Cartilage tears usually result in knee pain and swelling. While they are sometimes caused by one specific injury, they can also occur with every day use.
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PROCEDURES:
PHYSICIAN: DR. JONES
MENISCAL REPAIR
Meniscus tears are a common injury in both athletes and from degenerative changes associated with arthritis. Active individuals with acute meniscus tears tend to have a healthy joint and repairing the meniscus is important for good long term outcomes. These injuries are often associated with other injuries such as ACL tears. The rate of meniscus healing is very high especially if the surgery is preformed before substantial damage occurs to the tissue.
Degenerative meniscus tears are typically “wear and tear” injuries and are often associated with early arthritic changes. Although, these are often not as readily repaired, in some cases repairing these tears is possible and can prolong the lifespan of the joint and improve longterm function.
Anatomy
The meniscus is a wedge shaped shock absorber between your thigh bone (femur) and your lower leg (tibia) The meniscus serves to nourish and protect the cartilaginous ends of these bones that come together to form your knee. This is an important structure in preserving the lifespan of your knee and providing maximal pain free function.
Menisci tear in different ways. Tears are noted by how they look, as well as where the tear occurs in the meniscus. Common tears include bucket handle, flap, and radial.
Sports-related meniscus tears often occur along with other knee injuries, such as anterior cruciate ligament tears.
Sudden meniscus tears often happen during sports. Players may squat and twist the knee, causing a tear. Direct contact, like a tackle, is sometimes involved. Older people are more likely to have degenerative meniscus tears. Cartilage weakens and wears thin over time. Aged, worn tissue is more prone to tears. Just an awkward twist when getting up from a chair may be enough to cause a tear, if the menisci have weakened with age.
Symptoms
You might feel a "pop" when you tear a meniscus. Most people can still walk on their injured knee. Many athletes keep playing with a tear. Over 2 to 3 days, your knee will gradually become more stiff and swollen.
The most common symptoms of meniscus tear are:
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Pain
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Stiffness and swelling
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Catching or locking of your knee
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The sensation of your knee "giving way"
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You are not able to move your knee through its full range of motion
If there is suspicion of a torn meniscus, an MRI will be ordered to evaluate the meniscal tissue and the knee cartilage.
Treatment
The outside one-third of the meniscus has a rich blood supply. A tear in this "red" zone may heal on its own, or can often be repaired with surgery. A longitudinal tear is an example of this kind of tear. In contrast, the inner two-thirds of the meniscus lacks a blood supply. Without nutrients from blood, tears in this "white" zone cannot heal. These complex tears are often in thin, worn cartilage. Because the pieces cannot grow back together, tears in this zone are usually surgically trimmed away. Along with the type of tear you have, your age, activity level, and any related injuries will factor into your treatment plan.
Surgery
Knee arthroscopy is one of the most commonly performed surgical procedures. In it, a miniature camera is inserted through a small incision (portal). This provides a clear view of the inside of the knee. Your orthopaedic surgeon inserts miniature surgical instruments through other portals to trim or repair the tear.
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Partial meniscectomy: In this procedure, the damaged meniscus tissue is trimmed away.
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Meniscus repair: Some meniscus tears can be repaired by suturing (stitching) the torn pieces together. Whether a tear can be successfully treated with repair depends upon the type of tear, as well as the overall condition of the injured meniscus. Because the meniscus must heal back together, recovery time for a repair is much longer than from a meniscectomy.
Many meniscus tears are able to be repaired. The repair is typically done with a minimally invasive approach with a camera. Sometimes additional 1 cm incisions are made around the knee to suture together torn tissue in difficult repairs. Repairing the torn tissue restores the function and the protective benefits of the meniscus. The recovery for a repaired meniscus is very different from removing the damaged tissue. In most cases, you will be locked in a brace in extension for 4 weeks and will need crutches for 2-4 weeks following the procedure. Running is permitted between 2-3 months and return to sports is allowed after 6 months.
In general, if a meniscus is able to be repaired I will typically suggest we proceed with repair. Although the recovery is harder and there is a small chance the meniscus may not heal, the long term outcomes are much better.
Posterior Root Tears
A common meniscal injury associated with arthritis is a tear of the attachment in the back of the meniscus. This tear can lead to quickly advancing arthritis and loss of joint function. Sometimes, this tear is amenable to repair. If there is good cartilage in the affected part of the joint and the meniscus tissue is relatively healthy, we can proceed to a repair. The recovery after the procedure is the same as for any meniscal repair but the long term outcomes are improved if the meniscus heals as intended.
ARTICLES:
Meniscal repair overview
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4714576/
Decreased Arthritis Risk
https://pubmed.ncbi.nlm.nih.gov/29146386/
Posterior Root Repair