I get many questions about meniscus tears of the knee and management. Here is a blog to clarify many of your questions about meniscus tears.
The knee menisci are 2 wedge shaped fibro-cartilagenous structures located between the femur and the tibia. They are essentially the shock absorbers of our knee joint. In other words the axial load on the knee is absorbed and displaced longitudinally through out the joint.
Back in the old days, surgeons believed that the menisci served no purpose and completely removed it in many surgeries !!!! Follow up years of research (http://www.mdalert.com/article/surgery-for-torn-meniscus-in-the-knee-is-often-unnecessary-ineffective-misdirected) showed that excision of the menisci causes significant acceleration in joint space and cartilage loss and progression to advanced osteoarthritis. Glad we are not doing that anymore!!
The blood supply to the meniscus is also important. The peripheral portion of the meniscus does contains a blood supply that can heal. The central part of the meniscus does not contain a blood supply, making it harder to heal.
There are different types of meniscus tears:
Longitudinal Meniscus Tear: These tears parallel the long axis of the meniscus. Basically the tear divides the meniscus into an inner and an outer part. A bucket handle tear is a displaced longitudinal tear.
Horizontal Meniscus Tear: These tears divide the meniscus into a top and bottom portion. (Think of opening up a PITA Bread). You are essentially dividing the top and bottom into equal parts. These tear can also be associated with an Oblique component. They can also be associated with a perimeniscus cyst.
Radial Meniscus Tear: These tears run perpendicular to the long axis of the meniscus. They are almost always to due high energy trauma. They start at the inner margin and go either partial or all the way through the meniscus, dividing the meniscus.
Complex Meniscus Tear: Is a combination of some of the above tears mentioned. They are usually associated with trauma.
Familiarize your self with the pictures provided below regarding meniscus tears.
In young people, meniscus tears are usually due to trauma from sports injuries such as soccer, football or skiing. Many times, there is a rotational aspect to the trauma. They are often associated with other injuries such as ACL (Anterior cruciate Ligament) MCL (Medical Collateral Ligament) or LCL (Lateral Collateral Ligament) injuries.
In the elderly, meniscus tears usually have a degenerative and long term wear and tear component. This can be exasperated by even a minor trauma.
Although meniscus tears can be can be inferred by physical exam, the gold standard to diagnose a meniscus tear and the type is by MRI.
Treatment for a meniscus tear:
REST: Limit activities that make your knee painful, including walking. Use crutches if needed.
ICE: This helps reduce pain and swelling. You can do it for 15-20 minutes, 3 to 4 times a day, for a few days. Wait at least 1 hour between each icing session.
COMPRESS: Use neoprene sleeves or elastic wrap to help control and reduce your swelling.
ELEVATE: Use a pillow under your heel when you are sitting or lying down.
PLATELET RICH PLASMA THERAPY (PRP)
If RICE and conservative treatment have not helped, PRP can be an effective additional treatment in healing meniscus tears. In this procedure, a small volume of blood is taken from the patient (just like any other lab test) and spun down in a centrifuge. The separated plasma rich in platelets and growth factors is injected into the knee joint under real time ultrasound guidance. Make sure that this procedure is always done under ultrasound guidance. Even though the knee joint is an easy joint to access, it only takes a few millimeters to be in the wrong place. Having done a large number of knee injections, I have had many cases that are not straight forward and ultrasound has helped make sure that I was in the right spot.
Arthroscopy is a surgical procedure where a tiny incisions are made in the knee and a camera (arthroscope) and a variety of instruments are inserted into the knee joint to treat knee disorders such as meniscus tears, ACL tears and articular cartilage tear.
If you experience locking and difficulty bending and straightening your knee, you may have a displaced meniscus fragment causing these symptoms. Large or displaced meniscus tears, possibly from sports injuries, may also involve other injuries including tears of the ACL, MCL, and LCL. In these cases, the damaged and displaced meniscus will usually be resected. Resection of the fragments will help relief knee locking and difficulty bending or straightening the knee. The down side to meniscus resection is that there is less cushion in your knee joint and in the long term, you will almost always accelerate joint space loss and development of osteoarthritis.
If you have a meniscus tear, do your best to heal with conservative treatment including RICE and PRP.
If you have a meniscus tear with displaced or loose fragments and experience locking in your knee joint, then you probably need arthroscopic surgery.
If you can, it is best to try to avoid resection of your meniscus. Just think of it, once you cut out your shock absorbers, you increase the amount of pressure of the impact on your knee cartilage and accelerate your chance of developing arthritis.
Posted on behalf of Advanced Healing Institute
22972 El Toro Road
Lake Forest, CA, 92630
Phone: (949) 239-3206