A meniscus 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 so it’s present on the bottom of the femur, at the knee, on the top of the shinbone or the tibia. 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 osteoarthtitis.
Why Do Meniscal Tears Occur?
Orthopedists see many patients who present with knee pain and are found to possess meniscus tears. Why do these cartilage disks seem to tear so easily once we reach our fourth, fifth decades and beyond?
Our meniscal tissue is non-regenerative. It’s similar to our brain or our heart tissues. If we have a heart attack or a stroke, we do not regenerate those areas of our heart or our brain. It simply scars in. Yet if we cut our skin, our skin heals. That tissue is regenerative, same with muscle and a lot of other tissues in our body.
Meniscal tissue has a very limited blood supply and therefore have a limited capacity to repair 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 tears. (This is why most tears are called degenerative tears) Sometimes it tears just turning and reaching for something in your refrigerator. A lot of times people will note that they knelt down to pick up something up and when they went to stand up they felt something rip inside their knee and noted the onset of pain.
Do I Have a Meniscus Tear?
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 meniscal tears will complain of pain going downstairs. They’ll have pain getting up from a seated position. They’ll have pain with turning, pivoting and twisting and some patients, if the tear is large will complain that the knee is buckling or giving way and feels unstable.
Meniscus Tears: From www.aaos.org
Types of Meniscal Tears?
The most common type of tear we see are degenerative tears. When you look at the meniscus, 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. It’s similar to the front your favorite pair of blue jeans that you’ve worn for decades and the material just simply wore out.
Then there are those who have suffer from more acute tears. Acute tears, caused by some form of trauma, can have different shapes and different patterns. Your symptoms will to a large degree be dependent on the shape and pattern of the tear. 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 where 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 an arthroscopy for treatment of those tears.
Treatment Decision Making
Physicians should endeavor to treat patients, and not an MRI finding. The decision as to whether or not surgery is necessary is really based upon the level of pain you’re experiencing, the effect it’s having on your quality of life, the type of tear that you have and how long you’ve been experiencing the symptoms. The pain from many tears will dissipate over 4-6 weeks and you may be able to return to a normal lifestyle.
It is (ultimately) YOUR DECISION whether or not surgery is necessary!! This should be viewed as a quality of life decision.
If you have knee pain, you are referred for an MRI fairly early and you’re found to have a degenerative meniscus tear — I typically advise patients to simply just wait. A lot of times your symptoms will go away and either they’ll never come back or they’ll come back once or twice a year and you’ll still be able to lead a very active lifestyle. If you sustain an injury and you have a an unstable tear, tear patterns we call a horizontal cleavage tear, a radial tear or a flap tear — these tear patterns tend to remain bothersome. If after four, five, or six weeks, you still have the same degree of discomfort and suffer quality of life issues, then you might be a good candidate for an arthroscopy.
The Bottom Line
If you have a meniscal tear, it’s not all doom and gloom. Many meniscal tears do not require surgery. Some of them do. Some meniscal tears are repairable. Some are simply removed. If you have had pain, significant enough to affect your quality of life, and you find this unsatisfactory then you should consider surgery. If you do choose to have surgery, by no means is this “urgent” surgery or “emergent” surgery. Take your time, consider your options, rest, and consider a second opinion.
As always, my disclaimer applies. This is not medical advice. You should discuss these issues with your orthopedic surgeon, or your family, friends and primary care doctor to determine if based upon your symptoms and quality of life you feel you would rather be treated surgically or nonsurgically. If you have any questions, feel free to reach out to me through my website, YouTube, Twitter, Facebook and wherever else I reside online.
Adam has worked in the local news industry for the past two decades in Westchester County and the broader Hudson Valley. Read more from Adam’s author bio here.
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