Meniscus tears are a very common source of pain in the knee. They are also commonly seen on MRIs obtained for other reasons – and are not necessarily the cause of your pain. I have had multiple patients with meniscus tears recently and each of them has had very similar questions. In this post we will explore what a meniscus is, what meniscus tears are, why meniscus tears are so common — and we will attempt to address the issue : Why meniscus tear surgery isn’t always necessary.
So let’s talk about meniscus tears. What is a Meniscus? It is a cartilage disk that’s found in the knee. There are actually two of them. We have one on the inner side of the knee which we call the medial meniscus and one on the outer side of the knee which we call the lateral meniscus. These two disks function as shock absorbers or cushions to minimize the stress on another type of cartilage that we have in the knee which we call the articular cartilage. The articular cartilage is the cartilage that actually coats the ends of the bones. If the two menisci are not present or they’re torn, then the articular cartilage sees an increase in stress and can trigger the onset of osteoarthritis. That is by no means the only cause of osteoarthritis. However, it is certainly a significant contributor.
Why do meniscus tears occur?
Unlike muscle, fascia, bone and other connective tissues in our body, the meniscus tissue in our knee has very few mechanisms for repairing itself. Therefore, every step that you’ve taken, every twist that you’ve done, every time you’ve knelt down or squatted down, you’ve put a force across that meniscus and eventually it wears out and the meniscus tears. (This is why most tears are referred to as being degenerative.) Sometimes it tears just with turning and reaching for something in your refrigerator. A lot of times people will note that they knelt down to pick up something and when they went to stand up they felt something rip inside their knee and noted the onset of pain.
When does a meniscus tear hurt?
The typical patient with a meniscus tear doesn’t have much in the way of pain with walking straight ahead. Sometimes they do. It depends on the size of the tear but usually they’ll tolerate walking in a single direction very well. Patients with meniscus tears will occasionally complain of pain going down stairs. They’ll have pain getting up from a seated position. They’ll have pain with turning, pivoting and twisting and some patients, if the meniscus tear is large, will complain that the knee is buckling or giving way or feels unstable.
Types of meniscus tears
What are the different types of meniscal tears? There are degenerative meniscal tears . When you look at the cartilage disc, the edges are simply frayed. The tissue has been destroyed from years and years of use…nothing you did wrong…the tissue simply wore out.
Then there are those who have suffered more acute meniscus tears and these tears can have different shapes and different patterns —the shape and pattern will determine how symptomatic or how bothersome the meniscus tear will be. If a loose flap of tissue is created and that flap is moving around within the knee—that’s when you’re going to have “giving way” and you’re going to have pain with many activities. You’re not going to tolerate those tears well and those patients with flap tears (or unstable tears) will usually (not always) go on to require an arthroscopy or a scope to try to either repair or remove that torn piece.
Most people with degenerative meniscal tears may have one or two exacerbations or periods during the year when their knee hurts, but by and large they get around just fine and lead very active lifestyles with these degenerative tears and do not require surgical repair.
So the decision as to whether or not meniscus surgery is necessary is really based upon the pain you’re experiencing, the effects it’s having on your quality of life, the type of tear that you have and how long you’ve been experiencing the symptoms. ( It is ultimately YOUR DECISION whether or not knee surgery is necessary!!)
How do we treat Meniscus tears?
Whether or not surgery is needed is usually a wait and see scenario. Early hands on treatment (Active Release Technique® or Functional Range Release®) combined with exercise therapy will help decrease the swelling, increase the range of motion and mobility, and regain your stability.
If you have an unstable tear, and four, five, or six weeks later you are experiencing the same degree of pain and discomfort and quality of life issues, then arthroscopy may be a good option for you.
No matter what, therapy can be beneficial before surgery (pre-habilitation), instead of surgery, or after surgery.
As always, if you have any further questions please feel free to send us an email or give us a call.
Dr. Colin Leis, B.Sc., D.C.