Meniscal tears

What is the meniscus?

The meniscus, or meniscal cartilage is a wedge-like rubbery cushion that sits between the two major bones (femur and tibia) of the leg and prevents them from grinding against each other. It works as a strong stabilizing tissue to help the knee joint carry weight, glide and turn in many directions.  It is shaped like the letter “C”, curving at the inside and the outside of each knee and is one of the most commonly injured parts of the knee.

What causes meniscal tears?

The meniscus can tear in a number of ways.  People who play football or other contact sports may tear the meniscus by twisting the knee, pivoting, cutting or decelerating. In athletes, meniscal tears often happen in combination with other injuries such as a torn ACL (anterior cruciate ligament). Older people can injure the meniscus without any trauma.  The meniscal cartilage weakens and wears thin over time and may result in a degenerative tear.

What are the symptoms?

Many patients describe a “popping” sensation when the meniscus tears. Most people can still walk on the injured knee and many athletes keep playing. If the surrounding tissues become inflamed as a result of the tear, the knee can become painful and tight. There may be stiffness and swelling, tenderness around the joint, and swelling in the knee (“water on the knee”).

Without treatment, a fragment of the meniscus may loosen and drift into the joint, causing it to slip, pop or lock (get stuck) often at a 45-degree angle.  The knee remains in this position until manually moved or otherwise manipulated.

How are meniscal tears diagnosed?

Most meniscal tears are diagnosed with a good clinical examination.  X-rays may be ordered to rule out osteoarthritis or other possible causes of knee pain. Sometimes a magnetic resonance imaging scan (MRI) is required to better assess the soft tissues of the knee joint.

Can Meniscal tears be treated without surgery?

Immediate treatment of a meniscal tear follows the basic RICE formula: rest, ice, compression and elevation.  Nonsteroidal anti-inflammatory medications are effective for pain relief.  If the knee is stable and does not lock, this may be all that is needed.  Blood vessels feed the outer edges of the meniscus, allowing small tears to heal themselves with rest.

What operation may be beneficial?

If the meniscal tear does not heal spontaneously and the knee becomes painful, stiff or locked, surgical repair may be required. Arthroscopy (key hole surgery) can be effective in trimming the damaged pieces of cartilage from the meniscus and providing relief from symptoms.  In young patients (generally less than 20yrs of age) the meniscus may be repaired.  The surgery offered depends on factors such as the type of tear, the presence or absence of an associated injured ACL, and the age of the patient.  .