Meniscus 101: A Guide to Tears and Treatment

I often see patients with knee pain. One of the main sources of knee pain is a torn meniscus, and it is one of the most common surgeries I perform on the knee. However, not everyone who comes in with knee pain has a torn meniscus despite what “Dr. Google” tells them. Some patients have a torn meniscus and do not even need surgery. Here’s why:

The meniscus is a shock-absorbing cushion that sits in the knee between the femur and tibia bones (Figure 1; MM=medial meniscus, ML=lateral meniscus). Each knee has two of them. Its main function is to distribute forces evenly across the knee and protect the cartilage from wear that can lead to arthritis.

Early in life, the meniscus is a robust piece of tissue that usually tears due to playing a sport or some sort of trauma that involves a twisting injury. These are the types of tears I treat surgically because patients do not tolerate the symptoms well. Typical symptoms are localized pain, catching, clicking, and sometimes instability.

Treatment involves arthroscopic surgery where one of two actions is taken. The more common surgery involves trimming out the piece of unstable tissue. It is a quick surgery and rehabilitation with limited restrictions early on, allowing patients to ease back into activities quickly. The alternative surgery is to repair the meniscus if the tear is in a location amenable to repair. Basically, it has to occur in a location with a good blood supply. The rehabilitation for this type of surgery is much longer and involves restrictions, but is better in the long run for patients.

Over time, the meniscus starts to degenerate and wears down. The tissue quality is not as good, and its function starts to deteriorate, which leads to arthritic changes in the knee. It is not uncommon for patients in their 60s and older to have meniscal tears that do not bother them or only cause minimal symptoms. Surgical intervention is often not necessary for these cases because the symptoms can frequently be resolved with time, exercises, and/or a cortisone injection.

Patients with advanced arthritis of their knees often have concomitant tears in their meniscus. It is in this scenario where arthroscopic surgery would not benefit the patient because the worn-out joint is largely their main problem. That is when I have a conversation with patients about a total knee replacement. This can sometimes come as a shock to patients after “Dr. Google” told them they needed arthroscopic surgery… www.orthopartners.com