What is a Torn Meniscus?
Patients who have a meniscus tear often report a prior twisting injury to the knee, often during sports requiring a lot of lateral movement such as basketball, soccer, football, or tennis. The pain is often at the joint line between the femur (thigh bone) and tibia (shin bone). The pain is aggravated by bearing weight on the knee and with knee motion. Clicking and locking may be present. In severe cases, a part of or the entire torn meniscus may be displaced into the wrong side of the joint, causing the knee to be completely locked and immobile (see MRI image below).
X-rays of the knee are usually negative, although they may show arthritis in older patients. MRI may need to be performed in order to confirm the diagnosis, although this is not 100% necessary in order to proceed with treatment since the diagnosis is often obvious with a simple history and physical examination from an experienced orthopedic surgeon.
Treatment of a Torn Meniscus
Treatment of a mild meniscus tear usually begins with rest, ice, elevation and a compression wrap. Over-the-counter anti-inflammatory medications can be useful. If the knee pain fails to improve over time, a cortisone injection may be useful to break the cycle of inflammation or pain, particularly for meniscus tears associated with knee arthritis. Occasionally, partial meniscectomy (cleaning up the frayed or torn part of the meniscus) or, more rarely, meniscus repair can be performed. The choice of operation depends largely on the exact geometry of the tear and where it is located. Tears located in the peripheral “red zone” of the meniscus have a better blood supply and are more likely to heal with a repair whereas tears in the more central “white zone” have little chance of healing and are better treated by removing the small torn portion to alleviate catching, locking, and pain symptoms.
Though surgical treatment of meniscus tears once involved making a large incision and opening the knee joint, the modern standard surgical care for meniscus tears consists of minimally invasive arthroscopic treatment. Pain is less, recovery is faster, and scars are often difficult to see.
In the videos below, the technique of partial meniscectomy and meniscus repair are presented by Daniel Quinn, M.D.