The meniscus is a crescent-shaped cartilage in the knee joint that is essential for load transmission, shock absorption, and stability. Each knee has two menisci: the medial (inner) and lateral (outer) meniscus. Meniscus tears are common, especially among athletes and older adults, and can result from acute trauma, such as sudden twists or direct impacts during sports, or degenerative changes associated with ageing. Symptoms include knee pain, swelling, stiffness, and a reduced range of motion, with some people experiencing a popping sensation at the time of injury. Diagnosis involves a physical examination, patient history, and imaging studies like MRI to confirm the tear and guide treatment.
Non-Surgical Treatment Options
Non-surgical treatment options for meniscus tears are often recommended for minor tears, degenerative tears, or for people who may not be suitable candidates for surgery. These treatments focus on relieving symptoms and improving knee function. The decision between non-surgical and surgical options should be made in consultation with an orthopaedic surgeon, considering the specific characteristics of the tear and the patient’s overall health.
Rest, Ice, Compression, and Elevation
Rest involves avoiding activities that cause pain or stress on the injured knee, allowing it time to heal. Ice helps reduce swelling and numb the pain; it should be applied at 20-minute intervals several times a day. Compression with an elastic bandage or knee brace can prevent further swelling and provide support to the injured area. Elevation involves keeping the knee raised above heart level to reduce swelling and promote fluid drainage.
Medications
Medications can help manage pain and inflammation associated with meniscus tears. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen are commonly used. In some cases, paracetamol may be recommended to control pain without the anti-inflammatory effects.
Injections
In certain cases, corticosteroid injections may be administered to reduce inflammation and alleviate pain. These injections provide temporary relief and are typically considered when other non-surgical treatments have not been effective. Hyaluronic acid injections, which aim to lubricate the joint, may also be used in some patients.
Surgical Treatment Options
When non-surgical treatments are ineffective or when the meniscus tear is severe, surgical intervention may be necessary. Surgical options aim to repair or remove the damaged meniscus to restore knee function and alleviate symptoms.
Arthroscopic Surgery
Arthroscopic surgery is a minimally invasive procedure used to diagnose and treat meniscus tears. It involves inserting a small camera (arthroscope) into the knee joint through tiny incisions. This allows the surgeon to view the inside of the joint and perform the necessary repairs with specialised instruments. Arthroscopy is often recommended due to its shorter recovery time and reduced risk of complications compared to open surgery.
Meniscectomy
A meniscectomy involves the partial or complete removal of the damaged meniscus. Partial meniscectomy, where only the torn portion is removed, is more common and aims to preserve as much of the meniscus as possible to maintain its function. This procedure is typically performed arthroscopically and is indicated when the tear is in a non-repairable area or when a repair is not feasible.
Meniscus Repair
Meniscus repair involves suturing the torn pieces of the meniscus back together. This procedure is suitable for tears in the outer edge of the meniscus where there is a good blood supply, promoting healing. Meniscus repair is recommended over meniscectomy as it preserves the meniscus, potentially preventing long-term complications like osteoarthritis. However, it requires a longer recovery period and has specific post-operative restrictions.
Meniscus Transplantation
Meniscus transplantation is an option for patients with significant meniscal damage who have developed knee pain and dysfunction. This procedure involves replacing the damaged meniscus with a donor meniscus from a cadaver. Meniscus transplantation is typically considered when other surgical options are not viable, and it aims to restore knee function and delay the progression of joint degeneration.
Conclusion
Meniscus tears are common knee injuries affecting mobility and quality of life. Non-surgical treatments, including rest, physical therapy, medications, and injections, can alleviate symptoms and improve function for minor or degenerative tears. When necessary, surgical options such as arthroscopic surgery, meniscectomy, meniscus repair, and meniscus transplantation can restore knee function and relieve pain.
Treatment choice depends on the tear’s characteristics, the patient’s health, activity level, and preferences. With appropriate treatment, many people with meniscus tears can return to their regular activities and maintain an active lifestyle.
Dr LS specialises in enhanced recovery after knee surgery. He also specialises in meniscal repairs with minimally invasive techniques to aid in the full recovery of patients after knee meniscus tears.
