What is it?
The meniscus is a “C-shaped” fibrocartilage structure that is located in the knee between the femur (thigh bone) and tibia (shin bone). Its primary purpose is to act as a shock absorber in the knee, protecting the cartilage from experiencing excess stress. Meniscus injuries typically occur during activities when the knee forcefully rotates or pivots, such as soccer, basketball, or football.
WHAT ARE SIGNS AND SYMPTOMS OF A MENISCUS INJURY?
Common symptoms of meniscal injuries include:
• Pain, especially with twisting or pivoting movements
• Difficulty straightening the knee fully
• Catching, popping, or clicking sensation
• Swelling, stiffness
• Feeling of the knee giving way
DIAGNOSIS
In the office, a complete history and physical exam is obtained. The knee is examined for any deformity or tenderness to palpation. A comprehensive test of all the structures in the knee, including the meniscus, is performed and oftentimes compared to the uninjured side. Imaging studies, such as an X-Ray and MRI, may be necessary to confirm the diagnosis.
TREATMENT
Conservative treatment of meniscal tears is initially recommended. Such treatments include rest, ice, anti-inflammatories, and physical therapy. Crutches and a knee brace may be used initially to support the injured knee.
Surgical treatment of meniscal tears may be indicated if symptoms continue to persist despite conservative treatment, or if there are mechanical symptoms, such as the knee catching or locking. Generally, meniscus tears are treated surgically either by repairing the meniscus or trimming the torn tissue (partial meniscectomy).
Arthroscopic partial meniscectomy is a minimally invasive technique that utilizes small incisions and instruments to precisely remove the torn meniscus. This is typically done in an outpatient setting under regional anesthesia, allowing patients to return home the same day.
In certain cases, the meniscus can be repaired. This is dependent on multiple factors including the meniscus tear pattern, location of the tear, and the presence or absence of arthritis. Similar to other arthroscopic procedures, meniscus repairs are typically performed arthroscopically, using sutures to sew the meniscus together, allowing the meniscus to heal. In rare cases, the meniscus may be torn off its bony attachment (meniscal root tear), and a more complex repair may be necessary.
In conjunction with supervised physical therapy, surgical treatment of meniscal tears has been shown to support the successful return of patients to their activity or sport.
RECOVERY
Partial Meniscectomy
Following surgery, patients are placed on crutches and are allowed to bear weight immediately. Physical therapy begins within the first week of surgery. Over the next six weeks, patients will focus on knee strengthening, range of motion, and gait training. Return to activity is generally permitted around 6-8 weeks postoperatively.
Meniscus Repair
Following surgery, patients are placed in a long hinged knee brace for six weeks. Weight bearing status is dependent on the type of meniscus repair performed. Physical therapy begins within the first week of surgery, with emphasis on knee range of motion. At six weeks, the brace is removed and the focus turns to gait training and strengthening. A jogging program is initiated about 3-4 months postoperatively, followed by an agility program at 5-6 months. Sport specific drills are initiated at six months and patients generally return to sports around 9-12 months postoperatively.
ARTHROSCOPIC MENISCUS REPAIR
The following animation demonstrates an all-inside meniscus repair. A meniscus repair device is passed through the meniscus and deployed on the periphery. The attached sutures are then passed through the meniscus, and the preset knot is cinched down, securing the repair. Multiple implants may be necessary to complete the repair.
ARTHROSCOPIC MENISCUS ROOT REPAIR
The following animation demonstrates a meniscus root repair. Two sutures are passed through the torn meniscus root. A small drill hole is then created from the front of the tibia (shin bone) to the meniscus root location. A shuttling wire is then passed through the tunnel, and the meniscus sutures are placed through the wire and pulled out of the front of the tibia. The meniscus sutures are then tensioned and secured to the tibia with an anchor.