Meniscus Tears and Repairs

A healthy knee joint contains two “C”-shaped fibrocartilage like structures, each one called a meniscus. The one on the inside of the knee is the medial meniscus and the one on the outside is the lateral meniscus. Each meniscus is smooth, flexible, and rubbery in quality. The meniscus acts to provide both stability and protection for the knee articular hyaline cartilage covering the ends of the bones of the joint.

The meniscus can tear from acute injury or trauma to the knee. In addition, knees degenerate over time with age and activity, and we also see degenerative changes in the meniscus. The degenerative joint changes also can result in meniscus tears, which should be treated differently from acute or traumatic tears. Acute meniscal tears may happen during sports or other activities, often with a twisting mechanism. Acute meniscus tears frequently occur in combination with other knee injuries, particularly anterior cruciate ligament tears (ACL tears). Many acute tears can be surgically addressed. Degenerative meniscal tears are more subtle and may develop gradually over time as the quality of the meniscus deteriorates over time. Many of these tears are not symptomatic or bothersome. Though the meniscus structure may not be normal, these asymptomatic tears can be left alone and observed. A degenerative meniscus can also experience acute tearing, and it may be reasonable to consider surgical repair. In these cases, the meniscal tissue quality may be too degenerated to allow a good repair, and so many of these are still treated non-operatively or by partial meniscectomy (partial removal).

The most common symptoms of a meniscus tear include joint pain, limited range of motion of the knee, locking, catching, audible clicking, or “giving way”. Any combination of these symptoms may be present.

Meniscus tears are diagnosed by a combination of patient history, mechanism of injury, physical examination, x-rays, and Magnetic Resonance Imaging (MRI). Commonly, the patient will report having experienced a sudden onset of pain following a twisting, cutting, stopping, or stooping mechanism. During physical examination, the doctor may discover joint line tenderness, a positive McMurray’s test, mechanical symptoms, and pain with bending and twisting of the knee. An MRI can be ordered to confirm the suspected meniscus tear and reveal the extent of tearing and possible injury to other surrounding structures.

The decision to operate depends on symptoms, x-ray findings, MRI findings, and the response to conservative treatment. Dr. Chudik will recommend the best treatment option based on your situation, the type of meniscus tear (its size, location, stability), consideration for your general knee condition, relative age, sports, and activity levels. The treatment must be catered to your specific circumstances. Not all types of tears are treated the same in all people. Often, particularly with degenerative type tears, surgery is not needed, and physical therapy, ice, anti-inflammatory medications, and various types of injections may help improve symptoms and restore activity and function.

Sometimes, Dr. Chudik will recommend a minimally invasive procedure called arthroscopy. Arthroscopy allows Dr. Chudik to see inside your knee via small incisions and gain access to your knee and meniscus. Arthroscopically, Dr. Chudik can repair the meniscus to restore its function or trim the damaged section of the meniscus which is called partial meniscectomy. The goal is to preserve the meniscus and maintain as much of its normal function as possible.

The surgery is performed as an outpatient procedure (go home the same day) with light anesthesia. After meniscus Repair, patients can expect to be in a brace non-weightbearing with crutches for approximately 6 weeks.

After partial meniscectomy, patients can expect to use crutches briefly and gradually progress weight bearing on the operative leg over 2 weeks post-surgery. This allows the bone and cartilage of the knee to gradually adapt to its environment after surgery. The incisions should be kept clean and dry for the first 3 days after surgery. Showering lightly is allowed after 3 days but wounds cannot be submerged under water for at least 3 weeks. Driving should be avoided while you are wearing the brace, under the influence of pain medication, or your knee lacks motion and strength. Physical therapy will be required to restore motion, strength, and proprioception (balance) following surgery and may take anywhere from 4 to 6 months for a meniscal repair and 6-12 weeks for a partial meniscectomy.

A patient may return to light (sedentary) work or school the day after surgery for a partial meniscectomy and a long weekend after a meniscal repair as long as  the pain is tolerable, and you are able to elevate your leg appropriately. It is important to avoid “overdoing it” with the involved leg during this time to avoid aggravation or re-injury to the healing structures. Additionally, it is imperative that the patient work on restoring strength and full extension to the knee following surgery. Frequent stretching and strengthening should be a priority and can be performed while simultaneously working on deskwork tasks.

After the knee is fully rehabilitated, Dr. Chudik’s Return to Sport Testing is performed to determine that the knee is fully rehabilitated and more importantly, that any errors in movement patterns known to put patients at risk for knee injury are corrected. Once this assessment is successfully completed. Patients may return to sport activity. Timelines for return to sport vary depending on the sport and position and typically requires between 4-6 months for meniscal repair and 4-6 weeks for partial meniscectomy.

Meniscus repairs perform well over the long term, especially when maintained with an appropriate regime of strength training, flexibility, and non-impact exercises. In general meniscectomies are associated with good symptom improvement, as well as relatively rapid recovery from surgery, but increased potential for developing arthritis. Most importantly, non-impact activities such as biking or swimming are well tolerated and are good healthy options for exercise following meniscal surgery. It is important to remember that joint with a history of injury such as a meniscus tear are at higher risk to develop arthritis.