The two C-shaped discs of cartilage that connects the thighbone to shinbone are called menisci. These two menisci in the knee are a medial (internal) and a lateral (outside) and act as shock absorbers for the bones that also help in keeping the knee stable. Meniscus tears are the most common knee injury and can occur in patients of all ages. Athletes who play contact sports are commonly at risk from meniscus tears (tears in the pad of cartilage that protects the knee joints). In some of the cases, torn meniscus can be treated by non-surgically or minimally invasive techniques and requires proper time to heal. If the meniscus tears are less than 55mm, then there are good chances of it healing on its own (especially in younger patient). In this case, doctor may recommend wearing braces for weeks to keep the knee functional along with the help of physical therapy. The area of the injury or tear can affect whether or not a surgical repair will be successful. The inner meniscus can be easier to repair whereas outer meniscus is difficult to access. The tear that occur due to sudden injury have cleaner and more repairable meniscus than the tear occur from wear and tear over the period of time in which the meniscus becomes more thin and rough. Overweight people are also more prone to the tear of meniscus.
People with the injured knee can still walk but over the time of three-four days, knee will gradually become more stiff and swollen. There are some most common symptoms of meniscus tears following:
1. Pain near the injured knee tears, while moving, resting or immediate after the injury.
2. Stiffness and swelling due to accumulation of the fluid within the knee joint which is also known as “water on the knees”.
3. Knee locking if the piece of meniscus breaks free and may drift into the joint causing it to lock and a person loses the ability to fully straighten the leg while sitting or standing.
4. Not able to move knee completely
The treatment of a meniscus tear can be done through medications or surgery depending on the severity, area and underlying cause within the knee joint. Doctor may suggest some anti-inflammatory medications and physical therapy rehabilitation to strengthen muscles around the knee to avoid joint instability. In extreme case, immediate surgery may require to continue their activity. Doctor will examine the patient by performing several tests. Among them, the main test for meniscus tear is the McMurray test in which orthopedic will bend the knee, then straightened and rotate it to see if there is any clicking sound. Some other test may include apley’s compression test, X-rays and MRIs. Meniscus tears can be described as:
• Flap tear - in which tear occurs on the side of the meniscus, splitting the inner tissue away from the edge causing a flap.
• Degenerative tear – damage to the meniscus over the period of time causing progressive tear near the outside of the meniscus.
• Bucket handle tear – that runs between the outer edge of the meniscus and the interior tissue. Edge of the meniscus is separated from the rest of the cartilage and this torn piece of cartilage lifted up to form the shape of bucket handle.
• Radial tear – tear that occurs on one edge of the meniscus and moves into the tissue, straight on the edge.
Based on the type of injury doctor will decide the type of surgery required:
1. Arthroscopic surgery – knee arthroscopy is most common surgical procedure for meniscus tear. Doctor will make some small incisions and insert an arthroscope (miniature camera) to see inside the knee to check the tear.
2. Arthroscopic partial meniscectomy – a piece of the torn meniscus will be removed to make the knee function normally.
3. Arthroscopic total meniscectomy – in which doctor will remove the whole meniscus.
During the arthroscopic surgery, doctor will make small cuts around the knee and insert the arthroscope to view inside the knee. Surgeon may also smooth the nearby tissue surrounding cartilage and removed the damaged part. Sutures will be placed and drain out any torn tissues from the knee. The incisions will be closed after removing the surgical instrument.
Post surgery, patient may need to wear braces or use crutches to avoid any pressure on the knee. The recovery from the surgery may depend on some factors such as age, overall medical condition, severity of the injury and ability to follow the physical therapy. Proper care and hygiene is required to avoid any infection at the incision site. Doctor may recommend a physical therapy and some exercises to do at home that will help in moving of the knee and get it stronger. He may also suggest compression stockings to prevent blood clots. If the patient has partial or total meniscectomy, the recovery will take about a month whereas if the meniscus is repaired, it can take as long as 3 months to get it fully recovered. Meniscus repair is low risk and complications are rare that may include injury to skin nerves, infections, and knee stiffness. Antibiotics will be given to prevent infection.