Meniscus tears are very common. The meniscus is a cushion within the knee. We have two menisci. The medial meniscus on the inner side of the knee and the lateral meniscus on the outer side of the knee. A meniscus tear is commonly due to aging, wear and tear, and injuries.
Let’s explore:
- What is a Meniscus and its function?
- How does a Meniscus Tear occur
- Why does a Meniscus Tear hurt?
- What types of Meniscus Tears are there?
- Does a meniscus tear require surgery?
What is a Meniscus?
A meniscus 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 so it’s present on the bottom of the femur and on the top of the shinbone or the tibia.
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. That is by no means the only cause of osteoarthritis. However, it is certainly a significant contributor.
How does a meniscus tear occur?
Many of the patients I see each week who present with knee pain are suffering from a meniscus tear. Some of the patients I see are young and have healthy meniscus tissue that tore as the result of trauma. But the vast majority of patients I see with a meniscus tear are over 35-40 and do not recall any injury. Why does a meniscus tear so easily once we reach our fourth, fifth decades and beyond?
Our meniscal tissue is non-regenerative. That means it has a very poor ability to heal itself. 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.
Many of our tissues in our body are injured by “repetitive micro-trauma”. A meniscus 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 tears (this is why most tears are called degenerative tears). Sometimes the meniscus 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?
Initially, after a meniscus tear occurs you may have pain all the time – and with all activities. Don’t despair. In most situations, the pain improves dramatically over the next few days to weeks (one reason not to rush into an MRI machine). 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 usuall, they’ll tolerate walking in a single direction very well. Patients with meniscal tears will 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 tear is large will complain that the knee is buckling or giving way or feels unstable.
Now… that being said… there are plenty of you out there who have tears and do not even know it. Not all tears hurt.
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. More on that later!
Types of meniscus tears?
What are the different types of meniscus tears? There are degenerative meniscus tears . When you look at it, the edges are simply frayed. The tissue has been worn out 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 tears, and these tears can have different shapes and different patterns. The tear shape or 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 gonna have pain with many activities. You’re not going to tolerate meniscus 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.
Most people with degenerative meniscus 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 surgery ( arthroscopy ) for treatment of those tears.
So the decision as to whether or not 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 surgery is necessary!!)
Do meniscus tears require surgery?
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 a very unstable meniscus tear, a tear we call a horizontal cleavage meniscus tear, a radial meniscus tear or a meniscus flap tear, those tears tend to remain symptomatic(bothersome)—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.
Bottom Line:
So if you have a meniscal tear, it’s not all doom and gloom. Many meniscus tear(s) do not require surgery. Some of them do. Some meniscus tears are repairable. Some are simply removed.
We try to repair as many meniscus tears as possible – but only certain meniscus 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.
And by no means is this urgent surgery or emergency surgery. Take your time, rest and consider a second opinion.
What is the best treatment for your Meniscus Tear or Cartilage Tear ?
Know your options. Contact me if you have any questions about Meniscus Tear or Cartilage Tear injuries.
If you live in Dutchess or Westchester County, NY … Contact us at 914.789.2735
As always, my disclaimer applies.
