Meniscus tears are seen in a wide variety of populations from young to old and a question that is always asked when a patient is diagnosed is will I require surgery? This blog will look into what a meniscus is, the types of tears and management options.
Each knee has a medial and lateral crescent shaped meniscus that sits on the top of the tibia and attached by a number of different ligaments. The meniscus act to distribute force evenly through the knee when loaded. It also helps to create a friction free surface for the femur to articulate with the tibia. As we age the blood flow to our meniscus decreases to the point where only the outer zone has a good blood supply. This affects the healing potential of the meniscus as blood is what supplies the nutrients needed to heal tissue. Does this mean my meniscus will never heal? Unlikely but it does mean that healing takes longer than other tissues such as muscles or bones.
Meniscus tears are caused by either acute traumas such as twisting and change of direction activities in sports or age-related tears from the wear and tear of everyday life. There are several different ways to classify tears but the four most common are: radial, flap, peripheral, and longitudinal. Each type of meniscus tear is on a continuum from a simple tear to a complex or displaced tear. Due to the nature of the type of injury required to sustain an acute tear, meniscal tears often present with other injuries such as ACL ruptures, MCL tears and LCL tears to names a few and can even be over looked in the diagnosis due to more pressing concerns.
In 9/10 people the answer to this question will be no. Meniscectomy (removal of the meniscus) or partial meniscectomy used to be a favourite of surgeons for treating knee pain. It has fallen out of favour as recent long term studies show that those who had partial or full meniscus removal had similar short term outcomes verse no surgery and those who had surgery had increased wear and tear of articular cartilage long term. However, there are still some reasons a surgical approach may be required such as, mechanical locking. This is when your knee gets stuck in one position and you are unable to bend or straighten it, a failed attempt at conservative management (6-8 weeks of really focused rehab), or in association with another injury e.g. ACL rupture.
Physiotherapy rehabilitation has been shown to be extremely effective at treating meniscus tears and returning patients to normal function. Treatment includes soft tissue work, joint mobilisation, and an exercise program. Each rehabilitation program should individualised based off a patients abilities and goals.