The Meniscus

Feb 20, 2023

What is a meniscus?

The meniscus are located inside your knee joint between your thigh bone (femur) and tibia (shin bone). They are half-moon, wedge shaped cartilage structures that act as shock absorbers for your knee joint. There are two menisci in the knee joint, one located on the inside of the knee (medial meniscus) and one located on the outside of the joint (lateral meniscus).

Injuries to the meniscus

Tears to the meniscus can occur due to an acute traumatic event or can occur gradually over time (known as degenerative tears).

Acute Tears: The meniscus can be injured or torn during a forceful twisting of the knee joint. This often occurs when landing from a jump or turning quickly on the field of play. Tears to the medial meniscus are most common. Injuries of this nature are known as traumatic tears and more commonly occur in athletes or younger patients. Patients will often report hearing a pop and experience some swelling the next day with stiffness. Tears to the medial meniscus are most common. Sometimes a ‘bucket handle tear’ occurs where a piece of the meniscus flips into the joint space (just like a bucket handle!). This can cause the knee to lock. In these cases, it is recommended to seek urgent orthopaedic care.

Degenerative Tears: In middle aged or older patients’ tears can occur in the meniscus without any trauma or injury. These tears are often thought to be an early sign of osteoarthritis. Not all degenerative meniscus tears cause pain and require treatment. Some risk factors for degenerative meniscus tears include poor fitness and strength, obesity or prolonged participating in high impact activities/work.

Symptoms of Meniscus Tears

Most patients will describe some of the following:

· Pain on the inside or outside of the knee along the joint line

· Pain +/- catching on bending and straightening the knee

· Pain +/- catching on twisting/turning, walking or running

· Swelling

· Stiffness or restriction in range of movement

What should I do if I have an Meniscus Tear

The primary treatment for meniscus tears is physiotherapy and rehabilitation. We do not recommend the use of braces following a meniscus tear. Early movement is strongly encouraged in the days following the injury. It is preferential to try and regain as much function as possible prior to undergoing any surgical procedure. You should start rehabilitation immediately following your injury under the guidance of your physiotherapist.

Degenerative tears are primarily treated with rehabilitation. Some patients may require injection therapy in the form of cortisone to help with pain and inflammation. This will allow them to participate in their rehabilitation. For patients that fail to make any progress with conservative treatment, surgical treatment options are discussed which is in the form of an arthroscopy and meniscal debridement. Sometimes surgery in this case is performed in an effort to improve comfort and function. This can also delay the requirement for a joint replacement (in the case of osteoarthritis).

Acute traumatic tears in young active patients that do not respond to exercise or where range of movement is restricted often require surgery. There are two types of meniscal surgery.

Meniscal Debridement

Surgery for meniscus tears is most often in the form of an arthroscopy (keyhole) procedure that is performed to debride or shave out the damaged tissue. This can also remove any loose bodies. Watch an animation of the procedure HERE. The procedure itself takes approx. 20 minutes. You will be able to go home a few hours after the surgery and crutches are not usually required. Most patients can return to play and activity within 6-8 weeks. If you had significant restrictions in movement before the surgery, a longer recovery time is generally required to help restore movement and function. Recovery following degenerative tears is often longer as the health and function of the knee joint prior to surgery heavily influences the level of comfort and function following surgery.

Meniscal Repair

In some cases of acute traumatic meniscal tears in young athletes, it is possible to repair the meniscus. Professor Moran will discuss this with you if he feels it is feasible to achieve a secure repair. Factors that influence success of a meniscal repair are the patient’s age, time since injury and location and pattern of the tear. In a repair procedure the meniscus is reattached to the bone. Consequently, the recovery time is significantly longer than the meniscus debridement procedure as caution is needed in the early stages to protect the repair. Athletes can expect a recovery time of 4-5 months to returning to play following a meniscus repair. The first 4-6 weeks are usually spent on crutches and some patients will also be put in a brace to help offload the knee and protect the repair. You can ready about what to expect in our surgery booklet

Recovery following arthroscopy for meniscal tears

Your recovery after an arthroscopy is heavily dependent upon your compliance with the post operative rehabilitation protocol. You can find out more information on our Meniscus Debridement Protocol and Meniscus Repair Protocol by checking out our easy to follow guides.

If you’re looking for more information about other types of injuries, visit our blog section including ACL Injury, Shoulder Instability and much more. If you have ANY questions at all, please be sure to touch base with our team by calling 01 526 2352