Torn meniscus: Is it worth having meniscus surgery?

Meniscus tears are among the most common orthopedic injuries. Meniscus surgery can reduce knee pain, help you feel more stable, improve comfort as you walk and stand, and return to activities you enjoy. But is it the only option?

Get to know your meniscus

The meniscus is a C-shaped pad of cartilage inside the knee. It is located behind the kneecap and between the shinbone and thighbone. Each knee contains two meniscus pads, one on the inside of the leg and one outside.

You can tear a hole in the meniscus when you forcefully twist your knee or by jumping, swerving, or pivoting while playing sports. When the meniscus is torn, it can no longer cushion the bones, absorb shock, or support the knee joint as well as it should.

Symptoms of a meniscus tear

A torn meniscus can make the knee unstable, and the joint may:

• Be difficult to bend or straighten
• Cause a popping or clicking sensation
• Feel as if it is locked in place
• Give out unexpectedly

In addition, meniscus tears can cause pain, swelling, and stiffness.

Left untreated, meniscus tears may progress to osteoarthritis, in which a lack of healthy cartilage cushion damages the underlying bone.

Imaging to diagnose meniscus tears

Your surgeon may also order imaging tests to learn where the meniscus is torn and how badly it is damaged. Most people will have an MRI, which creates detailed pictures of the entire knee joint. An MRI can reveal the location and severity of the meniscus tear and any additional injuries to surrounding tissues.

Based on MRI findings, a torn meniscus will be assigned one of four grades. Grades 1 and 2 usually do not need surgery unless they grow larger or symptoms worsen. Generally, grade 3 and grade 4 meniscus tears require surgical repair.

Types of meniscus tears

There are three main types of meniscus tears:

• Radial tears occur on the inner edge of the meniscus.
• Longitudinal tears run lengthwise down the center of the meniscus.
• Horizontal tears occur between the top and bottom layers of the meniscus.

More severe forms of meniscus tears include:

• Bucket handle tears, which can split the meniscus lengthwise down the middle
• Flap tears, which can cause a fragment of the meniscus to come loose
• Parrot beak (oblique) tears, which start as radial tears and then grow toward the center of the meniscus
• Root tears, which occur when the meniscus is torn from its anchor point, often due to injury or gradual wear and tear

Alternatives to meniscus surgery

Not all meniscus tears require surgery. Depending on the tear's severity, you may need nothing more than time and at-home care using:

• The RICE method: rest, ice, compression (wrapping the knee to prevent swelling), and elevation (raising the injured knee above the heart level to reduce pain and swelling)
• Over-the-counter pain relievers, such as nonsteroidal anti-inflammatory medications
• Corticosteroid joint injections
• Physical therapy

When surgery is the best option

You may need surgery if at-home care and rest don't allow the tear to heal. Many meniscus surgeries are performed using arthroscopy, a minimally invasive surgery involving small incisions and tiny, specialized tools. These procedures can be completed in about an hour.

Meniscus surgery aims to preserve as much healthy meniscus as possible. You may need one of the following procedures:

• Partial meniscectomy (meniscus removal) is a procedure to trim away the damaged portion of the meniscus and prevent the tear from worsening.
• During meniscus repair, your surgeon sews the torn edges of the meniscus together. The meniscus then heals on its own.
• Meniscus transplant replaces damaged or missing meniscus tissue with tissue from a donor.

Your surgeon will choose one of these procedures based on factors including:

• The type of tear
• The extent of the damage
• Your age
• Your activity level
• Any related knee injuries
• How much your symptoms affect your lifestyle

After surgery, you can expect rehabilitation to take a few weeks and complete recovery to take a few months.

If a torn meniscus is causing pain and interfering with your lifestyle, it may be time to consider surgery. Request an appointment with a Reid Health orthopedic specialist today.