Knee Pain – Meniscus Tears

 

Knee pain is one of the most common reasons for people to seek orthopedic care.  The knee is a complex joint that complex arrangements of ligaments that create a modified hinge joint.

Chondromalacia Grade 1Seif_knee anatomy01

Anatomy

 

There are two types of cartilage in the knee.  The articular cartilage is the smooth covering of the bones that allow them to glide along one another during movement.  The  MENISCUS are the wedge shaped “shock absorbers” that lie between the femur and the tibia.  Please see my post at http://coloradosportsdoctor.com/knee-cartilage-injuries for a complete discussion on articular cartilage injuries.  Read on to learn more about meniscal tears.

 

 

 

Cause

 

Tears of the menisci are a very common injury and cause of knee pain.  Many of these injuries happen to athletes during participation in a sport the involves cutting or pivoting.  They plant their foot to change directions and the meniscus tears as the two bones twist over one another.  However, these injuries are common in non-athletes as well.  The meniscus tissue degenerates with time and becomes weaker.  This weaker tissue is not as tough as the normal meniscus and is susceptible to tearing during an awkward twist of the knee.

 

bigstock-Meniscus-Injury-27613586

 

TYPES OF TEARS FROM TOP LEFT TO RIGHT: NORMAL MENISCUS, RADIAL TEAR, PERIPHERAL VERTICAL TEAR (THESE ARE OFTEN REPAIRABLE)

BOTTOM LEFT TO RIGHT: COMPLEX TEAR, HORIZONTAL AND PARROT BEAK

 

 

Symptoms of meniscal tears can include:

 

  • Pain which is usually sharp in nature
  • Catching or hanging up of the knee
  • Tightness and swelling
  • Giving way or inability to bear weight

 

Doctors Visit

 

History and Physical examination: The doctor will first ask questions regarding your symptoms.  These will include a detailed history of the injury, the progression of the symptoms and what exactly brings on the symptoms.  Following the history, the doctor will examine your knee specifically looking for swelling, specific sites of tenderness, assess range of motion and stability.

 

Imaging Studies: The first imaging study that will be performed is regular xrays.  Although they do not show meniscal tears, they do give the orthopedic surgeon a lot of information about your knee.  If indicated, an MRI (magnetic resonance imaging) will be ordered and are very good at diagnosing meniscal tears.  However, MRI’s are not always necessary if the diagnosis is very clear.

 

Treatment

 

After your evaluation, the doctor will reveiw all of the findings on history, physical exam and imaging studies and recommend the most appropriate treatment.

 

Non-surgical:  Some meniscal tears can be treated non-operatively,  It really depends on the type of tear you have and whether or not it is causing sypmtoms.  If the tear is very small and at the periphery of the meniscus, they often cause pain for a period of time and then settle down.  These tears are typically managed with the standard R.I.C.E. program ( rest, ice, compression wrap, elevation) in the acute setting and then rehabilitated with the assistance of physical therapy.

 

Surgical: When symptoms are severe, or they do not improve with conservative treatment, surgery is indicated to treat the problem.  There are two basic options for treating meniscal tears: remove the torn fragment or repair the torn meniscus.  Generally, the only tears that are repairable are tears at the periphery of the meniscus as this is the only part of the meniscus that has a blood supply.  The central part of the meniscus does not have blood vessels and therefore does not have the ability to heal.  In this situation, the best option is to simply remove the torn fragment that is causing the pain.  The photos below are examples of what a normal medial meniscus looks like through the arthroscopic camera and a medial meniscus with a parrot beak tear (unstable fragment).  The final image is after removal of the fragment.

 

NORMAL MEDIAL MENISCUS

NORMAL MEDIAL MENISCUS

 

TORN MEDIAL MENISCUS WITH UNSTABLE FRAGMENT

MEDIAL MENISCUS TEAR WITH UNSTABLE FRAGMENT

TORN FRAGMENT RESECTED

MENISCUS TEAR FRAGMENT REMOVED

 Rehabilitation

 

Following surgery, I prefer to send patients to physical therapy for rehabilitation.  The physical therapists can help guide recovery with my direction in order to maximize and speed your recovery.  Your activity level and speed of recovery can depend on multiple factors including, extent of other damage in your knee, amount of meniscus requiring removal or if a repair was performed.

 

Our goal in treating these injuries is to maximize your recovery and get you back to the activities that you enjoy.  If you are having symptoms consistent with a meniscal tear, please call my office for an appointment at 719-632-7669.  I would be happy to evaluate you.