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Meniscus Tears

Description

The Meniscus is a pair (medial and lateral) of soft cartilages that sits between the thigh bone (Femur) and leg bone (Tibia), and acts a cushion providing shock absorption and stability to the knee.  The Meniscus can become torn from trauma such as a fall, from twisting the knee, or just through a wear and tear or aging process.  Sometimes patients can not come up with an obvious reason as to how the meniscus became torn.  

Symptoms

Patients often complain of pain and swelling of the knee, and at times a clicking sensation.  Some patients may also get a mechanical locking, catching, or buckling, and can have limited range of motion of the knee.  These symptoms can be intermittent whereby there is pain, swelling, and mechanical symptoms followed by times of relative normalcy for several weeks or months, followed by symptoms again.

 

Diagnostic Testing

Usually Dr. Steven Lee will start with an xray to help determine if there is any pre-existing arthritis of the knee as well as to help rule out other diagnoses.  If needed, he may order additional radiologic studies such as an MRI.  

 

Nonoperative Treatment

The treatment depends on a number of factors such as the type, size and location of the tear, as well as patient factors such as age, activity level, and the amount of pain or disfunction of the patient.  Partial thickness tears, degenerative tears, and tears that are associated with significant arthritis can often be treated non-operatively with Physical Therapy and time.

Meniscus tears that are full thickness especially in the context of relatively younger age (under 40), or tears that are causing mechanical symptoms (especially a locked knee), or those meniscus tears that have not responded despite nonoperative treatment are often treated with a knee arthroscopy.  Arthroscopy entails making small incisions (2-3 mm in length) in the knee, and using a small video camera and instruments thinner than a pen to either debride (partially remove) or repair the meniscus.  The decision on whether to debride or repair the meniscus is usually made at the time of surgery and depends on a number of factors including the type of tear (clean cut or multiple tear lines), or whether the tear occurs in a vascular area of the meniscus (tears that occur in a non-vascular area cannot heal with a repair).  

If full tears are not treated, or partial tears are allowed to propagate, the knee will lose it's shock absorbing ability and can lead to early arthritis. This concept is especially true in those patients whose meniscus initially is symptomatic, but then with time feels better, but then again feels symptomatic again.  Each time it feels better, patients tend to think everything is fine and procrastinate getting treatment.  Unfortunately, every time that it becomes symptomatic, the meniscus is likely tearing further.  This may turn a repairable meniscus into an irreparable one, or cause a smaller tear to turn into a bigger tear, necessitating a larger portion of the meniscus to have to be removed, and ultimately causing increased chances for arthritis.

Dr. Steven Lee has performed thousands of arthroscopies, is fellowship trained in Sports Medicine, is part of the teaching faculty for the Lenox Hill Sports Medicine Fellowship (which is the oldest sports medicine fellowship in the country), and is currently the Associate Director at NISMAT, which is the first institute in the country dedicated to sports medicine research.  He has also co-developed and authored a meniscus repair technique that is now currently widely used by sports medicine surgeons around the country. Learn more about scheduling surgery. 

 

Postoperative Care

If the meniscus was debrided,  Dr. Lee will typically allow full weight bearing on the operated leg.  However, for the first few weeks, it is recommended that walking be kept at a bare minimum if possible.  After the sutures are remove at around a week, physical therapy is usually initiated emphasizing swelling control, range of motion, and progressive gentle strengthening.  Return to normal walking usually occurs at around 2-3 weeks, and normal activities including sports around 6-8 weeks.

 

If a meniscus repair has been performed, a brace will usually be recommended for up to 6-8 weeks, while still allowing weight bearing on the leg.  However, progressive range of motion with physical therapy is pursued in a much more progressive and delayed manner compared to a debridement.  Normal walking does not occur until about 8 weeks, and return to normal sports and activities can take 4-6 months. 

 

Learn more about post-operative care.

 

Post-Operative Instructions

Download here.

 

*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables.  It is provided as an educational service and is not intended to serve as medical advice.  Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.

 

*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.