Meniscus tears are very common. Each knee has two menisci which serve as cushions. They can tear due to degeneration, or they can tear due to trauma or a sports injury. The treatment of a meniscus tear will depend on the type of tear you have, whether or not you also have osteoarthritis and the nature of your complaints.
Many people do not understand why many meniscus tears do not require surgery. Having a firm understanding of what the meniscus does and why some tears do not require surgery should go a long way in assisting you in your surgical decision-making.
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
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 meniscus 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 given 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 no need to rush into surgery.
- If your pain is starting to improve and
- if the pain does not interfere with your quality of life
- If compression sleeves work to control the pain
- 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 than 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 surgery, which we call 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.
Many patients feel that a compression sleeve makes them feel better and improves their sense of stability – see some of our patients’ favorite knee compression sleeves here.
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 ¼ 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. For more information there is a more in depth section on meniscus tears here.
And by no means is meniscus surgery or emergency 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?
Due to the overwhelming popularity of this post, I want to make sure that the many and varied needs that each of you have is met during your visit here. With that in mind, you may benefit in reviewing these related posts on this site:
Vicky
Hi Dr Luks
Thank you for your wonderful site and your helpful advice.
I am 64 and have medial meniscus tears in my right. The MRI scan notes that ‘There is a peripheral vertical tear of the body of the medial meniscus and there is meniscocapsular separation of the body and posterior horn of the medial meniscus. A small subcapsular medial and later joint effusion is present and extends into the suprapatellar bursa – possible media patella plica syndrome.’ Everything else is fine and my Xray shows no arthritic conditions.
I have an appointment with a sports-oriented orthopedic surgeon – my referring doctor has said that the OS will recommend an arthroscopy and, on investigation, is likely to remove the medial meniscus due to my age and the reduced healing capability of the meniscus.
What are the likely negative health outcomes eg arthritis etc resulting from the removal of the meniscus and what alternatives can I discuss with him – is an allograft at all feasible?
Thank you,
Vicky
Howard J. Luks, MD
Thanks for stopping by Vicky…
I assume you also have pain? Not a silly question believe it or not :-)
The treatment alternatives include
* time: just waiting to see if the symptoms will subside with time (not all tears hurt, and many will become nearly pain free)
*Physical Therapy — surprisingly useful for many
*activity modification – for some a reasonable option
*medications: natural (tart cherry juice) or routine anti-inflammatories (assuming you are allowed to and tolerate them)
*arthroscopy – many will do well… some will not. Middle aged women have a small, but not insignificant chance of getting a post-menisectomy (after arthroscopy) stress fracture in the bone. This can lead to numerous problems including the potential need for a knee replacement.
Lastly…. your tear IS in the repairable zone. Most middle aged folks do not have repairable tears… but sometimes they do. It is always best to attempt a repair, if the meniscus appears to be repairable. The risk is another arthroscopy down the line to remove a piece that doesnt heal. However, minimizing the risk of developing osteoarthritis is worth the risk. In my opinion.
Good Luck with your decision making.
Howard Luks
Vicky
Thank you so much – especially the reparable information!!! great to know and I will push this option. Other options very welcome and I really like the tart cherry juice version of an anti-inflammatory. Thank you again!
Vicky
Debbie
Hello Dr. Luks,
I injured my knee 2 years ago while doing Zumba. I twisted to my right and my knee didn’t make the turn. OUCH! I rarely experienced pain the last 2 years. Lately, I have intermittent pain while walking. My regular Physician advised that I do not need to see an Orthopedic Surgeon/Sports Medicine Doctor unless it is bothering me constantly. He also agrees with you that leave it alone as long as I am having quality of life.
Now for my question? The pain is more frequent & my hips are extremely tight. I used to be able to do Yoga and sit cross legged. Now, it is too painful to cross my leg & pulls my knee. I have also been doing an exercise program called barre Amped which is isometrics including squats & lunges. I’m fine while doing these exercises but feel the pain afterwards. Is the hip pain a secondary condition to the knee and are there stretches or exercises that I can do which will loosen my hips and leg muscles? Should I make an appointment with an Orthopedic Surgeon or a Sports Medicine Dr. to get a diagnosis?
Thank you for this website. I’m so glad I found it and your wonderful advice.
Howard J. Luks, MD
Thanks Debbie… I’m glad you found it useful. I would think that a set of X-rays and an evaluation by an Orthopedist might be able to tell you why your hips are bothering you. Hip pain can be secondary to knee problems if our knee pain alters our gait, etc. But if your gait is normal, then perhaps something in the hip is responsible for your stiffness and discomfort.
Howard Luks
Sandy
Hi Dr. Luks,
This site has been super informative. I love your approach to healing.
Obviously, I’m here for a reason. I’m a 39 yr old female runner, skinny. Run 40-50km a week. I’ve had varying degrees of PFS, but I’m stymied by something new on my left knee.
I don’t recall a specific injury, but my patellas pop etc regularly, and frankly, I could have done something and passed it off. No swelling or redness. I noticed a dull ache medial joint line, approx 3/5 of the way posteriorly. Deep palpation on the joint line here is painful. Deep squats or trying to lock my knee in extension brings along something akin to hitting my ulnar nerve! I cannot bring my heel to bum anymore.
This was three weeks ago, and I still ran on it until a week ago, when my GP suggested a rest. She won’t refer me for an MRI, which is fair enough, but driving me bananas when I want to know what lies ahead. After a week, the pain has not changed, although I am still doing some light swimming, and walking.
I am suspicious its a medial menisci tear. My knee feels a bit wobbly as well. Should I continue taking time off, or can a I continue to run through this? Will continued running make it worse? I was training for a marathon in November, and have another booked in February. Add that in to my runner’s brain…and you can only guess how this is driving me mad!! I need to lace up!
Thanks in advance!!! Sandy
Howard J. Luks, MD
Thanks Sandy .. I understand your plight, runners do have a very unique personality and NEED to run to feel complete. Tough for me to say what is bothering you. Likely suspects in that area include the meniscus, the pes tendons ( snapping tendons, or pes tendinosis, bursitis) as well a posterior articular cartilage injuries. Of course there are many other less likely possibilities. Getting runners to rest is very very difficult. Especially when you do not have a source of pain, and therefore do not know if it will improve with time, etc. If not an MRI, perhaps a visit to an Ortho will set you on the right course.
Good Luck
Howard Luks
Eshan Arora
hello sir,
My name is Eshan arora & i am from India.
On 8th July, 2012 i suffered an injury while playing soccer with my friends. At first the pain was unbearable and it took me around half an hour to go back to my house which in normal condition takes only 5 minutes. After reaching home i took some pain killers and applied pain relieving gel on my knee. For the next 2 weeks i had 0 activities and started doing my work slowly. after that i went to a physiotherapist and started my rehab their. After 2 months of physiotherapy i was finally in good condition and was able to walk properly, do my regular exercises, do my work and there was only a slight problem in going down the stairs. I continued my physiotherapy for another month and then stopped going there but i was still doing my exercise my doctor told me to do everyday.
Then after 2 months, while i was playing Cricket (As he had recommended me to not play soccer ever again) i felt some pain in my knee again, so i stopped playing and went to my doctor who told me to get a MRI scan for the knee and i went to the hospital and underwent the MRI scan. the report is provided at the end. Everything was going fine, but one day while sleeping i was turning my position and suddenly i felt a snap in my knee and pain started in my knee and it was very severe. So, i went to my physiotherapist again and with the help of a 2 week session i was not feeling pain.
The MRI report states that :-
“The study shows normal configuration and alignment of the bones forming right knee joint.
Linear hyper-intensity is seen in posterior horn of medial meniscus on PD fat sat images reaching up-to inferior articular and capsular surface suggestive of Grade 3 tear.
Altered signal intensity, appearing hyper-intense on PD fat sat images noted in anterior horn of medial meniscus extending up-to articular and capsular surface suggestive of complex tear.
Lateral meniscus is unremarkable in MR signal and morphology.
There is focal contour bulge in middle third of anterior cruciate ligament with heterogeneously hyper-intense signal on PD fat sat images sprain/ partial thickness tear.
The posterior cruciate ligament is unremarkable in MR signal and morphology.
The medial and lateral collateral ligaments are unremarkable in MR signal and morphology.
Medial and lateral patellar retinaculum are unremarkable in MR signal and morphology.
Quadriceps and patellar tendons are unremarkable.
Hoffa’s pad of fat is unremarkable.
Fluid intensity mild collection seen in suprapatellar bursa and in lateral and medial recess of knee joint”.
In all finding are:-
1. Grade 3 tear in posterior horn of medial meniscus.
2. complex tear in anterior horn of medial meniscus.
3. Sprain/Partial thickness tear of anterior cruciate ligament.
4. mild joint effusion.
Please suggest whether i should opt for an Arthroscopy surgery or not & if i want to play again what should i do.
Thank you
Howard J. Luks, MD
If you are unhappy with your quality of life, then a repair of the meniscus might be able to assist you in getting back into an active lifestyle without discomfort.
Good luck,
Howard Luks
Eshan Arora
thank you Doctor Howard for you reply