Over 1 million people go to the emergency room and almost 2 million people go to the doctor each year in the United States because of acute knee pain. Since the knee joint is one of the major weight-bearing joints in the body and can support 2 to 5 times a person’s body weight depending on the activity, this really isn’t surprising. While some pain may be caused by long-term overuse, certain activities are known to more commonly cause specific knee injuries. For instance, meniscus tear injuries often occur from twisting injuries. Athletes participating in sports such as football, soccer, basketball, pickle ball or tennis, who may change direction quickly may place enough stress on the knee to cause a tear. On the other hand, as we age, it is possible to tear a meniscus with minimal stress. If you or someone you know had a minor tear, the treatment may have been as simple as rest, elevation, ice, exercise and/or a brace. However, a severe meniscus tear may require different treatment options.
What is a Meniscus Tear?
The knee joint is large and complex. It consists of the two bones of the lower leg (tibia and fibula), the thigh bone (femur) and the kneecap (patella). There are also strong tendons connecting the bones to the muscles that support the joint, and ligaments that stabilize the knee. The knee also has 2 menisci that are shaped like crescent moons made of cartilage. These menisci are rubbery tissues that act like shock absorbers to help to absorb and spread out the force of impact activities on the knee joint, as well as supporting and stabilizing it during rotation. Often during a twisting or turning injury, stress placed on the joint will cause a meniscus tear. In younger people this often occurs during physical activity such as playing sports, however in older adults, a simple twisting motion or missed step can cause a tear.
How Will I Know if I Have a Torn Meniscus?
If you have had a very active weekend, maybe a strenuous workout, being sore for a few days may be expected, but acute knee pain is not normal. If you recently were playing a sport, you may or may not have noticed that you were injured. Some people can continue to participate in activity, while others have immediate pain. The more severe the tear, the more likely you will experience pain right away. Some people also experience a tearing or popping sensation at the time of injury, or the knee can give way and cause a fall. Within 24 hours you would usually experience swelling, and you may notice you have difficulty moving your knee or walking. Twisting, pivoting or squatting may be difficult. If left untreated, you may also notice your knee popping, locking or giving out. However, you will not know definitively if you have a torn meniscus without seeing a doctor.
Orthopedic surgeons are experts in treating knee pain and injuries. During an exam, they will be able to evaluate if you have symptoms of a meniscus tear by asking you questions, having you perform certain movements, and examining your knee joint. As part of the evaluation, you will receive an x-ray to evaluate for a fracture or arthritis. After an examination and basic x-rays, if your symptoms are consistent with a meniscus problem, and conservative treatment was not helped, an MRI (magnetic resonance imaging) will be obtained to find out if there is a tear and to determine the extent and size. If the meniscus is torn, it is a piece of rubbery tissue without a good blood supply, and does not heal by itself. Typically, a minimally invasive arthroscopic surgery is done remove the damaged portion of the meniscus and keep the healthy part, or sometimes to repair certain types of special tears.
What Treatments are Available for Severe Tears?
Anyone with a meniscal tear will start with the basics of orthopedic injuries. It is advised to rest, elevate your leg and ice the injury. A brace and crutches might be necessary. Activities that put a lot of stress on the knee like squatting, kneeling, twisting, climbing stairs, running or dancing should be avoided initially, but straight-line walking is typically ok. Conservative treatment includes exercises that strengthen the quadriceps muscles that support the knee. However, with more severe tears or symptoms, referral to an orthopedic surgeon for evaluation should be considered. Severe injuries would be suspected if you couldn’t resume your activity after the injury, if your knee is locked and difficult to move, has significant swelling, or if 4 to 6 weeks of conservative treatment doesn’t work.
A meniscectomy is a surgical procedure performed by an orthopedic surgeon to remove all or part of a torn meniscus. Typically only the damaged portion of the meniscus is removed, keeping the healthy portion. The ultimate type of surgery will be recommended by your orthopedic surgeon and will take into account the severity of the tear and where the tear is, as well as your age, health history and activity level. This procedure is usually done with an arthroscope, a surgical telescope the size of a pencil, so that your surgeon can examine your joint and do the necessary treatment for the meniscus at the same time. The arthroscope is a thin tube with a camera and light at the end. Small poke-hole incisions around your knee will let your orthopedic surgeon use instruments to repair or remove the damage. Arthroscopic surgery is usually easier on the knee as far as recovery and promotes a fuller and quicker recovery than older open incision procedures. Depending on the type of tear you have, your surgeon will either remove just a portion of the meniscus while smoothing the remaining edges, or rarely the entire meniscus if it is irreparably damaged. After surgery you should expect to be able to bear weight right away and be back to many aspects of full activity in about a month. Your orthopedic surgeon will design a rehabilitation regimen and timetable that is specific to your needs.
If you suspect that you have a meniscal tear, or are experiencing knee pain and/or swelling, your next step should be to seek the expert advice of a board-certified orthopedic surgeon. Our friendly team is here to answer your questions about knee injuries or any other problems with your bones or joints. Call the offices of Dr. Brett Gilbert at (919) 788-8797 or you can request an appointment with Dr. Gilbert using our appointment request form, or you can self-schedule your appointment here.