A torn meniscus is one of the most common knee injuries, particularly among athletes who play contact sports. Before you jump into a backyard football game after a Thanksgiving feast, learn the potential risks of this common knee injury! We recently sat down with Paul Thomas, M.D., of Bone and Joint Institute of Tennessee to learn more.
Williamson Source: To begin, what is the meniscus?
Dr. Thomas: Your knee has two C-shaped pieces of cartilage that act as a cushion. This is called the meniscus. It’s a structure that’s considered to be the shock absorber in the knee joint.
WS: How can you get a meniscus tear?
Dr. Thomas: The most common cause would be a twist or rotation of your knee when your knee is flexed – especially in athletic individuals.
WS: How do you diagnose a meniscus tear?
Dr. Thomas: First, it’s important to listen to the injured person describe the mechanism of injury. The symptoms of a torn meniscus are generally pain, swelling, and sometimes catching of the knee or the inability to fully straighten out the knee.
On exam, a person will likely have swelling in the knee that limits their motion and they’ll have tenderness in the inside (medial) or outside part of the knee where the menisci are located. Most patients have an inability to fully extend or flex their knee and attempting to do so causes increased pain.
WS: Do you need to do imaging of a potential meniscus tear?
Dr. Thomas: An x-ray will not reveal a torn meniscus. It just reveals whether the patient has any fractures or arthritis. To diagnose a torn meniscus, a patient has to undergo an MRI, which is required by insurance providers prior t surgery.
WS: Do you use operative or nonoperative treatments for meniscus tears?
Dr. Thomas: Because the meniscus doesn’t have a good blood supply, most meniscus tears do not heal unless they’re torn on the peripheral or outside part of the meniscus. As we get older, the blood supply to the meniscus is diminished, making it less likely that the meniscus will heal.
Initially it’s okay to treat a patient conservatively by elevating and icing, crutches, and physical therapy for strengthening of the muscles. A conservative treatment is always indicated unless someone has what we call a “locked knee,” meaning the knee is unable to bend.
The meniscus can sometimes get wedged in the knee joint and prevent it from bending at all. This is called a bucket handle tear, a semi-emergent case that has to have surgery.
Initial conservative treatment is generally recommended. Sometimes when I see a patient in the office, I immediately recommend surgery––for example a young athlete with a tear that’s locking the knee and preventing movement.
Conservative treatment would be recommended for the majority of people who come in, especially if it’s only been a few days since the injury.
As a final note, sometimes a meniscus tear can be inflamed, so a cortisone injection can be a common methodology of treating the injury. Generally after a month, if the patient is still symptomatic, they may get an MRI. At that point if the MRI shows a torn meniscus and they failed conservative treatment, we would likely recommend surgical treatment.
WS: What is surgical treatment like?
Dr. Thomas: There are two types of surgical intervention. The first is arthroscopic meniscectomy, removing only the piece of damaged or torn meniscus; that’s generally what we do in the older population. The second treatment is repair of the meniscus, and that’s generally performed in younger patients.
WS: What is the recovery process like?
Dr. Thomas: If we do a partial meniscectomy, the patient can weight-bear immediately. They might use crutches for a couple days and restrict their activities for a few days while icing and elevating. Then, they do physical therapy for about a week and they resume normal activities in about 3-4 weeks. This includes return-to-play.
Following a meniscus repair, we put the patient on crutches for a month and don’t let them bear weight for a month. We do physical therapy immediately to regain range of motion and strengthen. They usually have a couple months of physical therapy before they’re able to return to sports.
See a Physician at Bone and Joint Institute for Knee Injuries
For more information about meniscus tears and other knee injuries, contact Paul Thomas, M.D. at The Bone and Joint Institute of Tennessee. Call (615) 791-2630. You can also schedule an appointment online.
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