Meniscus Tears: Treatment Options

Meniscus Tears: Treatment Options

If a patient has a meniscus tear, there are different options they can choose to treat it. The patient always has the option to do nothing about it, but any symptoms they are experiencing will likely not go away. Not only that, but the likelihood of arthritis developing increases.

Here is a series of knee x-rays of a patient who does not have a healthy, intact medial meniscus. You can see over the course of 1 year how the joint space gets more and more narrow, causing arthritis, and eventually, they needed a partial knee replacement.

There are patients that want to avoid surgery, so they try nonoperative treatment first. Injections, physical therapy, and over-the-counter medications can improve symptoms. There are many different types of injections, and along with anti-inflammatory medications, are meant to help with pain. Physical therapy can improve stiffness and strength, possibly preventing the tear from getting any worse. Some patients may wear a brace to help their knee feel more stable as well. Unfortunately, the symptoms typically do not go away; they just might not be as bad.

Since meniscus tears rarely heal back to normal on their own, some type of surgery is usually needed to get the best result. For tears in the white-white zone, the surgeon will likely just trim out the torn tissue and remove it from the knee. The patient's symptoms will improve, but since there is less meniscus to help cushion the knee, there is an increased risk of developing arthritis.

If possible, repairing the meniscus is usually the best option. Tears in the red-white zone or the red-red zone have a good chance of healing. The surgeon will stitch the meniscus back together. That way, it can continue to provide the cushion in the knee to prevent wearing down the surface cartilage.

There are many different ways to repair a meniscus, and the surgeon will consider many factors when deciding the best way to fix it. The size of the tear, the direction in which it is torn, its location, and the amount of time that has passed since the initial injury. All will help the surgeon decide the type of repair that has the best chance of healing.

Two of the more common types of repairs are the all-inside repair, which is best for tears in the posterior horn of the meniscus toward the back, and the inside-out repair, which is better for tears in the midportion of the meniscus or even closer toward the front in the anterior horn.

Generally speaking, the sooner a meniscus tear gets fixed, the better chance there is of delaying the start of arthritis in the knee. Older patients can get chronic degenerative tears that happen over time. These do not occur from an injury but from the meniscus wearing out. These tears usually cannot be fixed. The torn tissue can be removed, but since the patient will likely have some arthritis as well, removing meniscus tissue may speed up the progression of that arthritis.

In extreme cases, a patient may require a meniscus transplant. This is when a meniscus from a cadaver is used to completely replace a patient's meniscus because of too much damage from an injury or if they had multiple previous meniscus surgeries and there is no meniscus left.

After surgery, recovery will look different depending on the type of meniscus surgery that was done. If the surgeon just trims out the torn tissue, many patients can walk without crutches after only a few days, regain their strength, and return to most of their activities around a month or so. If a repair is done, the surgeon will likely have the patient use crutches for around 4-6 weeks. If the patient puts too much weight on their leg too early, it could damage the repair. Then, they will start doing more and more range of motion and strength exercises. They will not do any running activity until about 3 months after surgery. Returning to any sports may not happen until around 6 months after the procedure.

Whether it is a nonoperative treatment, a simple clean up procedure, or a surgical meniscus repair, the patient and the surgeon should have a thorough discussion to determine the best course of treatment of that individual's meniscus tear to give them the best chance of returning to their desired activity level.