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 their 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 with or 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 osteoarthritis. Meniscus tears are by no means the only cause of osteoarthritis. However, they certainly are 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. Our skin tissue is regenerative, same with some 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”. A lot of times people will note that they simply 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.
Why 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. Many of you will also find you need to sleep with a pillow between your legs at night.
A meniscus tear hurts because they sometimes irritate the lining of the knee joint called the synovium. Tears can also hurt if there is a loose piece which is getting caught in the joint.
Types of meniscus tears?
What are the different types of meniscal tears? The majority of tears 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. 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. 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 flap 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.
We Treat Patients, NOT MRI findings…
Many patients with meniscus tear pain will improve within a few weeks of onset… in many cases there is not need to rush into surgery.
- If your pain is starting to improve and
- if the pain does not interfere with your quality of life and
- 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? Not all “tears” require surgery. Again, we as physicians need to treat the patient, and not the disease.
Consider this article which demonstrated that a sham surgery (incisions made, but nothing done) was no better then treating a meniscus tear when the patient had a degenerative meniscus tear. There are also plenty of studies which show that a degenerative tear can be treated with physical therapy.
How are meniscus tears treated?
If you have knee pain, 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. If you sustain an injury and you have an unstable tear, a tear we call a horizontal cleavage tear, a radial tear or a flap tear — those are the tears tend to remain bothersome. 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?
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 meniscus 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, what should you expect as your recovery from an arthroscopy for a meniscus tear?
Stay abreast of the latest information on meniscus tears via our Sports Medicine Blog
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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If you reside in Westchester or Dutchess County, NY… and are in need of Orthopedic treatment, 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.