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September 19th, 2018
Woman with Joint Pain in the Knee Lake Forest CA

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:

RICE PROTOCOL

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

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.

Bottom line:

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

Our Patient Reviews

Advanced Healing Institute

5 / 5.0

Based on 36 reviews

Rich G.

Dr. Reza is a genius. My knee has been bothering me for YEARS since I tore my meniscus playing football. Achy, bothersome, with occasionally a limp. I went into to get PRP (Platelet Rich Plasma) and it was everything I thought it would be and then some. The whole procedure took less than an hour, very little to no pain and in less than 24 hours my knee felt brand new. If you are looking for a quality Doctor who offers PRP -- go here! The rates are very on point. He is literally THOUSANDS of dollars less than some other clinics and believe me he does such an amazing job, he could charge 10x's and it would still be worth it. Don't sit there suffering, get up and get help. I am actually thinking of getting my other knee done and its not really necessary. Lol.. 10 STARS...

E Y.

Dr Reza is FANTASTIC. Staff is friendly and very accommodating. I was in such pain. He diagnosed the issue (Bursitis) and clearly understood everything about it from A-Z. So efficient and understanding, not to mention making the procedure painless. I barely slept a hour the night before, saw Dr. Reza at 5pm and was feeling a million times better by 7pm. It's been 36 hours and I went from practically a frozen shoulder in pulsating pain to gaining back 70% of my movement range and most importantly "NO PAIN". just stiffness which is the normal symptoms as kindly explained to me by Dr. Reza. Everything is as promised, I am fully confident that I will be back to 100% range of motion within 3 days. I'm still gonna take it easy and slowly stretch my shoulder back to full strength. Without his service, I would probably be feeling like I was hit by a truck laying in bed miserable. Thank you very much Dr. Reza for helping my aging old bones. Cheers!

Geri C.

I can’t say enough about how intelligent Dr. Reza Dehdari is! I came to him to read my MRI for my ankle and he found a tear that multiple Doctors missed!!!! Simply incredible and I trust him throughly. Thank you so much!

Marina S.

Had the PRP procedure and I have to say no pain at all, going on 6 weeks, if you decide to have the PRP listen to Dr. Dehdari's instructions thoroughly and do the physical therapy, it works and I am so pleased and it's getting better and better as days go on, Dr. Reza Dehdari is the best and very emphatic in explaining all your questions soothing away your doubts, and he checks up on you to make sure all is well, after the PRP procedure. Very trustworthy PRP procedure and his assistant Sandy is also the sweetest caring person you will ever meet. I'm a satisfied customer and patient.

Tara E.

My son went to see Dr. Reza for a shoulder injury he received from repeated use due to training. My son had tried physical therapy and a cortisone shot with little success. Dr. Reza thoroughly explained the benefits of PRP (Platelet Rich Plasma) and he felt confident he could help my son. The procedure itself is amazing and my son was comfortable the entire time. I LOVE the fact that my son's own body was healing itself without the use of drugs. His shoulder is so much better and he was able to resume training after two weeks. I would highly recommend the PRP shot with Dr. Reza and will definitely see him again if the need arose.

Helena L.

Within the last 6 months I've suffered two minor injuries on the same knee which have restricted my mobility and caused me a lot of pain. I've seen an orthopedic dr.,, a pain management dr., and a sports medicine dr., all of which simply told me either surgery or learn to live with the pain! I've heard about PRP as an alternative with a high percentage of success. Thus, I made an appointment to see Dr. Dehdari, and was pleasantly surprised by his high level of knowledge, professionalism and thoroughness. Dr. Dehdari reviewed my MRI (previously ordered by the Orthopedist) explained the extent of my injuries, took X-Rays and an ultrasound to carefully determined if I was a good candidate for PRP. I can only say that I wish more doctors will give you the time, attention and care that Dr. Dehdari provides. Thank you Dr Dehdari, thank you for such high work ethics and patient care. Many thanks to his staff as they are as attentive and caring as Dr. Dehdari. It has been only 24 hrs since I received my PRP treatment and my pain levels have drastically gone down! I highly recommend Dr. Dehdari.

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