This information will help you understand your choices, whether you choose to share in the decision-making process or to rely on your Physical Therapist or Physicians recommendation.
Key points in making your decision
How you and your health professional treat your meniscal tear, an injury to the cartilage that protects the knee joint, depends upon several variables, including your health professional’s preferences, your age, health, and activity level, and when the injury occurred. Consider the following when making your decision:
The location of the tear in the red and/or white zone of the meniscus is one of the most important factors in deciding whether surgery is indicated and, if so, which procedure is best. See an illustration of the meniscus zones.
If you have a minor tear at the outer edge of the meniscus (red zone), you may want to choose nonsurgical treatment, because often these tears resolve with rest.
If you have a moderate to large tear at the outer edge of the meniscus (red zone), you may want to consider surgical repair (sewing the edges together), because this zone has a good blood supply, and this kind of tear tends to heal well after surgery.
If you have a tear that extends from the red zone into the white zone, the decision is more difficult. Surgical repair of these kinds of tears yields varying results.
If you have a tear within the inner two-thirds (white zone) of the meniscus, surgical repair is usually not done because there is insufficient blood supply for healing. When these tears cause symptoms, the torn pieces are usually removed (partial meniscectomy). Rarely, the entire meniscus is removed (total meniscectomy).
You may be able to prevent long-term complications, such as osteoarthritis, with successful surgical repair of your tear. Although no long-term studies have proven this, health professionals believe that successful meniscus repair helps to evenly distribute the forces on the knee joint. If the knee is protected from uneven force, there is a lower risk of joint degeneration.
The pattern of the tear can determine whether your tear can be repaired. Radial tears may be reparable depending on where they are located. Horizontal, flap, long-standing, and degenerative tears?those caused by years of wear and tear?are generally not reparable.
What is a meniscus tear?
A meniscus tear is a common knee joint injury. This rubbery tissue acts as a shock absorber between the upper and lower leg bones. Each knee has two C-shaped menisci (plural of meniscus): a lateral meniscus at the outer side of the knee and a medial meniscus at the inner side of the knee. A meniscus tear can limit your knee function.
How is the meniscus injured or torn?
A meniscus tear usually occurs with a twisting or pivoting motion and often with the foot planted and the knee partially flexed (for example, when lifting or playing tennis). Other knee injuries, such as a torn ligament, can happen at the same time. As you age, your meniscus becomes worn and may tear more easily. Meniscus tears are rare in young children.
What are the symptoms of a meniscus tear?
The symptoms of a meniscus tear often vary. In a typical minor tear, there may be pain and slight swelling at first. These symptoms usually go away in 2 to 3 weeks. In a typical moderate tear, you may feel pain at the side or center of the knee, depending on where the tear is located. Usually, you are still able to walk. Swelling increases gradually over 2 to 3 days and may make the knee feel stiff and limit bending.
There’s often sharp pain with twisting or squatting. These symptoms go away but tend to recur with minor twisting or overuse. In severe tears, pieces of the torn meniscus can dislocate into the joint space and lead to “locked knee.” The knee may be very swollen and stiff. Older people whose menisci are worn may not be able to identify a specific event that caused the tear or may recall symptoms developing after a minor incident such as rising from a squatting position. Pain and minimal swelling are often the only symptoms.
How will my health professional diagnose a meniscus tear?
Your health professional will do a physical examination of both knees to evaluate tenderness, range of motion, and knee stability. He or she will ask how the injury occurred and whether you have ever had any other knee injuries. X-rays are usually done. Your health professional may suggest that you follow up with an orthopedic surgeon.
How is a meniscus tear treated?
Your treatment decisions depend upon your health professional’s preference; when the tear occurred; the location of the tear; and your age, health status, and activity level. Treatment options include:
Nonsurgical treatment with rest, ice, compression, elevation, and physical therapy. This may include temporarily wearing a knee brace.
Surgical removal of the torn section (meniscectomy). Rarely, the entire meniscus is removed. In general, surgical repair is favored over a partial or total removal. If the meniscus can be repaired successfully, saving the injured meniscus by doing a meniscal repair reduces the occurrence of knee joint degeneration compared with partial or total meniscectomy.
Small tears located at the outer edge of the meniscus often heal with rest. Larger tears located toward the center of the meniscus may not heal well because blood supply to that area is poor. In a young person, surgery to repair the tear may be the first choice because it may restore function. Your age and activity level will also determine whether surgery is a viable option for you.
In a young person, surgery to repair a tear may be the first choice because it has a greater chance of healing and restoring a more normal function to the knee. It is generally believed that there is a poorer potential for healing in older patients, but successful repair of tears in people older than age 50 has been reported. The most common risks of surgery include infection, a blood clot in the leg, damage to nerves or blood vessels, and the risks of anesthesia.
Your treatment choices are
Nonsurgical treatment to see if it heals on its own, wearing a temporary knee brace, and possibly starting physical rehabilitation to keep the knee muscles strong while the knee is not bearing as much weight. ? Surgical repair to sew the tear together.
Partial meniscectomy, which is surgery to remove the torn section.
Total meniscectomy, which is surgery to remove the entire meniscus. This is generally avoided, because this option increases the risk for osteoarthritis in the knee.
The decision whether to have meniscus surgery takes into account your personal feelings and the medical facts. Following are some general considerations about meniscus surgery.
Reasons to have surgery
- Surgical repair may result in decreased pain and return of normal function to the knee.
- If you don?t have surgery, you may have more pain or your pain may persist making it harder to perform your activities of daily living.
- You may be able to prevent long-term complications, such as joint degeneration (osteoarthritis), with successful surgical repair.
Reasons NOT to have surgery
- The meniscus can possibly heal on its own, making the surgery unnecessary.
- All surgery, including meniscal surgery, has risks. Meniscus surgery poses a risk of infection, damage to nerves or blood vessels around the knee, and blood clots in the lower leg.
- You must follow your physical therapists rehabilitation protocol in order to plan for optimal healing. Afterwards, you may still continue to have pain and require more Physical Therapy or sometimes additional surgery.
Following are some specific considerations about meniscus surgery based on the location of the meniscus tear.
Tears in the RED zone
- The success rate of surgical repair is 90-95%.
- Many minor meniscus tears heal on their own with rest.
- One can wait before surgery, but if symptoms persist, surgery is warranted.
Tears extending from the RED to WHITE zone
- Your orthopedist may recommend a surgical repair for tears in this zone, especially for younger, active people, because successful repairs help restore function
- The success rate of surgical repairs varies. There is no conclusive evidence supporting either option.
Tears in the WHITE zone
- Tears in the white zone typically do not heal well after surgical repair. If they cause pain or swelling, torn pieces need to be removed (partial meniscectomy) and the edges to be shaved down in order to smooth out the remainder of the meniscus.
- Partial meniscectomy often reduces symptoms, but can increase your risk of osteoarthritis. Meniscus tears.
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