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:
Name Judy
Dr. Luks: I fell recently on cement, hitting my knee hard. i had fallen 5 years ago, same knee injured. I had arthroscopy at that time. My MRI this time indicates I have a horizontal free edge tear of mid body of medial meniscus, with a minimal parameniscal cyst formation. There is also a horizontal free edge tear of the mid body and anterior horn of the lateral meniscus. There is also grade III-IV chondromalacia of the weight bearing surface of the lateral femoral condyle. My Ortho MD gave me an injection today to try and reduce the pain. He indicated that because of the arthritis I may be facing a total knee replacement in the near future. Do you think I should have the arthroscopy and then just try to deal with the arthritis with periodic in jections?
The pain in my knee radiates down the front of my leg and keeps me awake at night. I am 61 and planning to retire in 4 months.
Howard J. Luks, MD
Be very wary of treating arthritic knees with an arthroscopy. The current literature shows that physical therapy can be as effective as surgery in managing the pain associated with mensicus tears in the presence of osteoarthritis.
Good Luck
Rescue
Dr. Luks, thanks so much for having a site like this with great information and providing personal responses.
i got meniscus tear two months ago,now i m able to fold my knee by doing hamstring exercise,but while walking i m getting sometimes jerks and sudden pain in nerve.
can you please tell me what will be the problem??whether it is serious problem or healing is not complete..what i should do now??
suggest your advice…..thanx alot
Howard J. Luks, MD
You have a quality of life decision to make. If you have tried rest, activity modification, and physio and your pain persists then you might want to explore surgical options with your Orthopedist. Make sure you discuss repair vs removal.
Good Luck
Howard Luks
Rescue
thanks for fast reply…..:)
i hv tried rest for a week only as i m working.
but the condition is improving,i want to know how much time healing takes as per your opinion.even i hv shown to orthapedic in starting he told to do all activities and he told not much serious.
does it requires surgery?
Reshma
Hey Dr.luks,
i m from india,As i got meniscus tear in age of 22.from past two months healing is not complete and i use to get sudden jerks/attacks while walking.I am able to fold my legs but pain didnt went.
I got fear whenever i walk ,i dont know why this suddenly started,can you please tell me what i should do to get relief from this sudden pain in knee?
Howard J. Luks, MD
You may wish to speak with an orthopedic surgeon to explore your options.
Good Luck
Howard Luks
Name sean
Dr Luks , I’m 54 , I’ve been playing tennis for a number of years , anyway last year I swelled up one of my knees playing , got the MRI : in the medial compartment , there is complex abnormal signal intensity noted at the level of the meniscus. Specifically , there is a horizontal oblique component extending to a vertical component closer to a free margin of the meniscus . There is additional extension of the more horizontal oblique component to the undersurface of the meniscus . The medial collateral ligament is intact although thickened with faint increased signal intensity tracking along the ligament . The articular
Cartilage overlying the medial femoral condyle and tibial plateau are grossly within normal limits .
In the lateral compartment , there is visualization of a bow – tie type configuration to the meniscus on
Four contiguous Sagittal images , consistent with a borderline lateral meniscal discoid variant . The lateral collateral ligament is within normal limits . The articular cartilage overlying the lateral femoral condyle and tibial plateau is minimally thinned , with small osteophyte formation noted .
Both the ACL and PCL are within normal limits .
There is loss of the normal trilaminar appearance to the patellar cartilage with thinning medially .
There is increased T2 signal intensity noted subchondrally at the level of the medial patellar facet .
The extensor mechanism , patellar tendon as well as the medial and lateral patellar retinacula are grossly within normal limits .
There is no significant joint effusion . A trace amount of fluid is noted in the bursa between the medial head of the gastrocnemius and semimembranosus tendons .
I would like your opinion on wether to get repaired , the way I see if I want to continue to play tennis , I don’t have a lot of choice , your thoughts please and thank you .
Howard J. Luks, MD
Sean … After allowing a few weeks to see if the pain settles down and allows you to return to sports .. it becomes a quality of life decision as to whether or not surgery is in your best interest. Some tears simmer down and will not bother you.. some will not simmer down and would benefit from an arthroscopy.
good luck
Howard Luks
Name william winter
I’VE BEEN TOLD I HAVE BILATERALL PATELLA TENDONITIS,I CANT WALK UP OR DOWN STAIRS,CANT STAND UP AFTER BENDING DOWN WITHOUT HAVING SOMETHING TO HELP GET UP,AND FOR NO REASON AT ALL, EITHER KNEE WILL GET A SHARP PAIN FROM OUT OF NO WHERE AND SEND ME TO THE GROUND.I CANT DO ANY CRAWLING AT ALL.I AM A BOILERMAKER AND WORK IN BOILERS INSIDE POWER PLANTS AND HAVE BEEN OUT OF WORK 3 YEARS BECAUSE OF THIS.MY SPORTS DOC. SAYS HE HAS TRIED EVERYTHING UNDER THE SUN WITH NO LUCK,EVEN TRIED PLATLET RICH INJECTIONS 3 TIMES,NOW NO INSURANCE AND OUT OF MONEY BECAUSE INS. DONT COVER P.R.I. DO YOU ANY THOUGHTS ON THIS CONDITION I HAVE?THANKS
Howard J. Luks, MD
If your pain is truly due to patella tendonitis, and PRP injections have failed, there are surgical alternatives, with a great track record which could be performed to try and get you back up on your feet!
Good Luck to you!
Howard Luks
Prof. Dr. S. Balaji
Hello Doctor, This is Prof. Dr. S. Balaji, (chemistry by profession) from India. It is nice to see your untiring response for the world community. I seek your valuable advice for my son’s case. My son aged 13 fell down 4 months back (inside the home due to floor slip) and his right side of right knee touched the floor (twisted movement). He has pain in walking and we thought sprain and after applying some pain relieving gels the pain subsided and after a week we noticed that he has click sound when doing squatting. He managed as the pain was not continually persistent. Then we consulted with a physician who advised some physiotherapy. After physiotherapy for a week he felt lesser pain and wearing a knee cap as recommended. Since it is now 4 months we consulted an orthopedic and taken an MRI.
“MRI revealed Non-displaced oblique tear of the posterior horn of the medial meniscus”.
The doctor advises partial menicsectomy. The right now problems are: (1) clicking sound during deep squatting followed by pain for 3 minutes and then pain disappears (no clicking sound on non-deep squatting and no pain), (2) mild pain during stepping up the staircase, (3) Small swelling but no pain on touching or pressing (right knee front left side). He is walking as usual and even running some steps causes no pain. I need your valuable advice on the following issues.
1. Is surgery is unavoidable.
2. Can it heal on its own, if so how long would it take.
3. Can i postpone the surgery if how long.
4. If i avoid the surgery and manage by nonoperative procedures will it cause him any issues (from your review studies).
5. His school is near by home and there is no need to change the life style pattern, so if curing by rest (after schooling hours) is possible then we can postpone or avoid surgery.
After reading most of your replies, i went for a second opinion and the doctor said partial meniscetomy. I talked about the pros and cons (as learned from your replies), they said you need to find the balance between the two.
Looking forward your reply and advice.
Howard J. Luks, MD
Professor,
Most of us (sports medicine surgeons) would try to repair the meniscus (by suturing it together) before ever contemplating removing a portion of the meniscus in a 13 year old. 13 year olds have remarkable healing capabilities. It would be worth an attempted repair (in my opinion), with the clear understanding that it may not heal and a repeat arthroscopy may be needed in the future. Removing a piece of your son’s meniscus at this age would set him up for many problems down the road as a young adult.
If the tear was going to heal, I imagine it would have done so already. Meniscus tears in children are looked at differently than those in adults. Children tend to have traumatic tears, and these tend to heal nicely. Whereas adults tend to have degenerative tears which do not heal well… and often respond to non-surgical measures.
Good Luck to you and your son.
howard luks