The meniscus is a c-shaped cartilage that resides inside the knee joint. It is located between the cartilage ends of the femur and tibia and increases the surface area for force transmission between the two. As a result, it decreases pressure, adds to knee joint stability, and provides some shock absorption between the femur and tibia. There are two menisci in every knee, one on the inner side (medial meniscus) and one on the outer side (lateral meniscus). Meniscal knee injuries are common among athletes and can affect both menisci. The meniscus is extremely important to evenly distribute force across the knee, and protect the articular cartilage. They also serve as secondary stabilizers of the knee.
Meniscus injuries can affect both men and women of any age. In younger people, it is often associated with a sports injury or traumatic accident, whereas in older adults it occurs due to wear and tear of an active lifestyle. Tears in older patients due to lifetime wear are termed degenerative meniscus tears. The integrity and stability of a meniscus is directly related to its due to its shape and composition. If a meniscus sustains a significant tear it can lose its ability to remain between the ends of the femur and tibia. As a result, pressure upon the articular cartilage can increase predisposing one to degradation and wearing of the articular cartilage. Smaller meniscus tears do not disrupt the integrity of the meniscus and provide mechanical symptoms of catching and locking. Care must always be taken to protect as much of the meniscus as possible in instances of injury.
The primary symptoms of a meniscus tear include pain on the inside or outside of the knee with mechanical symptoms. Certain activities such as pivoting, running, climbing, or even arising from a chair may produce symptoms including popping and catching. Patients may hear a clicking sound with movement, and the knee may be tender to the touch for some in specific locations.
Upon the initial visit Dr. Anz will perform a complete physical examination and will move the knee in a series of tests that will help to determine where the injury is located. While an X-ray will not show meniscal damage, it is necessary to evaluate the overall health of the knee joint, as subtle changes on X-rays are common and help to guide treatment. Although a meniscal tear can be diagnosed by a patient’s symptoms and through the physical exam alone, an MRI is important to confirm diagnosis as well as inspect the cartilage surfaces throughout the knee joint.
Small meniscal injuries may be painful after initial injury and then improve with time. In cases where it appears that a small tear is present, Dr. Anz may recommend an initial non-surgical course. This will include rest, physical therapy, icing, anti-inflammatory medications, and possibly bracing. If symptoms continue, Dr. Anz may recommend surgery. This will depend on the patient’s age, activity level and activity goals.
If the meniscus has a small symptomatic tear, a tear that is shredded beyond repair, or a tear in the inner third of the meniscus, then each can be treated using an arthroscopic approach that allows Dr. Anz to remove the area of the tear. Arthroscopic knee surgery uses tiny keyhole incisions, a small camera to visualize the inside of the knee, and specialized instruments to perform the surgery. During a partial meniscectomy only the damaged meniscus is removed, and great care is taken to only remove the involved part of the tear and leave as much of the healthy meniscus as possible.
Some meniscal tears can be repaired, especially those that exist in the outer two thirds of the meniscus. Sometimes a repair can involve sutures placed from inside the joint, and sometimes an incision must be made on the outside of the knee using a combined arthroscopic and open procedure. Strong stitches are placed through the tear to bring the tissue back together and allow for healing.
Dr. Anz will prescribe a specific rehabilitation protocol after surgery on the meniscus, and physical therapy will vary depending on how complex the surgery was. Patients are strongly advised to follow the advice of their therapist and to follow the recommendations about when to put weight on the injured leg. Patients who had a full meniscus repair will be required to observe motion restrictions in a knee brace for up to six weeks.
For more information on knee instability or meniscus knee injuries, or to learn more about the surgical treatments for meniscus tears offered by Dr. Adam Anz, orthopedic knee surgeon, please contact the Gulf Breeze, Florida orthopedic surgeon, Dr. Adam Anz located at the Andrews Institute.