Meniscus tears are a very common source of pain in the knee. They are also commonly seen on MRIs obtained for other reasons – and are not necessarily the cause of your pain. Many people come in on a daily basis and ask if surgery for meniscus tear is always necessary. In this post we will explore what a meniscus is, what are meniscus tears , why meniscus tears are so common — and we will attempt to address the issue : Why meniscus tear surgery isn’t always necessary.
Howard Luks MD on what meniscus tears are and why many tears can be managed without surgery
Good morning. Let’s talk about meniscus tears. What is a meniscus? It is a cartilage disk that’s found in the knee. There are actually two of them. We have one on the inner side of the knee which we call the medial meniscus and one on the outer side of the knee which we call the lateral meniscus. These two disks function as shock absorbers or cushions to minimize the stress on another type of cartilage that we have in the knee which we call the articular cartilage. The articular cartilage is the cartilage that actually coats the ends of the bones. If the two menisci are not present or they’re torn, then the articular cartilage sees an increase in stress and can trigger the onset of osteoarthtitis. That is by no means the only cause of osteoarthritis. However, it is certainly a significant contributor.
Why do mensicus tears occur?
Now I see many patients every week who present with knee pain and many of them are suffering from meniscus tears. Why/How do we get meniscus tears? Why do these little meniscal disks tear so easily once we reach our fourth, fifth decades and beyond? Our meniscal tissue is non-regenerative. It’s similar to our brain or our heart tissues. If we have a heart attack or a stroke, we do not regenerate those areas of our heart or our brain. It simply scars in. Yet if we cut our skin, our skin heals. That tissue is regenerative, same with muscle and a lot of other tissues in our body.
The meniscus tissue in our knee has very few mechanisms for repairing itself. Therefore, every step that you’ve taken, every twist that you’ve done, every time you’ve knelt down or squatted down, you’ve put a force across that meniscus and eventually it wears out and the meniscus tears. (This is why most tears are referred to as being degenerative. Sometimes it tears just turning and reaching for something in your refrigerator. A lot of times people will note that they knelt down to pick up something up and when they went to stand up they felt something rip inside their knee and noted the onset of pain.
When does a meniscus tear hurt?
The typical patient with a meniscus tear doesn’t have much in the way of pain with walking straight ahead. Sometimes they do. It depends on the size of the tear but usually they’ll tolerate walking in a single direction very well. Patients with meniscus tears will occasionally complain of pain going downstairs. They’ll have pain getting up from a seated position. They’ll have pain with turning, pivoting and twisting and some patients, if the meniscus tear is large will complain that the knee is buckling or giving way or feels unstable.
I also see a number of patients in the office for a second opinion who have been told that they have a meniscus tear on an MRI which was obtained simply because they had pain one day and were immediately sent for an MRI (That’s a topic for another discussion) — and the MRI revealed a degenerative meniscus tear and now they’re being told by an Orthopedic Surgeon that they need surgery to “fix or repair that tear”– and they wonder if I agree.
Types of meniscus tears?
What are the different types of meniscal tears? There are degenerative meniscal tears . When you look at the cartilage disc, the edges are simply frayed. The tissue has been destroyed from years and years of use. Nothing you did wrong. The tissue simply wore out. Again, like my analogy with the rotator cuff, it’s like the front of a pair of blue jeans that you’ve worn for decades and the material just simply wore out.
Then there are those who have suffered more acute meniscus tears and these tears can have different shapes and different patterns — and based on the shape and pattern will determine how symptomatic or how bothersome the meniscus tear will be. If a loose flap of tissue is created and that flap is moving around within the knee—that’s when you’re going to have giving way and you’re going to have pain with many activities. You’re not going to tolerate those tears well and those patients with flap tears (or unstable tears) will usually (not always) go on to require an arthroscopy or a scope to try to either repair or remove that torn piece.
Most people with degenerative meniscal tears may have one or two exacerbations or periods during the year where their knee hurts but by and large they get around just fine and lead very active lifestyles with these degenerative tears and do not require an arthroscopy for treatment of those tears.
So the decision as to whether or not meniscus surgery is necessary is really based upon the pain you’re experiencing, the effects it’s having on your quality of life, the type of tear that you have and how long you’ve been experiencing the symptoms. ( It is (ultimately) YOUR DECISION whether or not knee surgery is necessary!!)
We Treat Patients, NOT MRI findings…
Most meniscus tear pain will subside within a few weeks of onset. If your pain start to improve. If the pain does not interfere with your quality of life. If your range of motion is well maintained and you can participate in your normal daily activities — then why would one consider meniscus surgery a necessity? Again, physicians need to learn to treat the patient, and not the disease.
How are meniscus tears treated?
If you have knee pain, you are referred for an MRI fairly early and you’re found to have a degenerative meniscus tear — I typically advise patients to simply just wait. A lot of times your symptoms will go away and either they’ll never come back or they’ll come back once or twice a year and you’ll still be able to lead a very active lifestyle. If you sustain an injury and you have an unstable tear, a tear we call a horizontal cleavage tear or a radial tear or a flap tear, those tears tend to remain symptomatic —and if after four, five, six weeks, you still have the same degree of discomfort and quality of life issues, then you might be a good candidate for an arthroscopy. Physical therapy can help those of you whose knees feel unstable or weak, and it can help those of you with significant swelling to gain back your motion, stability and strength. Therapy can be beneficial before surgery (pre-habilitation) , instead of surgery — or after surgery.
Do all meniscus tears require an arthroscopy?
What exactly is an arthroscopy? I suggest you check out my website further, where you can find some good animated videos about what exactly a knee arthroscopy entails. There is also a section that goes into even further detail about meniscus tears and the treatment alternatives.
Basically an arthroscopy involves bringing you into the operating room, inducing a light sleep, injecting local anesthesia and then placing a fiber-optic camera into your knee through a 1/4 inch incision. We then inspect the entire joint, find the tear and determine if it will be removed or stitched back into place. Most procedures take 15-45 minutes and you are able to go home the same day. Whether or not you can return to sports soon will depend on which procedure you had — repair versus removal. More on the recovery from meniscus surgery here.
So if you have a meniscuss tear, it’s not all doom and gloom. Many tears do not require meniscus surgery. Some of them do. Some meniscus tears are repairable. Sometimes the torn portion of the meniscus is simply removed.
We try to repair – or suture- meniscus tears whenever possible — but only certain tears are in fact repairable. One caveat: If you have a meniscal tear and you’re experiencing instability or giving way, be very careful with your activities. You don’t want to find yourself on the stairway carrying a load of objects and your knee gives way. If you have instability symptoms, make sure that you have a hand available to hold onto something at all times while you are in your recuperative phase or awaiting surgery or simply waiting to see if the symptoms are going to recover on their own.
Hope you enjoyed this post on – Meniscus Tears… Why surgery isn’t always necessary — for more information there is a more in depth section on meniscus tears here.
And by no means is meniscus surgery or emergent surgery. Take your time, rest and consider a second opinion.
After your meniscus surgery, if it proves “necessary, what should you expect as your recovery from an arthroscopy for a meniscus tear?
Due to the overwhelming success of this post, I want to make sure that the many and varied needs that each of you have are met during your visit here. With that in mind , you may benefit in reviewing these related posts on this site:
NIH Article on Meniscus Tears
Meniscus Tears: A more formal discussion
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Howard Luks MD
If you reside in Westchester or Dutchess County, NY… and are in need of Orthopedic care, feel free to contact us at 914-789-2735 to request a consultation
As always, my disclaimer applies. This is not medical advice. You should discuss these issues with your orthopedic surgeon or your family, friends and primary care doctor to determine if based upon your symptoms and quality of life you feel you would rather be treated surgically or without surgery. If you have any questions, feel free to hit me through my website, YouTube, Twitter, Facebook and wherever else I reside.