condition is not entirely understood but can cause unexplained and excessive pain and stiffness after surgery or after a trivial injury
Preparing for Meniscal Repair Surgery
Once it has been decided that surgery is required, preparation is necessary to achieve the best results and a quick problem free recovery.
Preparing mentally and physically for surgery is an important step toward a successful result.
- A treatment plan will be created specifically tailored for you
- I will need a complete list of your medications so that I can advise which ones should be stopped prior to surgery
- The admitting hospital will advise you of the fasting time and your arrival time on the day before surgery
- Do not eat or drink anything, including water, for 6 hours before surgery
- Stop taking aspirin, warfarin, anti-inflammatory medications or drugs that increase the risk of bleeding one week before surgery
- Stop or cut down smoking to reduce your surgery risks and improve your recovery
After Your Operation:
Your knee will be filled with log lasting local anaesthetic at your operation so there should be very little pain after surgery. However you will be given a prescription for pain killers and possibly anti-inflammatory medications
The wounds take 7-10 days to heal. Most patients improve dramatically in the first 2 weeks.
Occasionally, there are periods where the knee may become sore and then settle again. This is part of the normal healing process. If a meniscal repair (suturing the meniscus) was performed, it can take 3 months for it to heal fully.
Full weight-bearing and walking is allowed immediately after meniscal surgery. Most patients do not need walking aids after arthroscopic surgery, but if you do need crutches, the hospital will supply them. Crutches can usually be discarded after a day or two in most cases.
When can I Drive After Meniscal Surgery?
Driving a car is discouraged for 48 hours after an anaesthetic. After 48 hours, your ability to drive will depend on the side you had your operation, left or right, and the type of vehicle you drive, manual or automatic. You can drive whenever you feel comfortable and are walking well with good control over your legs and reflexes. You should not drive under the influence of strong pain killers, e.g. Endone or Codeine.
Return to Work After Meniscal Surgery
Return to work will vary depending on the procedure performed and type of work you do. Most patients can return to office work within a few days. Labour intensive work however, may require up to 3 weeks or longer before returning to full duties.
During this period you should try to avoid the following activities:
- Prolonged standing
- Heavy lifting
- Bending or
- Excessive stair climbing
Return to Sport After Meniscal Surgery
Time to return to sport depends on the type of surgery and the state of the knee, among other factors.
You may increase your activity level within comfort limits, avoiding excessive pain and swelling.
Often there is little pain after surgery. This is because local anaesthetic is injected around the wound during the procedure and it is performed arthroscopically (ie. minimally invasive keyhole surgery).