Should I have surgery for a meniscus tear?

What is a torn meniscus?

A torn meniscus is the most common injury to the knee, accounting for 61 cases per 100,000 people in the US.  The menisci are wedge-shaped structures located between the condyles of the femur and the tibial plateau. The medial meniscus is “U” shaped structure at the “inside” portion of the knee, and the lateral meniscus is more “C” shaped structure on the “outside” portion of the knee. Meniscal tissue consists mainly of water and collagen circumferential fibers that help to absorb the compression energy, and radial fibers which prevent longitudinal splitting of the circumferential fibers. Blood is supplied from the periphery of the menisci, which is of great importance for the potential healing of a meniscal repair, and the structure of these meniscal fibers are important clinically when deciding which meniscal tears are stable or which are unstable and warrant resection or repair.

 

Surgical vs Non-Surgical Approaches

Non-surgical approach - medical management of a meniscal tear can take around 2 months, dependent upon the type and severity of the tear, the patient's overall health and age, and the length of time that symptoms have been present.

Controlling inflammation via rest, ice, compression, and elevation is the initial treatment.  Your physician may provide non-steroidal anti-inflammatory drugs (NSAID's) to decrease pain and swelling as well.  Physical therapy should begin immediately and focus on maintaining or improving strength and range of motion, normalizing your walking pattern, and controlling inflammation.

Corticosteroid injections may be considered to decrease swelling and pain, but proceed with caution because cortisone is destructive to the cartilage, and care needs to be taken with people with diabetes due to the increase in blood sugar from the medications.

 

Surgical approach - there are two options your surgeon may pursue, a meniscectomy or a meniscal repair.  Many recent studies have shown there is no advantage to surgical interventions on tears that result from degeneration.

·      Partial Meniscectomy: trimming of the meniscus is completed when the tear occurs at areas that lack blood supply and will not heal.  This procedure may be completed when a patient has significant pain from the tear or if the knee is locking up due to the tear getting trapped.  It needs to be noted that a meniscectomy will change the function of the knee and will speed up degenerative osteoarthritis.  Physical therapy should begin immediately to prevent loss of strength and motion, and to normalize function.

·      Meniscal Repair: on a younger, active patient with a tear occurring in the outer periphery of the meniscus, a repair may be an appropriate approach.  Please note that most meniscal tears are not considered repairable.  If a repair is appropriate, the patient may need to be on crutches due to weight-bearing restrictions, and oftentimes a brace is required.  Again, physical therapy should begin immediately to prevent strength and motion losses and to restore normal function.

 

What should I do if I have a meniscus tear?

Initially a person should see their physician to have an X-ray to rule out fractures or other bone injuries as the cause of pain, and you may be prescribed medications to assist with pain and swelling.  An MRI may be help reveal the type and location of the tear but often won’t be ordered until conservative approaches have been tried first.

Physical therapy should begin immediately to assist with decreasing inflammation and preventing loss of function.

 

A referral for physical therapy is not required for you to be seen at Biokinetics Rehab; you can call us to make an appointment right now at (828) 528-1222.  

We work one-on-one with our clients instead of having 1-2 other clients overlapping your session.  Your sessions will always be for a 60-minute duration with the same physical therapist.  We will make every attempt to get you seen within 24-48 hours instead of having to wait weeks for an appointment.  We have the ability to spend the time needed to address your concerns and have the knowledge and experience to restore you to your highest level of function.