Meniscal Tears

by Keith M. Rezin, MD

Almost everyone has had a friend or family member who has stated that they have a cartilage tear. The cartilage is actually a specialized shock absorbing C-shaped structure which is within the knee which reduces stress across the knee joint and has a protective mechanism. This cartilage is susceptible to tearing and typically patients will present with pain, swelling, catching, locking, popping, or a combination of these. Usually, this is due to some traumatic twisting type episode, but it may be seen, especially in an older patient, with the simple act of bending or stooping into a crouched position.

Normally, plain x-rays are necessary to rule out any arthritic component but if symptoms are consistent with a meniscal tear, an MRI is most likely necessary to determine whether a tear is present. The MRI looks at the soft tissues, such as tendon, ligament, and cartilage, and can confirm a suspected meniscal tear.

Treatment of a meniscal tear usually involves surgery. Back in the 60's and 70's, it was our practice to essentially remove the whole meniscus, but now we are much more respectful of its function. It certainly has a shock absorbing and stress reducing function in the knee. What we are seeing now in those individuals who had their meniscus completely removed is the development of arthritic symptoms 15 to 20 years down the road. For this reason, we make every attempt to preserve as much meniscus as possible. Depending on the tear, location of the tear within the meniscus, and the age of the tear, this may be repairable with advanced arthroscopic techniques that are now available. Certain tears are not repairable and a simple partial meniscectomy, which means removing part of the meniscus is done. However, at all times, we try to maintain most of the meniscus and usually no more than 20-25% of the meniscus would have to be removed. Hopefully, this will decrease arthritic changes down the line.

Following the arthroscopic procedure, which is usually done under a general anesthetic or a spinal anesthetic, the patient is allowed to go home. They can be full weight bearing with crutches for approximately 3 days and then can discard the crutches. Typically within 2-3 weeks patients are doing quite well. It is not uncommon for patients to get back to light duty work as quickly as 3 or 4 days with regular duty work depending on the patients occupation.

Arthroscopic meniscectomy or meniscal repair is a safe, relatively noninvasive surgery which has many advantages over the older arthrotomy, which is making an incision in the joint. It has become a commonplace surgical procedure and with some of the advanced arthroscopic tools now available, we are able to repair more and more meniscal tears.

If you have any of the above symptoms, you may wish to have this evaluated.