The knee joint, which is the meeting point of the femur with the tibia has 2 menisci. These menisci are nothing but cartilages that cushion and protect the joint from injury. When the menisci are injured, it results in pain at the joint.
Causes of Tear
A meniscus tear can have a lot of causes:
- When the knee is suddenly twisted, the meniscus can suffer damage.
- Sports that involve feinting, like rugby, football, etc. might result in a meniscus tear. Contact sports injuries are another cause.
- Lifting heavy objects can, in some cases, lead to a meniscus tear.
- In older adults, meniscus tear can happen even without an injury – due to wear and tear over the years.
Symptoms and Diagnosis:
- Knee pain and inflammation which, in some cases, may set in gradually and not immediately after an injury.
- Some people might even hear the knee go ‘pop’ when they sustain a tear.
- Knee’s range of motion is reduced.
- Sometimes, when the torn menisci detach and get trapped in the knee joint, the knees might get locked.
Diagnosis involves a physical examination to check the knee’s mobility. The doctor will also want to know the history of the injury. Imaging tests may also be required.
Can the meniscus heal on its own?
- Injury to the outer portion of the menisci has a good chance of healing on its own as blood supply is good. However, the interior of the menisci has reduced blood supply and the chance of self-healing is also less.
- The size of the tear plays a role as a smaller tear has a greater chance of healing on its own.
- Similarly, youngsters heal better compared to elderly.
- The stress the knee is subjected to also decides the healing process.
- If other parts of the knee are injured along with the meniscus, that can delay healing as well.
Does Treatment Always Involve Surgery?
Definitely not. No doctor will suggest surgery as the first line of treatment. Non-invasive treatment options will be tried first. After the injury is sustained, following the below-mentioned guidelines will help in recovery.
- Giving sufficient rest to the knee joint. If you have to walk, use a walking aid which can reduce the pressure on the joint.
- For pain relief, applying an ice pack to the joint will help.
- Wrapping the knee will help with the inflammation.
- Keeping the leg raised will bring down inflammation.
- If the pain is bad, ask the doctor for pain relief medication and do not self-medicate.
- Under the guidance of a physical therapist, stretching and strengthening exercises can be done.
- Care should be taken to avoid any activity that stresses the injured knee.
If these measures do not resolve the condition and the pain gets debilitating, the doctor might suggest surgery. For the elderly, a meniscus surgery will enable a better quality of life.
Surgery – What to Expect
Preparing for Surgery
- Before surgery, tests will be done to check the person’s health status and suitability for surgery.
- The surgeon will discuss the kind of anesthesia to be administered and give a list of pre-operative instructions.
- The doctor has to be aware of any medication the patient is on as it might have to be stopped prior to surgery.
The Surgical Process
- Surgery involves making very small incisions on the knee and inserting an arthroscope and surgical tools through these incisions to repair the tear.
- An arthroscope is a flexible fibre optic tube that has a camera attached to the tip.
- The output of the camera can be viewed on a display device and hence the surgeon will be able to see the joint and the injury.
- This kind of surgery is called a keyhole surgery and usually takes around 1-2 hours.
- Depending on the tear, the doctor will either repair the meniscus or remove it completely.
- While repairing and retaining the meniscus will be the preferred choice, if the tear is too large, removal will have to be done.
- Hospitalization of a day may be required and in some cases the patient can even go home on the day of surgery itself.
After the Surgery
- The knee might be put in a brace after a meniscus repair.
- The patient will feel some pain after surgery.
- This is expected and as the pain might persist for a few weeks, painkillers will be prescribed.
- Avoid squatting or bending the knee too much for the first few days after surgery.
- Staying seated for too long should also be avoided.
- The patient will need help at home for sometime after surgery to help the knee heal.
- Driving will not be possible in the first 3 weeks.
- However, it is important to commence physical therapy as the doctor directs. This is crucial to regain movement of the joint and to benefit fully from the surgery. With regular physical therapy, the knee will heal in a few months.
Meniscus surgeries have a high success rate and there are few complications. After surgery, the patient will be put on a course of antibiotics to prevent any possible infection.
What to Watch Out for
After discharge, if any of the below-mentioned symptoms are experienced, it is best to consult the doctor immediately.
- High fever
- Discharge from the wound
- Inflammation of surgical siteand it feels warm when touched
- Breathing difficulty
How to Prevent a Tear
- Exercising regularly to strengthen the muscles and joints will minimize the possibility of a tear.
- Adequate rest too is important and over exercising should be avoided.
- Proper footwear when performing high impact activities is recommended.
- Warming up before starting an exercise routine and gradually increasing exercise intensity is important.
- For those with a weak knee or previous knee injury, wearing a brace will protect the knee.
For senior citizens who suffer from pain and mobility restriction due to meniscus tear, surgery can vastly improve their quality of life and make them independent. People who suffer from a locked knee because of meniscus detachment can also benefit greatly from this procedure.