The knee is one of the most complex and largest joints in the body and is more susceptible to injury. Meniscal tears are one among the common injuries to the knee joint. It can occur at any age but are more common in athletes playing contact sports. These tears are usually caused by twisting motion or over-flexing of the knee joint. Athletes who play sports such as football, tennis and basketball are at a higher risk of developing meniscal tears. They often occur along with injuries to the anterior cruciate ligament, a ligament that crosses from the femur (thigh bone) to the tibia (shin bone).
The meniscus is a small, "c" shaped piece of cartilage in the knee. Each knee consists of two menisci, medial meniscus on the inner aspect of the knee and the lateral meniscus on the outer aspect of the knee. The medial and lateral meniscus act as cushion between the thigh bone (femur) and shin bone (tibia). The meniscus has no direct blood supply and for that reason, when there is an injury to the meniscus, healing cannot take place. The meniscus acts like a "shock absorber" in the knee joint.
Diagnosis
A careful medical history and physical examination can help diagnose meniscal injury. The McMurray test is one of the important tests for diagnosing meniscal tears. During this test, the doctor will bend the knee, then straighten and rotate it in and out. This creates pressure on the torn meniscus. Pain or a click during this test may suggest a meniscal tear. The physician may order imaging tests such as knee joint X-ray and knee MRI to help confirm the diagnosis.
The symptoms of a meniscal tear include:
- Knee pain when walking
- A "popping" or "clicking" may be felt at the time of injury
- Tenderness when pressing on the meniscus
- Swelling of the knee
- Limited motion of the knee joint
- Joint locking can occur if the torn cartilage gets caught between the femur and tibia preventing straightening of the knee
Treatment
The treatment depends on the pattern and location of the tear. If the meniscal tear is not severe, the physician may begin with non-surgical treatments such as RICE:
- Rest: Avoid activities that may cause injury. Crutches may be temporarily used to limit weight bearing.
- Ice: Ice application to reduce swelling
- Compression: with an ace bandage, sleeve or brace
- Elevation: keep the injured knee elevated
- Pain medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) may help reduce swelling and pain
- Physical therapy may be recommended for muscle and joint strengthening.
If the symptoms are persisting and conservative treatment fails, a knee arthroscopic surgery to repair the torn meniscus may be necessary. When possible, arthroscopic surgery is preferred because it causes less muscle and tissue damage and leads to a quicker recovery. However, sometimes the tear pattern, location, or severity makes open surgery necessary. Surgery is almost always needed when a tear doesn’t heal with conservative treatment, such as rest or ice, the knee joint goes out of alignment or becomes locked.
There are two main approaches used for a meniscectomy: arthroscopic surgery is usually done using spinal or general anesthesia as an outpatient surgery, and the patient can go home the same day as the surgery. Open surgery requires a general or spinal anesthesia and possibly a hospital stay.
Partial meniscectomy is performed arthroscopically. The torn portion of the meniscus is resected. Partial meniscectomy refers to removal of only the damaged part. The physician attempts to try to preserve and sculpt as much of the remaining meniscus to try to minimize the chance of a re-tear. The surgery involves making 2 small incisions on either side of the patellar tendon, with one being used for the arthroscopic camera and the second used for the arthroscopic instruments. The meniscus tear is trimmed down and "cauterized" to remove any edges which could catch in the joint and cause further pain, but at the same point in time trying to preserve as much meniscus as possible. The recovery period following arthroscopic surgery is usually shorter than that for open surgery.
Total meniscectomy involves surgical removal of the entire meniscus. A large incision is made over the knee, so the entire knee joint is exposed. The joint is examined, and the tear is identified. The damaged meniscus is removed. Then the incision is sewn or stapled closed.
Recovery from a Total Meniscectomy procedure will take about four to six weeks, depending on the surgical approach used. Other factors that affect recovery time include severity of the injury, the patient’s overall health and usual activity level, adherence to physical therapy or home exercises. The pain and swelling get better quickly. By about the third day after surgery, the patient should be able to perform daily activities and return to work if the job doesn’t involve a lot of standing, walking, or heavy lifting. Driving may be allowed one to two weeks after surgery. Three weeks after surgery, previous muscle strength in the leg may be attained. By four to six weeks after surgery it may be possible to start playing sports and return to work that involves a lot of standing, walking, and heavy lifting.
- Recovery room stay for an hour or two.
- Knee will be painful and swollen as anesthesia wears off
- Swelling will be managed by elevating and icing your knee for the first few days after surgery.
- Pain medication, possibly an opioid, may be prescribed for the first two to three days.
- Or the knee may be injected with a local anesthetic
- Nonsteroidal anti-inflammatory drugs should be enough to relieve pain after the first three days or so.
- May need crutches for walking for about one week. The doctor will discuss how much weight to put on the leg.
- Physical therapy and/or home exercises may be prescribed to help the knee regain strength and mobility.