Each knee has two C shaped pieces of cartilage, each of which is called the meniscus (plural: menisci). These rings of cartilage act as a cushion between the 2 bones of the knee (the femur and tibia). One meniscus is located in the inner edge of the knee and the other at the outer edge of the knee. Commonly, athletes engaged in sports that require quick turns, pivots or planting of the foot can suffer a tear in the meniscus. For others, the meniscus can begin to wear due to aging and become more prone to tearing.
Symptoms of a Meniscal Tear can include:
- A sudden “pop” in the knee
- Pain in the inside or outside of the knee
- Swelling of the knee
- Difficulty walking or bearing weight on the knee
- Feeling of the knee “catching” or “locking”
One of the most important things to note is that the meniscus will not heal itself. This is due to the cartilage being having little to no blood supply, which is needed for the healing process. However, this does not mean a meniscus tear is an immediate indication for surgery.
If you have been diagnosed with a torn meniscus, or suspect your meniscus is torn, here are 3 important things you should know.
1. Not Every Patient Needs Surgery
As mentioned above, not all patients with a torn meniscus will need surgery. Many meniscus tears are partial or incomplete tears and often do not require surgery. These less severe types of tears are often managed with anti-inflammatory medications, physical therapy or therapeutic injections. It is only when the symptoms of the injury begin to affect the function of the knee, or cause interference with the activities of daily living, that surgery should be considered.
2. The Type of Surgery Depends on the “Zone” of the Tear
Being that the meniscus has little to no blood supply, the “zone” in which the tear occurs is usually the best indication of what type of surgery is appropriate.
A Tear in the Red Zone
The Red Zone is the outer edge of the meniscus that does have some blood supply. Due to this blood supply, the healing potential is usually much greater and the cartilage is able to become strong and healthy again.
The most common procedure to treat the Red Zone tears is a Meniscus Repair. This procedure involves using a small puncture to access the meniscus. Once the incision is made, a small camera (arthroscope) is inserted into the knee and small surgical tools are used to stitch the meniscus back to its original position.
A Tear in the White Zone
The White Zone is the inner 2/3 of the meniscus that is avascular, meaning it has no direct blood supply. For this reason, tears in this area not stitched back together because they will not heal.
If surgery is needed for a tear in the White Zone, a procedure known as an Arthroscopic Meniscectomy is performed. This procedure involves using a small puncture to access the meniscus. Once the incision is made, a small camera (arthroscope) is inserted into the knee and the torn portions of the meniscus are trimmed. These torn pieces of meniscus have exposed nerve endings and will often cause the pain and inflammation associated with a meniscus tear.
3. You Can Usually Go Back to Sports/Activity in 6 Weeks (If You Are Committed)
At Mahwah Valley Orthopedic Associates, meniscal procedures are performed on an outpatient basis. Once the surgery is completed, the patient is able to rest and become comfortable. After the patient is evaluated they are able to return home the same day as surgery.
Physical Therapy will begin the day following surgery to ensure that the strengthening of the quadriceps and hamstrings begins immediately. Dr. Nicholas Alexander works with both the patient and the Physical Therapist to determine a rehab protocol that is unique to each patient based on lifestyles and goals.
Physical Therapy will include a variety of weight bearing and strengthening exercises 2-3 days per week. If the patient is committed to their protocol, they are able to return to sports or activity in only 6 weeks after a menisectomy. Usually, meniscal repairs require 6 weeks to heal, and return to sports is usually within 2-3 months.
Dr. Nicholas Alexander is the Founder of Mahwah Valley Orthopedics and a Board Certified Orthopedic Surgeon specializing in both the surgical and non-surgical treatment of hip and knee conditions. Dr. Alexander completed his Fellowship in Adult Reconstruction and Reconstructive Surgery of the Hip and Knee at the Johns Hopkins School of Medicine. He also serves as the Chairman of the Valley Hospital Total Joint Center. Dr. Alexander has offices in Mahwah and Clifton, NJ. If you, or someone you love, is considering treatment for a meniscus tear, contact us today for a consultation.