One of the most common conditions that can cause pain and discomfort in the knee is a meniscal tear. Meniscal tears can occur in people of all ages from teenagers to these in retirement.
What is the meniscus?
You have two C-shaped rings of cartilage, called the meniscus, that sit between the femur (thighbone) and tibia (shinbone). The meniscus act as shock absorbers in your knee. They also play an important role in keeping the knee stable.
People who regularly play sports like football and basketball are prone to meniscus tears. But even less sporty individuals can commonly injure their meniscus following a squat or twisting injury.
A meniscal tear can be associated with more significant injuries in the knee, such as a Anterior Cruciate Ligament (ACL) injury.
The risk of injury increases as you get older, when bones and tissues around the knee begin to wear down.
What symptoms will I get if I tear my meniscus?
If you tear your meniscus, your knee might swell and feel stiff. You might feel pain when twisting your knee, or be unable to straighten your leg fully.
Symptoms of a meniscus tear include:
• Difficulty bending and straightening the leg
• “Locking” or catching of the knee
Symptoms from a meniscal tear can vary considerably. A meniscus tear can be painful and debilitating. Conversely people can sustain a meniscal tear and have none of the symptoms described above. It is worth noting that almost 50% of people 65 or older have a meniscal tear and many of them have no symptoms.
How do you diagnose a meniscal tear?
Often the history given by the patient clearly points to a diagnosis of a meniscal injury.
Specific tests can also be performed whilst examining the knee which can suggest that a meniscal tear has been sustained.
Ultimately a MRI scan of the knee will is often required to confirm the diagnosis.
In an older patients it is important to have an x-ray of the knee as well. Meniscal tears in older patients are often part of a more significant degenerative process in the knee. An x-ray is often better at diagnosing arthritis in the knee compared to a MRI scan.
What's the Treatment for a Meniscus Tear?
The treatment of meniscal tears has changed considerably in recent years.
Many years ago, the standard treatment for a meniscal tear was an open meniscectomy. A large incision was made over the front of the knee and the whole meniscus was taken away. While this was helpful in the short term, patients rapidly developed osteoarthritis (wear & tear) of the knee as the “shock absorbing” function of the meniscus was no longer there.
Nowadays all meniscal operations are done by keyhole surgery, called a knee arthroscopy.
In general I try and divide meniscal tears into two categories:
A fresh (acute) tear in a younger patient - these patients should have a consultation with a knee surgeon early on to explore if the meniscus can be repaired.
A “degenerative” tear in the older patient - these should be treated without surgery where possible. Degenerative tears are often part of the “ageing” process and I would consider are normal in the ageing population. However if symptoms have failed to improve after 3 months of “conservative” treatment (which will often include physiotherapy) you should see a knee surgeon to consider key-hole surgery.
Will I need an operation?
Not all meniscal tears require surgery.
Certainly if you have a “degenerate” meniscal tear, and your knee is not locking or catching I would advice against surgery initially. In many of these cases symptoms resolve with physiotherapy, sometimes an injection in the knee can help relieve pain and swelling.
However in a younger patient I would recommend an early consultation with a knee surgeon to discuss whether meniscal repair surgery may be helpful.
If a tear is large, unstable, or causing locking symptoms surgery may be required to either repair or remove unstable edges.
Can my meniscal tear be repaired?
Not all meniscal tears are repairable and this is largely due to the fact that the meniscus generally has a poor blood supply.
Factors that often dictate whether a meniscus is repairable include:
Location of the tear - The outer part of the meniscus has a better blood supply and therefore a repair in this area is more likely to be successful.
Age of the patient - The blood supply of the meniscus reduces with age, therefore in older patients a repair would probably not be successful.
Timing of surgery - Surgery performed soon after injury is more likely to be successful.
Associated injuries - If other surgery is being performed at the same time as a meniscal repair (eg an ACL reconstruction) a meniscal repair is likely to be more successful.
What does surgery involve?
Key hole surgery for meniscal tears is performed under a general anaesthetic (you are asleep).
Surgery is performed as a “day case” so patients can go home the same day as surgery.
If the meniscus is not repairable, the torn part of the meniscus if trimmed (partial meniscectomy).
A meniscus is performed using special sutures (stitches) which re-attach the torn part of the meniscus.
How long will it take to recover from surgery?
The recovery from a simple trimming of the meniscus is quite fast. You may require crutches for a few days following surgery (though some of my patients tell me that they are able to walk out of hospital without crutches). Most people can return to work after 5-7 days.
If the meniscus is repaired, the recovery is longer. You will be on crutches and in a knee brace for 6 weeks following surgery. These precautions are required to “protect” the repaired meniscus and prevent excessive pressure on the repair.
Input from a physiotherapist after surgery is crucial to prevent muscles wasting and to maintain movement and strength in the leg.
About Mr Deepu Sethi
Mr Deepu Sethi is an established Consultant Orthopaedic Knee Surgeon with a specialist interest in sports Knee Injuries, Joint Preservation Surgery and Knee Replacement Surgery. Find out more here.