MENISCAL TEARS

 Anatomy

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The meniscus is a wedge-shaped disc of shock-absorbing cartilage between your thigh bone (femur) and shin-bone (tibia). There are two menisci in each knee - one on the inside (medial meniscus) and one on the outside (lateral meniscus).

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Each is made of strong fibrocartilage and shaped like the letter "C". They help transmit weight from one bone to another and play and important role in knee stability.

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Overview

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Meniscal tears are a common injury and can result from acute trauma or as the result of degenerative changes over time. Tears are noted by how they look, as well as where the tear occurs in the meniscus. Common tears include bucket handle, oblique, and radial.

Causes

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Acute meniscus tears often happen during sports. These can occur through either a contact or non-contact injury (for example, a pivoting or cutting injury).

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As people age, they are more likely to have degenerative meniscus tears. Aged, worn tissue is more prone to tears. An awkward twist when getting up from a chair may be enough to cause a tear in a degenerative.

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Tears of your menisci can be associated with injuries to other soft tissue structures in the knee such as the anterior cruciate ligament (ACL).

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Symptoms

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The most common symptoms of a meniscus tear are:

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• Pain

• Stiffness and swelling

• Clicking, catching or locking of your knee

• The sensation of your knee giving way

• Inability to move your knee through its full range of motion

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Treatment

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Treatment will depend on a number of factors, including your age, symptoms, and activity level. They will also consider the type, size, and location of the injury.

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The outer one-third of the meniscus has a rich blood supply. A tear in this "red" zone may heal on its own, or can often be repaired with surgery. A longitudinal tear is an example of this kind of tear.

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In contrast, the inner two-thirds of the meniscus lacks a significant blood supply. Without nutrients from blood, tears in this "white" zone with limited blood flow cannot heal. Because the pieces cannot grow back together, symptomatic tears in this zone that do not respond to conservative treatment are usually trimmed surgically.

 

Nonsurgical Treatment:

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Many meniscus tears will not need immediate surgery. If your symptoms are mild or intermittent and you have no locking or swelling of the knee, your doctor may recommend nonsurgical treatment:

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• RICE. The RICE protocol is effective for most sports-related injuries. RICE stands for Rest, Ice, Compression, and Elevation.

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• Non-steroidal anti-inflammatory drugs (NSAIDs) e.g. Ibuprofen and Naproxen can help reduce pain and swelling.

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• Steroid injection

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Surgical Treatment:

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Most acute tears will require surgical treatment. The options depend on the factors mentioned above but can be broadly summarised into:

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• Partial meniscectomy

  • This involves partial removal of the torn meniscus with trimming away of the damaged tissue. The procedure allows for immediate weight bearing and full range of motion soon after surgery.​

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• Meniscal repair​

  • Some meniscal tears can be repaired by suturing (stitching) back together​. The success of this procedure depends on the type of tear, its position, and the overall quality of the meniscus. Recovery time is longer compared to a partial meniscectomy, as the meniscus needs time to heal back together.