Meniscus tears of the knee are a common source of pain among Central Texas athletes but also occur frequently in sedentary individuals. The meniscus is a C-shaped rubbery structure that functions primarily as a shock absorber but also helps to stabilize the knee. In addition, it helps to protect the joint cartilage from arthritis. Each knee has two menisci (plural of meniscus)one at the outer edge of the knee and one at the inner edge.
Meniscus tears occur in males two and a half to four times more often than in women. Injuries to the meniscus may occur in young patients typically between the ages of 11-20 in women and 21-30 in males especially in association with ACL tears. Meniscus problems are also common in runners. "Watch your footing and the surface on which you are running," says Mary Faria, PhD, FACHE, VP/Administrator, Seton Southwest and avid runner. "My injury was from slipping into a pothole while doing a long run."
Upon Injuring The Knee
- Rest and reduce activity. Avoid motions or positions that cause discomfort. Depending on your injury and pain, your health professional may recommend crutches and a brace.
- Try applying ice to your knee during the first 48 hours after discomfort begins. To avoid harming your skin, place a thin towel between the ice pack and your body, or put a pillowcase over the ice pack. Apply ice 2 to 3 times a day, up to 20 minutes at a time.
- Elevate your knee higher than your heart.
- Take nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, or naproxen to relieve pain and reduce swelling.
- Follow your health professional's instructions for rest and rehabilitation of your knee. " from was
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"Most importantly be patient and know that you will get
back to running, especially if you recover properly.,
says Mary. "Use the recovery time to water run, bike,
or in my case, learn to swim!"
If the tear is minor and your symptoms go away, your doctor may recommend a set of exercises to build up your quadriceps and hamstring muscles and increase flexibility and strength. It's important to follow your health professional's guidance to avoid a new or repeat injury.
"Meniscus tears may occur in isolation or may be associated with other injuries to the knee such as ACL tears and fractures of the tibial joint surface," says orthopedic surgeon Scott Welsh, MD. Younger patients with an isolated meniscus tear usually can recall a twisting injury or hyperflexion injury. Degenerative type tears usually occur in the population over age 40. "These tears often develop without any history of a traumatic event and can occur with simple walking, getting out of a car, or climbing stairs."
Because the meniscus loses it's elasticity as we age, it may tear with minimal injury. These tears will commonly cause immediate pain along the joint line (one finger breadth below the kneecap) and swelling that gradually develops over a 24-48 hour period. Other symptoms include: catching, locking, a sharp/stabbing pain, and occasionally giving way. The pain is often worse with flexion of the knee past 90 degrees, pivoting maneuvers, stair climbing (especially descending), squatting, or lunging. Patients may also present with pain behind their knee which is usually related to a Baker's cyst which develops from swelling in the knee. Most meniscus tears involve the posterior horn of the medial meniscus which is on the inside of the knee towards the back.
Diagnosis and Treatment
The diagnosis of a meniscus tear can usually be made based on the mechanism of injury in combination with the patient's complaints. Physical examination generally consists of a variety of pivoting maneuvers and an examination of the ligaments to rule out associated tears of the ACL or collateral ligaments. X-rays are helpful to evaluate for arthritis or fractures. An MRI is the best diagnostic tool available to confirm a meniscus tear with an accuracy of about 95%.
Treatment of meniscus tears is dependent on the size, location, and pattern of the tear. "The amount of disability caused by the tear is also important in considering treatment options," explains Dr. Welsh. "Conservative treatment such as physical therapy, anti-inflammatory medications, brace wear, and possibly a cortisone injection should be considered if the symptoms are minimal, if the MRI is inconclusive, or if the tear is small and does not appear to correlate with the patient's complaints." Surgical treatment is recommended if symptoms are severe enough to affect one's daily activities, work, or sports despite conservative measures. A minimally invasive arthroscopic procedure is performed to either resect or repair the torn meniscus. Tears along the outer third of the meniscus can usually be repaired with sutures while tears involving the inner two thirds most often are removed. The majority of tears that occur require resection due to the poor blood supply of the meniscus. After partial removal of a meniscus, patients can usually start walking without crutches 2 to 3 days after the procedure and full recovery is usually about 6-12 weeks. The success rate for a partial meniscectomy ranges from 80-95% but decreases to 62% in patients who have associated arthritis.
Time needed to return to activities Uncomplicated partial meniscectomy Meniscus repair surgery Weight bearing As tolerated With a brace Time on crutches 2 to 7 days 4 to 6 weeks Driving, if the affected leg is to be used for gas/brake or clutch 1 to 2 weeks, if you have regained motion with minimal pain and you are not taking narcotics 4 to 6 weeks Regain full range of motion 1 to 2 weeks 4 to 6 weeks (motion is generally limited to 90 degrees for the first 4 to 6 weeks to allow meniscus to heal) Return to heavy work or sports 4 to 6 weeks, if you have regained motion and strength and your knee is not swollen or painful 3 to 6 months Scott A. Welsh, MD
Orthopedics
Appointments: (512) 301-9922 or email
Cypress Creek Orthopedics & Sports Medicine
Seton Southwest Hospital Medical Plaza
7900 FM 1826 Suite 170A specialist in sports medicine and general orthopedics, Dr. Welch has a particular interest in arthroscopic cartilage restoration procedures for the knee. He received his undergraduate degree from the University of Illinois and attended medical school at Loyola University Chicago. He then completed his orthopedic residency at Michigan State University and a sports medicine fellowship at the Florida Orthopedic Institute in Tampa. He has worked as a team physician for the University of South Florida, University of Tampa, Western Michigan University, Saint Leo University, and several high schools in the Tampa area.
