Meniscus Injuries

racquetball player without hip or knee pain

What is the meniscus?

The meniscus refers to two C-shaped pieces of cartilage in the inner (medial) and outer (lateral) portions of the knee. The meniscus is an important part of the knee joint because it absorbs about a third of the impact pressure across the knee joint. Without its protective padding, you would feel a painful rubbing of the leg bones in the knee as you move.

meniscus_anatomyThe anatomy of the menisci are important, since the location of a meniscal tear determines the treatment that be performed successfully. The outer one-third of each C-shaped meniscus has a rich blood supply. A tear in this “red zone” may heal on its own or can be repaired with surgery. However, the inner two-thirds of each meniscus lacks a blood supply. Without nutrients from blood, tears in this “white zone” will not heal reliably, even with surgical repair. Therefore, surgery for tears in this zone simply trim away what is torn.

What are meniscus injuries?

Meniscal injuries are one of the most common types of knee injuries. Sometimes, a meniscus injury is the result of trauma, but meniscal injuries are often due to a minor motion across a meniscus that is already damaged.

What are the different types of meniscus injuries?

There are several different types of meniscal tears, based on the location, shape, and cause of the tear. A knee specialist can determine the best treatment options for a meniscal tear, based on these features. Meniscal tears can affect either the medial or lateral menisci or both. The different shapes of meniscal tears include:

  • Longitudinal
  • Parrot-beak
  • Flap
  • Bucket handle
  • Complex

The mechanism of injury, or how the meniscal tear occurred, is an important factor when considering different treatment options. Meniscal tears can occur suddenly during activity involve squatting, twisting, or a direct blow to the knee. These are “acute” meniscal injuries. Meniscal tears that develop over time are called “degenerative” meniscal tears, and they usually occur in patients with underlying knee arthritis. Over time our meniscal tissue becomes brittle and more prone to tears. Sometimes it only takes very minor trauma (getting up from a chair or a gentle twist of the knee) to cause a tear.

What causes meniscus injuries?

Meniscal tears typically result from trauma (such as sports injuries) or from long-term wear and tear to the knees. As you age, your knee cartilage weakens, making the menisci more prone to degenerative meniscal tears. Once weakened, a tear may occur with even the most simple movements, such as squatting, stepping, or getting out of a chair.

What are the signs and symptoms of meniscus injuries?

Symptoms of meniscus injuries vary depending on the severity and location of the tear. Symptoms may include:

  • Slight pain or swelling
  • Pain at side or center of knee
  • Swelling that increases over the course of a few days
  • Stiffness in the knee
  • Inability to move the knee joint with full range of motion
  • Pain when squatting or twisting
  • Popping feeling in the knee
  • Locking up / tension in the knee
  • Inability to straighten the knee
  • Feeling that the knee “gives way” or is unstable

How are meniscus injuries diagnosed?

Dr. McLawhorn will start by asking you a series of questions to better understand your current bone and joint health, and he will ask about the specific history related to your knee injury. In addition to a medical history, a thorough physical evaluation will be performed. If necessary, imaging may be recommended in order to evaluate the health of the joint and determine whether your knee pain is being caused by a meniscal tear. X-rays are a good first screening test to determine if there is any underlying knee arthritis. MRI may be necessary if there are further questions about the health of the bone, cartilage, menisci, ligaments, tendons, or muscles around the knee. MRI determines how severe a tear is, its location, and surgical options for patients who do not achieve significant symptom relief with nonsurgical treatments.

How are meniscus injuries treated?

Often, meniscal tears can be treated with nonsurgical treatments. Dr. McLawhorn is committed to personalized care for all of his patients, using evidence-based methods and nonsurgical treatment options whenever possible. Nonsurgical treatments for meniscal tears may include:

  • Rest, Ice, Compression, and Elevation (RICE)
  • A brief period of activity modification
  • Anti-Inflammatory medications
  • Knee injections
  • Physical therapy

When meniscal tears are severe or are not responding well to conservative treatment options, a surgical procedure may be necessary. Meniscus surgery options may include:

  • Knee arthroscopy is a type of less invasive knee surgery that can be used to treat a torn meniscus. The surgery is performed through several small incisions in the skin that allow a small fiberoptic camera and precision surgical instruments to be introduced into the knee. Depending on the type and location of injury, the torn portion of the meniscus will be either repaired or removed. Arthroscopic knee surgery is a reliable option for acute meniscal tears that do not respond to nonsurgical care.  It may also be used for patients with mild to moderate knee arthritis and a symptomatic degenerative meniscal tear. However, the results from this procedure are less reliable and sometimes may actually worsen knee pain and accelerate the need for partial or total knee replacement.
  • Knee arthrotomy is an open knee surgery that involves making an incision over the knee joint in order to repair or remove the damaged meniscus. This procedure is rarely necessary, given modern arthroscopic surgical techniques.

If you believe you may be suffering from a meniscus injury, it is important to seek advice from an orthopedic knee specialist to accurately diagnose and treat your condition.  Dr. McLawhorn is a hip and knee specialist at Hospital for Special Surgery serving patients in New York City, Westchester, and Stamford, Connecticut, with extensive training in diagnosing and treating meniscus injuries. To learn more, call 203-705-2113 (CT) / 212-606-1065 (NYC) today or schedule an appointment by using the form on this page.

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