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Knee

Meniscus Injuries

Meniscal tears are one of the most common knee injuries, affecting millions of people each year. These injuries are a frequent cause of knee pain, swelling, and mechanical symptoms like locking or catching. While some meniscal tears can heal on their own, others require medical intervention to prevent long-term damage to the knee joint. In this article, we’ll explore what meniscal tears are, the different types of meniscal injuries, their symptoms, and how they are treated.

The meniscus is a C-shaped piece of cartilage located in the knee joint between the thigh bone (femur) and shinbone (tibia). Each knee has two menisci—one on the inside (medial meniscus) and one on the outside (lateral meniscus). These structures serve several important functions, including shock absorption, stabilization of the knee, and distribution of load across the joint. When the meniscus is torn, it can lead to pain, swelling, and mechanical problems in the knee.

Meniscal tears can occur from traumatic injury or develop over time due to degenerative changes. Left untreated, a meniscal tear can lead to long-term complications, including damage to the articular cartilage and the development of osteoarthritis.

There are two main types of meniscal tears: degenerative and acute (traumatic) tears.

Degenerative meniscal tears are more common in middle-aged or older adults and are often associated with the natural aging process. Over time, the meniscus can become worn, frayed, and more susceptible to tears. These injuries are frequently asymptomatic, meaning patients may not initially experience any noticeable pain or discomfort.

However, when symptoms do arise, they are typically mild and can include occasional knee pain, swelling, and stiffness. Degenerative meniscal tears tend to occur from repetitive stress on the knee rather than a single traumatic event.

Recent studies have shown that surgery is often not recommended for patients with degenerative meniscal tears. Conservative management, which includes physical therapy, rest, and anti-inflammatory medications, is typically effective. Surgical removal of meniscal segments in degenerative cases has not been shown to provide significant improvement in symptoms compared to non-surgical treatment.

Acute or traumatic meniscal tears are often caused by a sudden injury, such as during sports activities like basketball, football, or skiing. These injuries typically occur when the knee is forcefully twisted or rotated while bearing weight. For example, pivoting quickly during a game or landing awkwardly from a jump can cause the meniscus to tear.

Acute meniscal tears are more likely to cause immediate and noticeable symptoms, including:

  • A popping sensation: Many patients report hearing or feeling a “pop” at the time of injury.
  • Knee swelling: Swelling usually occurs within the first 24 hours after the injury.
  • Pain: Particularly while twisting or rotating the knee.
  • Instability: A feeling of the knee giving way during activity.
  • Locking or catching: The knee may lock or catch when moving, as the torn tissue can get lodged between the bones.

In severe cases, patients may experience significant pain and difficulty bearing weight on the affected leg.

One of the most critical factors that determine whether a meniscal tear can heal on its own is its location. The meniscus has a limited blood supply, and regions with more blood flow have a better chance of healing.

  • Peripheral Zones (Zone 1 and Zone 2): These areas of the meniscus are located closer to the outer edge and receive a higher blood supply. Tears in these regions are more likely to heal with appropriate treatment, especially when surgery is performed to repair the damaged tissue.
  • Central Zone (Zone 3): This area, located in the middle of the meniscus, has a poor blood supply and therefore has a lower healing potential. Tears in the central zone are less likely to heal on their own and may require surgical intervention if they cause significant symptoms.

To diagnose a meniscal tear, a healthcare provider will typically begin with a physical examination of the knee, followed by imaging tests such as an MRI (magnetic resonance imaging). The MRI is particularly useful for visualizing soft tissue structures like the meniscus and can help determine the type and location of the tear.

During the physical examination, the doctor may perform specific tests to assess for meniscal injury. These include the McMurray test, where the knee is bent, and the foot is rotated while the doctor applies pressure to the joint. A painful click or popping sound may indicate a torn meniscus.

The treatment for meniscal tears depends on several factors, including the type of tear, the patient’s age, activity level, and overall health.

Non-Surgical Treatment

For many degenerative meniscal tears and smaller, stable tears, non-surgical treatment is the first line of management. Conservative treatments include:

  • Rest: Avoiding activities that exacerbate the symptoms.
  • Ice: Applying ice to reduce swelling and pain.
  • Physical Therapy: A physical therapist can provide exercises to strengthen the muscles around the knee, improve range of motion, and reduce stress on the joint.
  • Anti-inflammatory Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce inflammation and pain.

Surgical Treatment

If conservative treatment is ineffective or if the tear is large and causing significant symptoms, surgery may be necessary. The two most common surgical options for meniscal tears are:

  • Meniscus Repair: For tears located in the peripheral zones with good blood supply, a surgeon may repair the meniscus by stitching the torn edges together. This procedure has the potential to restore normal function and preserve the meniscus.
  • Meniscectomy: In cases where repair is not possible, a partial meniscectomy may be performed. During this procedure, the surgeon removes the damaged portion of the meniscus. While this can relieve symptoms, removing too much meniscal tissue can increase the risk of developing arthritis in the future.

Recovery time after a meniscal injury varies depending on the type of treatment. Patients who undergo non-surgical treatment may recover in a few weeks with appropriate physical therapy and rehabilitation.

For patients who undergo surgery, recovery can take several months. A strict rehabilitation program is essential to restore strength, range of motion, and stability to the knee. Following a meniscal repair, patients are often advised to avoid putting weight on the knee for several weeks to allow the tissue to heal properly.

Meniscal tears are a common cause of knee pain and dysfunction, but with proper diagnosis and treatment, most patients can recover and return to their normal activities. Whether you experience a degenerative or acute meniscal tear, early intervention and appropriate care are key to preventing long-term complications and preserving the health of your knee joint.

Orthopedic surgeon Dr. Mark Cinque is a sports medicine surgeon in San Diego, California who specializes in the treatment of complex knee injuries. He has spent time training at The Steadman Clinic and Stanford Orthopaedic Surgery. He has published over 100 peer-reviewed manuscripts and has presented research internationally. He uses minimally invasive arthroscopic procedures to preserve the natural joint and reduce recovery time to accelerate his patients’ return to the activities they love.

At a Glance

Mark Cinque, MD

  • Board-certified, fellowship-trained orthopedic surgeon
  • Orthopedic Residency: Stanford University, Fellowship: The Steadman Clinic
  • Authored over 100 peer-reviewed publications
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