Meniscus Tears: Evaluation and Treatment

(Updated: 11/3/2021)

You have injured your knee and think you tore your meniscus. Do you need an MRI? Will you need surgery?  What are your treatment options? These are important questions to discuss with your physician if you are suffering from acute knee pain.

Meniscal tears are one of the most common types of knee injury. They typically occur during forceful twisting activities of the leg such as a sudden change in direction or pivoting/cutting during sports or even day-to-day activities. However, any activity that generates high forces through the knee combined with rotation can increase risk of tearing.

What is the Meniscus?

The menisci are “C” and “O” shaped wedges of fibrocartilage inside the knee which are made of water, collagen, and glycoproteins. They act as shock absorbers, increase joint stability, help distribute load, and provide lubrication to the knee.

What are the types of Meniscus Tears?

Acute vs Degenerative:

• Acute – younger, active patients; often associated with a sports injury  (i.e. cutting, twisting) or taking a wrong step. Peak incidence of acute meniscal tears in males is 21 to 30 years old and in females is 11 to 19 years old.
• Degenerative – middle-aged to older patients; associated with wear and tear, may or may not be associated with trauma or falls. Degenerative meniscal tears most often occur in individuals aged 40 to 60 years old.

Types of tears – six major types of meniscus tears including intra substance/incomplete, radial, horizontal, flap, complex, and bucket handle

What are the symptoms of a Meniscus Tear?

Symptoms can vary from person to person and are also based on injury severity. Some people experience a popping sensation at the time of injury. Initially one may have pain, stiffness, and swelling. Depending on the type of tear, some may have mechanical symptoms like catching and locking or a feeling of knee instability. However, most people can continue walking immediately after a meniscal tear and some can even continue to participate in sport without significant discomfort.

I think I tore my Meniscus… Do I need an MRI?

Not all knee injuries require an MRI. A thorough evaluation by a physician is necessary to determine what test is necessary to evaluate your knee pain. Depending on your presentation, an X-ray may be the best initial test for your knee.

If you have an MRI showing a meniscus tear, it is important to focus on your symptoms more than the radiological findings. The Meniscal Tear for Osteoarthritis Research (MeTeOR) trial found no evidence correlating meniscal pain and symptoms with relevant MRI findings of various types of meniscal tears.

Will my Meniscus heal on its own?

The outer third of the meniscus has a good blood supply (red zone) but the inside two thirds does not (white zone). This means that overall, the outer third of the meniscus has a better chance at healing on its own and without surgery.

What are the treatment options?

The treatment options vary based on age, type of tear, timing of the injury, presence of knee arthritis, and other associated conditions. Options include:

• Decrease pain and swelling – RICE (rest, ice, compression, and elevation), NSAIDs and in some cases, steroid injections. Regenerative injections such as platelet rich plasma (PRP)  and prolotherapy can also be considered.
• Physical therapy – to restore joint range of motion, increase muscle strength, and improve function. PT also optimizes neuromuscular coordination and biomechanics to decrease stress on the knee.
• Surgery- meniscus repair and partial or total meniscectomy. Typically considered after failure of conservative care, and in cases affecting athletes and those with more mechanical symptoms.

Notably, a systematic review in the British Journal of Medicine in May 2017 showed that outcomes for knee arthroscopy were no better than those for exercise in people with degenerative meniscus tears, and moreover that surgery likely causes more harm. In most cases, PT is the first line treatment for meniscus tears.

Additionally, the prognosis is usually good for patients with non-degenerative meniscal tears treated nonsurgically. However, a meniscal tear that causes persistent knee pain, swelling, or mechanical symptoms (catching, locking, or knee instability), despite a trial of conservative management, warrants surgical evaluation. Up to one third of patients may need surgery, despite adequate physical therapy and strengthening.

If you would like to get evaluated for your knee pain, please contact us at Desert Spine and Sports to set up an appointment where we offer comprehensive, evidence-based, non-surgical care for your musculoskeletal needs.

References:

1. Katz JN, et al. Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis. 2013;358(18):1675-1684.
2. Siemieniuk R et al. Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline. BMJ2017;357:j1982
3. Mordecai S, Al-Hadithy N, Ware H, Gupte C. Treatment of meniscal tears: An evidence based approach. World J Orthop.2014 July 18; 5(3): 233-241
4. Herwig J, Egner E, Buddecke E. Chemical changes of human knee joint menisci in various stages of degeneration. Ann Rheum Dis.1984;43:635–640.
5. Greis PE, Bardana DD, Holmstrom MC, Burks RT. Meniscal injury: I. Basic science and evaluation. J Am Acad Orthop Surg. 2002;10:168-176.