The knee is complex structure, capable of withstanding shock and pressure and able to produce a range of motion. The meniscus is a strip of cartilage that provides a cushion between the thighbone and the shinbone. There are two menisci in each knee joint, on either side.
While the knee can survive consistent pressure and use, certain motions can lead to a tear, typically intense pressure or forceful rotation or a pivot, a common move on the basketball court or often the result of an impact in football or similar event. Some patients may suffer this injury in daily life, such as when raising the body too quickly to a standing position with a heavy item, repetitive kneeling, or wear resulting from age. A meniscus tear is one of the most common knee injuries.
Patients typically first notice a problem when the injury occurs, but are still able to continue activity. The day after the injury, pain and swelling increase and the knee may feel stiff and sore. The symptoms of a torn meniscus can include:
- Limited range of motion
- Popping sensation
- Locking sensation
Knee Structure Basics
The knee is comprised of bones, cartilage, ligaments, and tendons. Articular cartilage is a material protecting the ends of the joints and functions as a shock absorber. It is a slick type of cartilage, with a shiny, rubbery texture that makes it possible for the bones to easily slide without damage.
The ligaments and tendons are tough bands of tissue connecting the bones. In the knee, these are the MCL (medial collateral ligament) and the LCL (lateral collateral ligament).
When the meniscus of the knee is torn, the weight of the leg will be concentrated on one area of the lower leg bone, rather than equally spread as nature intended. The meniscus helps to stabilize the knee, acting as a wedge. When torn or damaged, the pain and instability in the knee joint can be extensive.
A meniscus tear can occur in several patterns, depending upon the type of motion that caused the damage, and the injury typically worsens with time. The types of tears include:
- Radial tear – which can progress to a flap tear
- Longitudinal tear – which can progress to a bucket-handle tear
- Transverse tear
- Horn tear
Healing a Meniscus Tear
The tear may heal on its own, depending upon where it occurred in the meniscus. Along the outer margin of the meniscus (called the “red zone”), there is adequate blood flow to promote healing of the damage. The “white zone” is the inner portion, which lacks sufficient blood flow and is not capable of healing well on its own. Injuries to the meniscus in the red zone can heal over time, with standard treatments including icing, anti-inflammatory medication, and pain medication to manage discomfort.
Injuries to the white zone must be treated differently, and may require removing the damaged portion of the meniscus (called a “partial meniscectomy”). More extensive damage in the white zone may require removing the entire meniscus, followed by a meniscus transplant.
Meniscal Repair: The Procedure
To repair a torn meniscus in the red zone, the patient will be on his or her back, often under general anesthetic. Most surgeries are performed with an arthroscope, with a camera and tiny instrument. The tool is inserted through tiny incisions. Once the interior of the knee is accessed, fluid is added so the damaged tissue can be more easily visualized, accessed, and then surgically repaired. The tiny camera allows our surgeon to view the inside of the knee on a monitor and to carefully perform the needed repair. Every injury is unique and various tools are used to restore function, including shaving and scraping certain portions to stimulate blood flow and promote faster healing.
The torn areas are then joined with sutures (stitches) or sutures and anchors (to hold sutures in place). Some repairs may involve the use of absorbable tabs.
After repair, the area is reviewed to ensure the tear is resolved and cleaned of any remaining debris. The incisions are closed with sutures, a dressing is applied, and the knee area wrapped in a protective bandage to keep it stable. The entire procedure requires about thirty minutes to an hour to perform, and almost all patients can return home the same day.
Recovery from Torn Meniscus Repair
During recovery, you will be required to keep your knee elevated on cushions and apply ice packs to minimize swelling. You may be prescribed pain medication, but most patients report the pain is minor and not difficult to manage. You will use crutches for a few weeks after surgery and physical therapy will help you to restore full range of motion. You may need a knee brace and will be asked to avoid putting pressure on the knee for four to six weeks. Full recovery, with the knee functioning as it should and without pain, typically takes three to four months, but you may be required to avoid certain actions (running, twisting, jumping) for up to six months after surgery to ensure full recovery.