A meniscus tear is a very common source of pain. In our last Expert Series post we explored the cause of most meniscus tears.
The cause of meniscal tears falls under two broad categories:
- Acute, thus following an injury.
- Degenerative, where your meniscus tore simply because it wore out.
Many patients who have knee pain — with or without an injury and are not sure what to do next. Do I see my Doctor? Do I wait?
In this Expert Series post we explore how the cause of your meniscus tear might effect our treatment recommendations and thus help guide your decision on your next steps in managing your painful knee.
Let’s read what our experts have to say.
Acute Tears: Typically the younger, active patients can’t do what they want to do – play their sport or do some type of exercise – so we discuss surgery. We might discuss physical therapy, rest, activity modification and other treatment ideas, but they are often so limited from what they want to do that they choose surgery fairly early in the process.
Degenerative Tears: For people with more degenerative tears, especially with co-existing arthritis, I emphasize trying a course of nonoperative treatment. Anti-inflammatory medications, activity modification, physical therapy and even injections might be options.
Initial treatment of meniscal tears: The treatment is dictated by the patient’s symptoms and the condition of the knee cartilage. If an 18 year old basketball player twists his knee and tears his meniscus and the knee is locked (meaning that full knee range of motion is not possible), then that person gets an urgent MRI and probably early knee arthroscopy. If there are no mechanical symptoms (the knee has a smooth range of motion, normal stability), then a period of relative rest to calm down the knee inflammation and beginning physical therapy may be appropriate. Both the medial and lateral meniscus are important for secondary knee stability and diffusing the pounding pressure of weight bearing (acting as shock absorbers), so tears in either meniscus can potentially require arthroscopic intervention.
Usually at initial evaluation, the tear is only suspected but not confirmed. As a result, the tear size, specific location and type are often unknown. In these cases, the initial treatment is usually based on the mechanism of onset (injury or none) and the patient’s age and level of pain or associated symptoms as well as a consideration for any treatments already attempted. If there is not much discomfort or associated symptoms and the patient is approximately >35-40 years old, I will often suggest a trial of rest, anti-inflammatories and either a home exercise program or formal PT. In those who have had a traumatic onset initiating their symptoms, have significant pain, other associated symptoms, such as a loss of motion, particularly straightening their knee or a suspected cruciate injury, I will usually order an MRI to obtain more information.
If the tear characteristics are known, then these characteristics often will come into play in determining a treatment plan. Acute Tears : Acute peripheral, vertical displaced tears are not only usually very painful, they are often repairable if treated more acutely. For this reason, I will usually suggest surgery. I make similar recommendations for acute traumatic radial and root tears in the correct patients. In other tears, I will try to use a treatment that best fits their individual needs (Shared Decision Making Principal). If the patient is younger or has significant pain or has social issues that make a more aggressive treatment preferable, I will proceed with surgery. Degenerative Tears: In all others, I will usually try a course of conservative treatment, particularly in older patients or those with degenerative tears and/or associated knee arthritis. This treatment usually consists of anti-inflammatories, rest and either formal physical therapy or a home exercise program.
Unless the meniscus tear involves a large, displaced piece which can “lock” the knee, the initial management of most meniscus tears is non-surgical. Many patients with knee pain related to a meniscus tear will become asymptomatic within 4-8 weeks with good conservative care. Degenerative tears, especially horizontal tears without displaced pieces, will often not require surgery.
Acute meniscal tears, or chronic degenerative tears with a loose flap can cause mechanical symptoms such as locking, instability and giving way. This always requires a visit to your Sports Medicine Orthopedist. Not only can you injure yourself if the knee gives way, the meniscus plays a very important role in maintaining the proper health of your knee joint.
What type of treatments are available for an acute meniscus tear which is unstable, or a chronic tear which produces minimal pain and no mechanical symptoms? That is the focus of our next Expert Series post.