Meniscus Tears

The meniscus is the cartilage between the femur (thigh bone) and tibia (leg bone) in the knee. This is a rubbery like structure which is a shock absorber between the two bones. Each of the bones themselves is covered in articular cartilage which is a very smooth surface, and this cartilage is smoother and has less friction when in contact with itself than ice gliding on ice when normal and healthy.

The meniscus can tear in multiple ways and multiple directions. Meniscus tears may occur in multiple ways including getting up from a low seated position especially with twisting, from a violent twist of the knee, landing awkwardly from a jump, or sometimes just from wear and tear like the knee on a pair of jeans can tear from overuse. The meniscus is a C shaped structure and is thinner near the center of the knee and can be very thick near the periphery. So some tears may be very small with just some slight fraying near the center of the knee (free edge tears) and some tears may be much larger. Also some tears are more stable (meaning they don’t flip back and forth) and some tears may be unstable (where they fold over on themselves or they displace into the middle of the knee). Stable tears tend to be less painful than unstable tears. In one large study 63% of meniscal tears were found to be asymptomatic (not pain generating). To make matters more complicated some knees have degeneration of the articular cartilage (loss of the cartilage on the bone) which can also cause pain. This is considered to be arthritis. Sometimes there is an additional injury to the underlying bone deep to the cartilage which also can cause pain. Both of these conditions can cause pain and may be the more significant reason why a person’s knee is painful. Sometimes it is a combination of the meniscus, the articular cartilage injury or arthritis, and the bone injury that is the reason for the pain. Also some meniscus tears are repairable (meaning they can be sewn back together) and some are not repairable as they have no healing potential. In the ones not repairable the torn meniscus tissue is removed so it doesn’t flip back and forth and cause pain.

When trying to decide treatment options for a patient with a meniscus tear all of these issues need to be considered. Surgery may be contemplated urgently in patients with a repairable meniscus and no arthritis. In the unrepairable meniscus, especially with a stable meniscus tear, conservative treatment (physical therapy, NSAIDs, injections, and time) should be considered as the first and second line of treatment prior to surgery. Those with unstable tears may do a shorter trial of conservative treatment prior to surgery. Lastly those with arthritis or bone injuries should proceed to surgery with caution as relief of pain may be limited due to these other conditions as most arthroscopic surgeries don’t address the pain caused by arthritis or bone injuries.

When you are being evaluated for possible arthroscopic surgery after being diagnosed with a meniscus tear, the surgeon should discuss these points with the patient so the patient may make an informed consent about whether to proceed to surgery or not. The award-winning Long Island knee surgeons and specialists at Total Orthopedics & Sports Medicine treat knee conditions of all kinds. Our knee program is led by Board Certified orthopedic surgeons Dr. Charles Ruotolo, Dr. Brett Spain, Arthroscopic Sports Medicine Specialist Dr. Richard McCormack, Dr. Champ Dengenis and Dr. Jonathan Owens. Patients can be seen and treated at multiple Long Island and NYC locations. Contact us today to learn more about treatment options.