Meniscus Tear Surgery and Treatment

Meniscal tears are amongst the most common knee injuries. Athletes, particularly those who play contact sports, are at risk for meniscal tears. However, anyone at any age can tear a meniscus. When people speak about torn cartilage in the knee, they are usually referring to a torn meniscus.

Anatomy

Normal knee anatomy

Three bones meet to form your knee joint: your thighbone (femur), shinbone (tibia), and kneecap (patella). Two wedge-shaped pieces of cartilage act as "shock absorbers" between your thighbone (femur) and shinbone (tibia). These are called the meniscus. They are tough and rubbery to help cushion the joint and keep it stable.

Description
Menisci tear in different ways. Tears are noted by how they look, as well as where the tear occurs in the meniscus. Common tears include longitudinal, parrot-beak, flap, bucket handle, and mixed/complex. Sports-related meniscal tears often occur along with other knee injuries, such as anterior cruciate ligament tears.

Common types of tears

Cause
Sudden meniscal tears often happen during sports. Players may squat and twist the knee, causing a tear. Direct contact, like a tackle, is sometimes involved.

Older people are more likely to have degenerative meniscal tears. Cartilage weakens and wears thin over time. Aged, worn tissue is more prone to tears. Just an awkward twist when getting up from a chair may be enough to cause a tear, if the menisci have weakened with age.

Symptoms
You might feel a "pop" when you tear a meniscus. Most people can still walk on their injured knee. Many athletes keep playing with a tear. Over 2 to 3 days, your knee will gradually become more stiff and swollen.

The most common symptoms of meniscal tear are:

• Pain
• Stiffness and swelling
• Catching or locking of your knee
• The sensation of your knee "giving way"
• You are not able to move your knee through its full range of motion
• Without treatment, a piece of meniscus may come loose and drift into the joint. This can cause your knee to slip, pop or lock.

Imaging Tests
Because other knee problems cause similar symptoms, your orthopedic doctor may order imaging tests to help confirm the diagnosis.

X-rays. Although X-rays do not show meniscal tears, they may show other causes of knee pain, such as knee arthritis.

Magnetic resonance imaging (MRI). This study can create better images of the soft tissues of your knee joint and is very accurate at identifying meniscal tears as well as other commonly seen injuries such as an ACL tear.

Treatment
How your orthopedic surgeon treats your tear will depend on the type of tear you have, its size, and location. Along with the type of tear you have, your age, activity level, and any related injuries will factor into your treatment plan.

The outside 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 knee surgery. A longitudinal tear is an example of this kind of tear.

In contrast, the inner two-thirds of the meniscus lacks a blood supply. Without nutrients from blood, tears in this "white" zone cannot heal. These complex tears are often in thin, worn cartilage. Because the pieces cannot grow back together, tears in this zone are usually surgically trimmed away.

Nonsurgical Treatment

If your tear is small and on the outer edge of the meniscus, it may not require meniscus surgery. As long as your symptoms do not persist and your knee is stable, nonsurgical treatment may be all you need.

The RICE protocol is effective for most sports-related injuries. RICE stands for Rest, Ice, Compression, and Elevation. Rest: take a break from the activity that caused the injury. Ice: use cold packs for 20 minutes at a time, several times a day. Do not apply ice directly to the skin. Compression: To prevent additional swelling and blood loss, wear an elastic compression bandage. Elevation: To reduce swelling, recline when you rest, and put your leg up higher than your heart.

Non-steroidal anti-inflammatory medicines. Drugs like aspirin and ibuprofen reduce pain and swelling.

Physical Therapy. Proper rehabilitation exercises along with other modalities may help with symptoms and prevent further injury.

Surgical Treatment
If your symptoms persist with nonsurgical treatment, your doctor may suggest arthroscopic surgery. Los Angeles surgeon Dr. Samimi specializes in the treatment of meniscal tears using the minimally invasive technique of arthroscopic surgery to allow for quicker recovery and return to activity.

What Happens during the procedure?
Knee arthroscopy is one of the most commonly performed surgical procedures. Dr. Samimi uses arthroscopy to evaluate, repair or remove damaged tissue.

First, he will examine your knee with the arthroscope. The arthroscope is inserted into your knee through a small incision large enough to fit the small camera. The arthroscope is connected to a video monitor in the operating room. All the tissues of your knee joint -- the cartilage, meniscus, and ligaments are inspected.

Once a thorough understanding of the meniscus tear and any other problems are obtained, damaged tissues are either removed or repaired. To do this, small surgical instruments such as scissors, graspers, or motorized shavers are inserted into the knee joint through these same small incisions. Usually 2 to 3 small incisions are all that are needed in knee arthroscopy.

The procedure usually lasts 30 minutes to an hour depending on the findings and the treatment necessary.

At the end of the meniscus surgery, your incisions will be closed with stitches and covered with a dressing (bandage). Almost all arthroscopic knee surgery is done on an outpatient basis. Typically you will go home the same day followed by a course of physical therapy. You will be able to remove the bandage and shower 2 days after meniscus surgery. A band-aid will simply cover the small incisions.

Rehabilitation
Once the initial healing is complete, your orthopedic doctor will prescribe rehabilitation exercises. Regular exercise to restore your knee mobility and strength is necessary. You will start with exercises to improve your range of motion. Strengthening exercises will gradually be added to your rehabilitation plan.

Los Angeles orthopedic surgeon Dr. Samimi offers meniscus surgey at 3 location in West Covina, Encino and Brentwood / West LA.