Meniscal Tear
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- Meniscal Tear
The meniscus, composed of strong fibrocartilage, serves a crucial role as a shock absorber in the knee joint. It distributes a significant portion of our body weight during activities such as walking, running, and jumping. Moreover, it plays a vital role in stabilizing the knee by helping to shape the femur and tibia bones. Additionally, the meniscus contributes to the nourishment of the joint cartilage, thus preventing early arthritis.
Symptoms
When a meniscal tear occurs, it can often be accompanied by an audible "pop" and a sensation of tearing or ripping within the knee. Immediate swelling may follow due to blood accumulation, though some meniscal tears may present with less acute symptoms. Patients frequently report sensations of popping or catching in the knee, sometimes feeling as though something is out of place. In severe cases, the knee may lock, hindering full extension or flexion. Pain is typically felt along the joint line of the knee and may initially be intense but can decrease over time, especially with reduced activity.
Causes
Meniscal tears can result from various traumatic events, often involving a twisting force that pinches the meniscus between the femur and tibia bones. Such injuries are common in sports-related activities and occasionally occur with ligament ruptures. However, not all tears require significant trauma; some can occur during routine activities like standing up from a squatting position. In older individuals, tears may develop gradually over time without presenting symptoms, known as degenerative meniscal tears. The location of the tear within the meniscus influences the appropriate treatment approach.
The meniscus usually tears in certain configurations. Traumatic tears from an injury may be longitudinal (along the fibers of the meniscus) and in some instances can flip towards the center of the joint causing “locking” (e.g. bucket handle meniscus tear). Degenerative tears are often described as complex since the tear pattern occurs in two planes (horizontal and radial). These are less likely to be repairable and may require surgical excision (meniscectomy) if non-surgical treatment does not improve the symptoms.
Treatment
Non-operative Treatment: Many meniscal tear symptoms, particularly those that occur as the result of wear and tear and not a specific injury, may resolve without intervention. Treatment is tailored based on symptoms and activity level. Some patients can manage without intervention after an initial recovery phase, while others may require ongoing management to maintain functionality. Non-surgical treatments such as closed chain knee exercises (either with a supervised or home-based physical therapy program) have been shown to be beneficial. Some patients may benefit from anti-inflammatory medication or an injection of corticosteroid into the joint to reduce pain and inflammation. Some patients have found the use of knee braces (either structural with hinges or simply a compression sleeve) to be beneficial to control the symptoms.
Surgical Options:
- Meniscal Tear Surgery: In cases where non-operative measures are insufficient, surgical intervention may be necessary. Depending on factors such as the patient's age, tear location, and activity level, surgical options may include partial excision (removal) or repair of the torn meniscus. Repair is often preferred over removal due to the meniscus’ role in preserving knee function and preventing early arthritis. Repair may not always be possible due to the inherent blood supply to the meniscus, or the type of tear present.
- Meniscal Transplant Surgery: Young, active patients with significant meniscal deficiencies may be candidates for meniscal transplant surgery. This procedure involves replacing partial or completely absent menisci with donor cartilage. It aims to alleviate pain, prevent joint space narrowing, and restore knee biomechanics. Rehabilitation typically involves a period of immobilization followed by physical therapy to regain strength and range of motion.
Physical Examination and Diagnosis
Deep palpation along the joint line of the knee elicits tenderness during physical examination. Twisting the knee while flexing it can reproduce or exacerbate the patient's symptoms (McMurray’s sign). Meniscal tears do not appear on standard X-rays due to the absence of calcium in the meniscus. Imaging techniques such as MRI scans are valuable tools for diagnosing and evaluating the extent of meniscal damage and may be ordered when the suspicion for their occurrence is high.