Things to Consider Prior to Surgery
The meniscus is the fibrocartilage between the two bones of the knee. There is a meniscus on each side of the knee, the medial and lateral meniscus. These are important for normal knee function and injury to the meniscus can cause pain and damage to the knee joint.
The meniscus function is in load transmission and shock absorption with the meniscus transmitting 50-90% of the load across the knee joint. They also aid in knee stability as well as nutrition and lubrication. The meniscus prevents friction between the two bones and allows for the diffusion of the normal joint fluid.
The meniscus can be injured by multiple mechanisms. Common injuries occur getting up from a squatting position, twisting the knee, an axial load such as landing hard on the knee during a jump, and long term wear and tear. Each of these mechanisms can cause a different type of meniscus tear and different size meniscus tear. The meniscus can also be affected by tears or strain on the ACL. Treatment for the meniscus tear should be guided by type of tear, size of tear, and associated knee problems. Other associated problems can be osteoarthritis, ligament injuries, and malalignment. Malalignment commonly occurs when the knee is bow legged or knock kneed causing excessive weight on one side of the knee. All of these factors should be considered when deciding on treatment for a meniscus injury.
Most meniscus tears are initially treated with conservative treatment meaning rest, ice and anti-inflammatories for swelling, and possibly physical therapy for stiffness or weakness. Many meniscus tears can become pain free with time. In one study 63% of meniscus tears found on MRI were asymptomatic. Reasons for early surgery are typically for tears that need to be repaired such as bucket handle tears, root tears without osteoarthritis, and oblique tears in younger patients that involve the entire meniscus. Other reasons for early surgery would be for any other type of tear that has a large flap causing the knee to catch or lock. In many of these situations the meniscus is not repairable and the portion that is displaced is removed. This is called a partial meniscectomy. All of these procedures are done through small incisions with a camera and are outpatient surgeries where the patient goes home the same day of surgery. Many tear patterns should almost always be treated conservatively on initial presentation including horizontal tears, free edge tears, and degenerative complex tears with osteoarthritis. Seeing an orthopedist who reviews the MRI images, your symptoms and exam is important is determining the correct course of action.
Visit The Knee Center at Total Orthopedics & Sports Medicine to learn more about knee injuries including meniscus tears and how our award-winning orthopedic surgeons can help you with the proper treatment.