Torn Meniscus Frequently Asked Questions

The two menisci of the knee are crescent-shaped wedges that fill the gap between the tibiaand femur. The menisci provide joint stability by creating a cup for the femur to sit in.
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The meniscus acts as a shock absorber for the knee by spreading compression forces from the femur over a wider area on the tibia. Click here for more information.

Patients describe meniscal tears in a variety of ways. Knowing where and how a meniscus was torn helps the doctor determine the best treatment. Your doctor will look for:

1. Location – A tear may be located in the anterior horn, body, or posterior horn.
2. Pattern – Meniscal tears come in many patterns which will influence the doctor’s decision on treatment.
3. Completeness – A tear is classified as being complete or incomplete.
4. Stability – A tear can be stable (does not move) or unstable (meniscus moves abnormally).

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1. Acute tears are often sports related and usually the result of a twisting injury.
2. Degenerative tears are more common in the older population and usually the result of a minor movement. Symptoms for both usually include pain, swelling, and movement irregularities, like “catching or “locking”.

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An orthopaedic surgeon will ask for the history of the knee injury and will determine if the signs and symptoms of an ACL injury are present. Then a physical examination is performed to check for swelling and tenderness and will likely include a McMurray’s Maneuver. X-rays can reveal signs of fractures or arthritis. A Magnetic Resonance Image (MRI) may be ordered to assess damage to ligaments and menisci. Click here for more information.

When determining the treatment for a meniscal tear, the orthopaedic surgeon will consider the following factors:

1. The patient’s activity level
2. The patient’s age
3. The location of the tear and the type of tear
4. When the injury happened
5. Injury symptoms
6. Any other associated injuries

After considering these factors the doctor will choose to treat the injury non-operatively or surgically. Click here for more information.

The use of a knee brace and restriction of activities may be recommended to prevent

further injury. The rehabilitation program for non-operative treatment of a meniscus injury mayinclude:

1. Use of crutches for the first 2-3 days.
2. flexion – extension exercises beginning 2-4 weeks after injury.
3. return to activities at about 4-6 weeks after injury.

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Surgical treatment for a meniscal tear may be indicated if:

1. symptoms are disabling or last for more than 2 – 3 months
2. a displaced tear causes the joint to lock
3. the anterior cruciate ligament is also injured – In this case, the knee is highly unstable and excessive motion exists within the joint. The meniscus is unlikely to heal without treatment.
4. the patient is a high-level athlete

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Following surgery and depending on what type of surgery is preformed, the patient will be started on a structured rehabilitation program which may include:

1. use of crutches for 2-3 days to 1-6 weeks
2. possibly brace the knee and restrict motion for 6 weeks
3. range of motion exercises 0-6 weeks after surgery
4. strength exercises
5. return to activities can start about 4-6 weeks to 3-4 months after surgery

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Small tears in the meniscus that are not dislodged may heal, or may eventually be symptomfree.  Larger tears that displace, and tears associated with instability, are less likely to heal.  Tears in the outer 1/3 of the meniscus are more likely to heal than tears toward the inside of the meniscus because the blood supply is better in the outer region.

1. the tear causes symptoms such as pain, swelling, catching, or locking
2. a displaced portion of the meniscus is causing the knee to lock
3. the tear is associated with knee instability.

An MRI is not always required to diagnose a meniscal tear. A meniscal tear can be accurately diagnosed with a doctor’s physical examination. However, an MRI can be useful to determine the extent of the injury, the displacement of a tear, and help determine if there are any other associated injuries.

The final decision is made during an arthroscopy when the surgeon gets a close look and probes the tear. Tears in the outer third of the meniscus are often repaired. This region has a better blood supply for healing. Also, the outer portion of the meniscus is thicker and resection of these tears will leave little meniscus remaining. Tears in the inner two-thirds of the meniscus often require that the torn portion be removed because the poor blood supply to this region limits healing. Also, the inner portion of the meniscus is the thinnest section so removing a torn piece here requires a minimal loss of tissue.

The meniscus has an important function inside the knee as a shock absorber that helps

distribute the load of the body. If the entire meniscus is removed, the rest of the joint gets overloaded and the knee is susceptible to arthritis.

There are many techniques and instruments available to repair a torn meniscus. Meniscal tears may be repaired using sutures or devices (such as arrows, tacks, and screws) that the body absorbs after the meniscus has healed.