Best meniscus tear treatment
IN Hyderabad
Comprehensive Care
Multidisciplinary Team
Advanced Rehabilitation Specialists
Anatomy
The knee is the largest joint in the human body and proper function and health of the knees is required to perform most everyday activities. The knee is made up of the lower end of the femur (thighbone), the patella (kneecap), and the upper end of the tibia (shinbone).
Articular cartilage, which is a smooth substance that protects the bones and allows them to move freely, covers the ends of the three bones and acts as the main “shock absorber.” Between the femur and the tibia are two C-shaped cushioning wedges known as the menisci that act as the secondary “shock absorbers.” Large ligaments (tough bands of tissues) help hold the femur and the tibia together to stabilize the joint by preventing excessive movement. The synovial membrane covers the lining joint, a thin lining that releases fluid that lubricates the cartilage, reducing the friction within the knee joint and providing nutrition to the cartilage. All of these components work together to facilitate proper function of the knee.
The menisci are tough and rubbery pieces of cartilage that fill the gap between the tibia and the femur, help cushion the joint, and keep it stable. The outer edges of the menisci are fairly thick, while the inner surfaces are thin to conform to the wedges of bone surrounding them. The medial meniscus is more commonly injured than the lateral meniscus as it is firmly attached to the medial collateral ligament and joint capsule. The medial and lateral meniscus were once thought to be of little use and were often removed when torn. However, more recently, their importance in joint stability, lubrication, and force transmission has become evident.
Causes
Meniscal tears are among the most common knee injuries, particularly among athletes who play contact sports. Meniscal tears can often occur during sports where an athlete may squat and twist the knee, causing a tear, or when a player is contacted by another player. Tears that occur as a result of sports related activities are generally diagnosed soon after the injury and are called acute tears. However, anyone at any age can tear a meniscus. When they occur in adults they are most commonly chronic, degenerative tears caused by repetitive use.
Symptoms of Meniscus Tear
Individuals who experience a meniscal injury generally have the following signs and symptoms:
- Hearing or feeling a popping sensation in the knee
- Swelling or stiffness in the knee joint
- Pain that increases with twisting or rotating the knee
- Inability or difficulty in fully straightening the knee
- Impaired range of motion – a sensation of catching or locking of the knee
Without treatment, a piece of meniscus may come loose and move into the joint, causing the knee to slip, pop, or lock. Therefore, visiting a sports medicine doctor if an individual experiences the symptoms mentioned above is highly advised.
Diagnosis
A meniscal injury is typically diagnosed with a combination of patient history, physical examination as well as imaging studies. The physician will examine the knee to assess the range of motion, stability, swelling, tenderness, and overall strength compared to the uninjured knee. The physician may conduct the McMurry test where the knee is bent and then rotated repeated to see if the tension on the meniscus causes pain. Since other knee problems tend to cause similar problems, the physician may order X-rays to evaluate damage to the bones or osteoarthritis. An MRI scan may be needed to determine the extent of damage as well as the location and nature of the tear.
The menisci may tear in different ways which can be determined by the nature and location of the tear. A tear may be located in the anterior horn, body, or posterior horn and the meniscus is further broken down into the outer, middle, and inner thirds. The third in which the tear is located will determine the ability of the tear to heal, since blood supply in that area is critical to the healing process. Tears in the outer third have the best chance of healing with treatment as the blood supply is significantly richer here than in the middle and inner thirds.
Treatment
Treatment for a meniscal injury or tear will vary depending on the individual based on the severity of the damage, age, the level of activity they wish to resume, and the location / type of tear. If the tear is small and on the outer edge of the meniscus, operative treatment might not be required provided the symptoms reduce with time and the knee is stable.
Non-Operative Treatment – The immediate treatment for a meniscal injury is the self-care RICE approach:
Rest – Walking will be painful, so it’s best to avoid putting pressure on the injured knee and limiting activity while inflammation persists.
Ice – Ice should be applied for the first 48 to 72 hours or until the swelling subsides for 10 to 20 minutes no more than once per hour. Use of a barrier, such as a towel, is strongly advised to protect your skin. Heat should be avoided while inflammation is developing; once the swelling goes down, heat can help soothe the pain.
Compression -– Using a compressing wrap can help significantly decrease swelling. Ensure that the wrap is snug; however, if there is numbness, tingling, or swelling above or below the wrap, it’s probably on too tight and needs to be loosed.
Elevation – Raising the knee above the heart level for a few hours a day can aide tremendously in decreasing swelling.
Medication – Over-the-counter anti-inflammatory medication such as ibuprofen and naproxen usually help reduce pain and swelling.
Operative Treatment – Once the initial swelling goes down with the help of the RICE approach, the patient and the physician will need to decide on the proper treatment plans. Considerations include, displaced tear is causing the joint to lock, and especially if the anterior cruciate ligament (ACL) is also torn or injured. The procedure chosen to treat a meniscal tear is usually dependent on the location and type of meniscal tear.
Small incisions are made around the joint where surgical instruments and the arthroscope (a small camera) will be inserted and the image will be sent to a video monitor allowing the physician to see inside the joint. Using the surgical instruments, the torn ACL is completely removed. The next step is preparation and the insertion of the graft:
Partial Meniscectomy – This surgery is used for tears with low potential to heal such as the part located in the inner two-thirds of the meniscus where there is no blood supply. The aim of this procedure is to stabilize the rim of the meniscus by removing as little of the meniscus as possible. The surgical instruments are inserted into the knee through an incision around the joint and used to trim the torn piece of meniscus.
Meniscal Repair – This surgery is used for clean tears located in the outer one-third of the meniscus where there is good blood supply. The surgical instruments are inserted into the knee through an incision around the joint and used to repair the damaged meniscus with the use of various devices as deemed appropriate by the physician.
Post OP Recovery
Regardless of the treatment approach taken, patients go through a rehabilitation program which includes physical therapy exercises that are crucial to strengthen your leg muscles and regain knee strength and motion. Each patient is unique, so the therapy program will vary based on his/her level of pain, extent of injury, and desired level of activity. For patients who have undergone partial meniscetomy, recovery can take upwards of six weeks. However, if an individual has undergone a meniscal repair, recovery can take three to six months.
FREQUENTLY ASKED QUESTIONS
Small tears in the outer region of the meniscus have the potential to heal on their own, especially with proper RICE therapy (rest, ice, compression, and elevation).
Larger tears in the inner region, and complex tears with flaps or displacement will likely require surgical repair to heal properly and restore full knee function.
A torn meniscus often presents with pain, especially when twisting the knee. The joint may also become stiff and swollen, limiting mobility. In some cases, the knee can even catch or lock due to a torn fragment, causing significant pain and restricted movement.
It’s possible to walk on a knee with a torn meniscus.The ability to walk with a torn meniscus depends on tear severity; small tears in the outer region may allow walking with minimal discomfort, while larger or inner tears can cause significant pain and limit walking.
Recovering from a torn meniscus varies depending on the tear’s severity and location. Smaller tears, especially in the outer, well-blooded region (red zone), might heal with physical therapy and rest (RICE) in 6-8 weeks. Conversely, larger or inner tears (white zone) may require surgery with a 3-6 month recovery depending on the complexity. Regardless, consulting a doctor is crucial for an accurate diagnosis and personalized treatment plan to ensure optimal healing and a full return to knee function.
A meniscus tear can range from a minor inconvenience to a serious injury. Smaller tears in the well-blooded outer region may heal on their own with minimal discomfort, while larger or inner tears can cause significant pain, swelling, and limit mobility. Ignoring a tear can even increase your risk of osteoarthritis later in life. Regardless of severity, consulting a doctor is key for proper diagnosis and treatment to ensure optimal healing and a healthy future for your knee.
While complete healing may not always be possible naturally, here are some approaches that can help manage a torn meniscus and promote recovery without surgery:
Applying ice, compression, and elevating your knee can significantly reduce swelling and pain. Your doctor might also recommend a knee brace for added support. To minimize stress on the meniscus, which acts as a shock absorber for your knee, they might advise using crutches, a knee walker, or a cane while it heals.
Ignoring a torn meniscus can lead to several potential complications down the road.
While only some people who ignore a torn meniscus will experience all the complications, it’s important to understand the potential risks. Early diagnosis and treatment can help prevent these issues and ensure a faster recovery and better long-term prognosis for your knee health.
A note from Impact Orthopedic Center:
The meniscus plays a vital role in keeping the knee joint healthy and mobile. While a minor tear might not cause immediate problems, ignoring a torn meniscus for an extended period can lead to significant complications down the road. Early diagnosis and treatment are key to optimal healing and preventing long-term issues.
Our dedicated orthopedic surgeons will diagnose the problem and recommend the most suitable treatment plan for a full recovery. We are committed to providing exceptional care and helping you achieve a pain-free life and, ultimately, a better quality of life. Book your appointment today.