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Overview

The menisci are small, semi-circular pieces of cartilage that act as a cushion in the knee. The knee has both an inner and outer meniscus. Treatment varies depending upon the extent and location of the tear; however, a large meniscus tear that causes pain or limits knee function may require arthroscopic surgery for repair. Surgeons often refer to this as "debriding" or "smoothing over" the tear.


Contact sports or high-impact activities involving rapid twisting movements may place extreme forces on the knee, which can lead to injury. Basketball, football, soccer, baseball, tennis, and skiing are common activities that can lead to a tear or damage to the meniscus. However, meniscal injuries can also occur in older adults as the menisci become weaker or degenerative with age. Simple activities such as missing a step on a staircase, stepping in a hole, or falling can cause meniscal tears.











Tissue Damage

Meniscus is a tissue called cartilage and acts as a shock absorber as it covers the surface of joints, allowing bones to slide over one another while reducing friction and preventing damage. The one disadvantage that cartilage has is that unlike other types of tissue it does not have a blood supply, and blood cells help repair tissue damage; therefore, the damaged cartilage may not heal quickly or at all. One of the most common, and potentially serious, types of cartilage damage is to the articular cartilage that is between joints.


Symptoms of articular cartilage damage include swelling, joint pain, stiffness, decreased range of movement in the affected joint and joints that lock or catch. The pain may prevent involvement in normal activities.


Treatment Options

Non-surgical

Partial ligament tears can typically be treated with rehabilitation and bracing. Complete tears in older patients or patients with lower physical demands may also be treated with rehabilitation only. However, specific treatment for a knee ligament injury will be determined by your physician based on age, overall health, medical history, extent of the injury, the patient's tolerance for specific medications, procedures and therapies. Also, depending on the extent of the injury, treatment may include RICE (rest, ice, compression and elevation) muscle-strengthening exercises, protective knee brace, or potentially surgery.


Advanced PRP or Stem Cell Injection

Another option is Platelet regeneration therapy through PRP injection.  Platelet-Rich Plasma, or PRP, is blood plasma with concentrated platelets. The concentrated platelets found in PRP contain huge reservoirs of bioactive proteins, including growth factors that are vital to initiate and accelerate tissue repair and regeneration. These bioactive proteins initiate connective tissue healing: bone, tendon and ligament regeneration and repair, promote development of new blood vessels, and stimulate the wound healing process.


Autologous adult stem cells are undifferentiated and still have the potential to develop into a specific type of cell. They can be obtained from bone marrow and other human tissues. These stem cells may have the ability to differentiate into normal cartilage.


Surgical

Arthroscopy is a technique that allows surgeons to visualize, diagnose and treat a variety of knee problems. Ligament tears, meniscal tears, damaged and loose cartilage, and many other conditions can all be treated arthroscopically. Arthroscopy is performed using an arthroscope, a small optic instrument that enables a close look at the inside of a joint through a small skin incision.


Arthroscopic surgery was developed as a way to avoid making long skin incisions. While the long incisions allowed surgeons to fully visualize the joint, the subsequent disruption of tissue created long healing times, increased risk of infection and resulted in long scars.


Arthroscopic surgery avoids long, invasive incisions by using an arthroscope, a small tube-like instrument that allows the surgeon to see inside the joint. The arthroscope is inserted into the joint through a short incision generally less than 1/4" - 1/2". Several small incisions may be made to see other parts of the joint or to insert instruments. The arthroscope uses a camera that projects the image of the joint onto a monitor. The surgeon is able to view the joint, and its structures, including cartilage, ligaments and surrounding tissue. Once the problem is identified, the surgeon may be able to use specially designed instruments and/or implantable fixation devices to repair conditions or remove any damaged bone or tissue.


Recovery

Arthroscopic surgery rarely takes more than an hour for isolated injuries. Most all patients who have arthroscopic surgery are discharged within the same day. The small skin incision wounds take several days to heal. Several follow-up appointments may be necessary.  The patient can usually resume daily activities within a few days, but the injury may require several weeks to months to fully recover.


    Non-operative Treatment
The rehabilitation program for non-operative treatment of a meniscus injury may include:

  1. *    Using crutches for protective weight bearing while walking. Crutch use is usually recommended for the first 2 - 3 days after injury, or until pain and swelling have subsided.

  2. *    Flexion - extension exercises for motion and strength. An exercise program begins about 2 - 4 weeks after injury. No rotational exercises are permitted until the knee is symptom-free.

  3. *    Return to full activity at about 4 - 6 weeks after injury. If the knee is still symptomatic after 2 - 3 months, further medical evaluation and surgery may be necessary.


    Partial Resection
The rehabilitation program for a partial resection of the meniscus may include:

  1. *    Crutch use for the first 2 - 3 days following surgery due to post-operative pain and swelling. After this, the patient may be weight-bearing as tolerated.

  2. *    Range of motion exercises are emphasized at first.

  3. *    Strength exercises begin once swelling has subsided.

  4. *    Return to full activity at about 4 - 6 weeks following surgery.


    Meniscal Repair
Rehabilitation after meniscal repair depends on the size of the tear, stability of the repair, and other injuries. In general, for an isolated meniscal repair:

  1. *    Full weight bearing is not permitted for 1 - 6 weeks after surgery, depending on the type of injury and repair. Crutches will be used initially following surgery.

  2. *    Many surgeons brace the knee and restrict motion for 6 weeks, to prevent excessive flexion and extension.

  3. *    Range of motion exercises begin anywhere from 1 - 6 weeks after surgery, depending on the type of repair.

  4. *    Strengthening exercises begin once full range of motion has returned.

  5. *    Return to vigorous activities, such as sports, may begin 3 - 4 months after repair.

Healthy Meniscus

Torn Meniscus

  1. *All literature found within this article has been abridged from the following sources: