One of the most common knee injuries is a torn meniscus. The meniscus is a piece of cartilage that provides a cushion between your femur (thighbone) and tibia (shinbone). There are two menisci in each knee joint, and these can be torn or damaged during activities that twist, rotate, or put pressure on the knee. Either conservative or surgical treatments may be recommended to improve symptoms and stability after a torn meniscus.
A meniscal tear can be the result of a direct injury or degeneration over time. Symptoms can include:
- Knee buckling
- Knee pain
- Knee swelling
- Knee stiffness
- Decreased range of knee motion
- A catching sensation in the knee
Treatment for a meniscal tear depends on the type and location of the tear. The location is important because certain parts of the meniscus can heal while other parts cannot. For example, a tear on the periphery of the meniscus may heal on its own or with the help of meniscal repair surgery, while a tear in the central part of the meniscus has little to no blood supply and may require meniscal debridement.
The cause of the tear is also an important factor. A tear due to a specific event or injury will likely need surgical repair, whereas a tear that has occurred gradually over time may respond well to conservative treatment. Lastly, factors such as age and activity level/goals (including a desire to return to athletics) will be considered when deciding between surgery and more conservative treatments.
- Physical Therapy (PT): PT is often recommended to regain knee motion and strength after a meniscal tear. PT may be advised in lieu of or in addition to surgery.
- Anti-Inflammatory Medication: Non-steroidal anti-inflammatory medications can decrease inflammation and pain due to a torn meniscus. Patients undergoing physical therapy may benefit from taking anti-inflammatory medications (over-the-counter or prescription strength) to reduce pain while they work to regain strength and mobility.
- Injections: Patients who need temporary pain relief or who cannot undergo surgery may benefit from injections to the knee joint. Injections may be comprised of steroids (anti-inflammatories), PRP (platelet-rich plasma to promote healing), or hyaluronic acid (to lubricate the joint and reduce inflammation).
- Surgery: For many patients, especially those with persistent pain that limits their activities, surgery may be necessary to restore a torn meniscus. The surgical options are either meniscus debridement (complete removal of the torn section of the meniscus) or meniscus repair (arthroscopic suturing of the torn edges together to help the meniscus heal). Which procedure is best for you will depend on your meniscal tear.
Frequently Asked Questions
A meniscus tear may be caused by an injury or by gradual degeneration over time. A torn meniscus can usually be recognized by localized pain on the inside or outside of the knee, swelling, buckling, stiffness, decreased range of motion, and/or a painful catching sensation in the knee. A diagnosis can be confirmed with a detailed history and exam, including x-rays and MRIs. These additional tests also determine whether the other soft tissue structures in the knee have been damaged as well.
The most common risks of not treating a meniscal tear are persistent pain, weakness, and stiffness from decreased use of the knee. Failing to undergo treatment when treatment is advised can prolong symptoms, limit physical activity, and even prevent a return to sports. If a torn meniscus causes minimal or no symptoms, treatment may not be necessary.
Patients whose meniscal tear is due to a specific injury or event will often be advised to undergo surgery. If the tear is degenerative, nonoperative treatments will usually be recommended as the first line of treatment. The type of tear, location of the tear, patient’s age, and patient’s activity level/goals (such as a desire to return to sports) will all be considered when deciding between surgery and more conservative treatments.
Meniscus repair and debridement are two different surgical procedures that can be performed to correct a torn meniscus. Meniscal repair surgery is an arthroscopic procedure in which the torn edges of the meniscus are surgically sutured together. This helps the cartilage to heal properly and preserves the full size of the meniscus. A meniscal debridement is a surgical procedure in which the torn section of meniscus is fully removed, leaving a smaller (but healthy) section of cartilage behind.
Several factors must be considered before determining which surgery is better for a torn meniscus. These include the age and activity level of the patient, quality of the tissue, type of tear, and location of the tear. A thorough evaluation will help determine the best course of action, but sometimes a conclusive decision cannot be made until the meniscus is assessed during surgery. Where possible, a meniscal repair is usually desirable, provided there is enough blood supply available at the location of the tear to promote full healing and functionality after surgery.
The meniscal repair recovery period is much longer than the recovery after a meniscal debridement. A supportive knee brace will need to be worn while walking and at night for 4 to 6 weeks after the procedure. Physical therapy (PT) will be necessary after surgery and may take several months; this is critical for a positive outcome and full healing. Full recovery, including resuming sports and athletics, may take 4 to 6 months.
A meniscal debridement can lead to full healing within 2 to 3 months. The use of crutches may be advised for the first few days of recovery to limit weight bearing, and patients can gradually increase activity levels as tolerated. Physical therapy (PT) may be recommended after surgery to assist with healing and ensure a positive outcome.