Meniscal tears are a frequent cause of knee pain, swelling, and instability. Meniscus tears are common among athletes but also occurs in less active people. Individuals who play contact sports are most at risk for meniscus tears, but anyone can suffer from a tear regardless of their age or activity level. In fact, MRI studies have shown that meniscal tearing is even very common in those without any knee pain.
The femur, tibia, patella, and fibula all meet to form the knee joint. The menisci are two semicircular wedge-shaped pieces of collagen sitting between the surface of the thighbone and shinbone. They help to provide stability, cushion, and support to the joint as the body moves. The menisci protect the cartilage and help stabilize the knee and leg.
Often when athletes tear their meniscus, they also suffer from other knee injuries. Meniscal tears are categorized by where the damage occurs and the shape. High contact activity (tackles), as well as sudden squats and a twist of the knee, can cause a tear. In older people, tears occur because of degeneration in the meniscus. The meniscus will become drier and therefore weaker with age and make individuals more at risk for tears with normal activity.
When the meniscus tears, many people report feeling a popping sensation. Many individuals continue activity for about 2 to 3 days after the initial damage, but over time the knee will become stiff and swell. Patients suffer from pain, decreased motion, locking of the knee and stiffness. Many people also report a feeling as if their knee is giving away. There is a deep aching pain with standing or walking, squatting, or kneeling.
The type of treatment recommended depends on the size, type, and location of the tear. A tear on the outside one-third of the meniscus can heal on its own or with surgery. The inner two-thirds of the meniscus can’t heal on its own because it doesn’t have a plentiful blood supply. Tears in this area are typically trimmed away surgically. However, many centrally located meniscal tears are successfully treated with therapy and bracing.
If the tear is small or located on the outer edge of the meniscus nonsurgical treatment may be recommended. Again, non-operative management can work for other tears and should be tried first in most cases. Doctors implement this treatment if the symptoms don’t persist and the knee is stable. RICE (rest, ice, compression, and elevation) and non-steroidal anti-inflammatory medicine will be most beneficial initially. Physician directed bracing encourages healing, and physical therapy is very effective as well.
If the patient’s symptoms persist, the doctor may recommend arthroscopic surgery. During this surgery, a tiny camera is inserted into the knee, and the surgeon will use surgical instruments to trim or fix the meniscus. After surgery, the doctor may recommend a cast or brace to stabilize the knee. Over time rehabilitation exercises can be used to restore mobility and strength. With proper treatment, patients will be able to recover and return to their regular activities.