Contact Dr. Gustavel for a consultation to learn what treatments are most suitable for your meniscal pain. If you are suffering from an ACL tear, then you are not alone. About , people go through ACL r A torn ACL is one of the most common injuries seen in high impact sports and activities like soccer, An ACL injury is one of the most common causes of a knee injury. Your ACL does a lot of work in your knee and unfortunately is often injured.
While there are nonsurg Experiencing pain, but unsure what is causing it? Has your doctor recently diagnosed you with a Torn The ACL is one of the major ligaments of the knee, rapid movement or change of direction can cause a Knee Share. Joint injections The injection of cortisone or hyaluronic acid can offer temporary relief from meniscus pain.
Knee Unloader Brace This brace has been an effective treatment for patients with knee osteoarthritis since it relieves stress to the knee's painful side by shifting it to the side with minimal arthritis. Your doctor will likely suggest the treatment that he or she thinks will work best for you based on where the tear is, the pattern of the tear, and how big it is.
Your age, your health, and your activity level may also affect your treatment options. In some cases, the surgeon makes the final decision during surgery, when he or she can see how strong the meniscus is, where the tear is, and how big the tear is.
Some kinds of tears can't be fixed. Radial tears sometimes can be fixed, but it depends on where they are. Most of the time, horizontal , long-standing, and degenerative tears—those caused by years of wear and tear—can't be fixed. The older you are, the less likely it is that your tear can be repaired. For these kinds of tears, you may need to have part or all of the meniscus removed. When possible, meniscus surgery is done using arthroscopy instead of open surgery. During arthroscopy, your doctor puts a lighted tube with a tiny camera—called an arthroscope, or scope—and surgical tools through small incisions.
In a young person, surgery to fix the tear may be the first choice, because it may restore use of the knee. Surgery has risks, including infection, a blood clot in the leg, damage to nerves or blood vessels, and the risks of anesthesia. After surgery you may still have pain and joint stiffness. This means that of people who have this surgery, 85 have relief from pain and can use their knee normally, while 15 do not.
Surgery to remove part of the meniscus meniscectomy is better at keeping your knee stable than surgery to remove all of the meniscus. Partial removal also allows a quicker and more complete recovery than total removal.
Removing the whole meniscus typically reduces some symptoms. But losing the meniscus reduces the cushioning and stability of the joint. Most people, especially if they are young or active, are not satisfied with a total meniscectomy. This is why surgeons try to remove as little of the meniscus as possible.
This means that 78 to 88 people out of people who have this surgery have reduced symptoms and are able to return to most or all of their activities. Small tears found at the outer edge of the meniscus often heal with rest. Instead of surgery, you may try rest, ice, compression, and elevation.
You may wear a knee brace. You can try over-the-counter medicine such as ibuprofen or naproxen to help with pain and to reduce swelling. If your symptoms go away, your doctor may suggest exercises to build up your quadriceps and hamstring muscles and increase your flexibility. It's important to follow your doctor's guidelines so that you don't hurt yourself again. These stories are based on information gathered from health professionals and consumers.
They may be helpful as you make important health decisions. I've had quite a bit of pain on one side of my knee for a couple of weeks, but my symptoms have decreased. My doctor thinks that my meniscus may be healing on its own.
I'm still seeing my doctor, though, and I've started rehabilitation with a physical therapist. He's got me going through range-of-motion and knee strengthening exercises at home.
I don't think I'll need surgery. A few months ago, I started having pain in my right knee when I would move it certain ways. My doctor examined my knee and asked me about my symptoms. He diagnosed a tear in my meniscus. A follow-up MRI confirmed it.
I've been doing rehabilitation, but it's been 2 months and I've still got pain, particularly if I twist my knee at all.
The orthopedic surgeon thinks that I may have a flap or piece of the torn meniscus moving in the knee, which is giving me a lot of problems with my knee locking.
He's recommending surgical repair, and I am going to go ahead with the surgery. I injured my knee about a month ago in a tennis game. It didn't take my doctor long to diagnose a meniscus tear, and I'm going to have an arthroscopic test to see just how much I've damaged the knee. The surgeon says she can do repairs in the same procedure. My mother has severe osteoarthritis, and I believe that my knee may develop early arthritis if I don't get this tear taken care of.
The arthroscopic surgery makes sense to me. I am a serious athlete and this isn't my first injury. But this is the first time I've had to think about surgery.
I've had bad pain in my knee fairly constantly since I twisted it in the gym a few weeks ago. It's particularly bad if I bend or flex my knee. The surgeon says that the MRI shows a large tear in the inner part of my meniscus, and that's the part that doesn't heal well. He's recommending a partial meniscectomy to remove the damaged tissue.
He says that he'll only have to remove a small part of the meniscus and I'll still have stability in the knee, and no more pain! I'm going to have the surgery next week. Your personal feelings are just as important as the medical facts.
Think about what matters most to you in this decision, and show how you feel about the following statements. I think my meniscus tear is minor. I want to wait and see if my knee gets better before I have surgery. I'm in a lot of pain, and I want to have surgery so I can start feeling better. Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
How sure do you feel right now about your decision? Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision. My treatment for a torn meniscus will depend on more than just how I hurt my knee. Are you clear about which benefits and side effects matter most to you? Do you have enough support and advice from others to make a choice?
Author: Healthwise Staff. Medical Review: William H. Blahd Jr. This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use.
Learn how we develop our content. To learn more about Healthwise, visit Healthwise. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. Updated visitor guidelines. Get the facts. Your options Have surgery to treat a meniscus tear. Don't have surgery. Use home treatment and physical therapy to treat your knee. Key points to remember Your decision about surgery for a torn meniscus will depend on where the tear is located, the pattern of the tear, and how big it is.
Your surgeon's experience and preference, as well as your age, health, and activity level, can also affect your treatment options. Another of the most common calls our office receives involves patients who have had part or all of their meniscus removed and are now suffering from continued pain or arthritis as a consequence of the meniscus or multiple meniscus surgeries they had. This is reflected in the types of emails that we get from people looking for help. They go something like this:.
I have severe osteoarthritis in both knees. I have had meniscus surgery on both knees. Every day I live with severe pain and swelling in both of my knees. I am told only knee replacements will help me now. I do not want any more surgery. I feel that it is the meniscus surgeries that put me in this position. I have had meniscus surgery on each knee. X-rays and MRIs show major arthritis in each knee. I just turned 50, I do not want to even consider knee replacement without trying everything first.
Again, some people do benefit from meniscus surgery in the short-term and near future. It is these recent surgical success patients that we do not see in our clinic.
Who we see are the people, who already had meniscus surgery and their knee is causing them problems, or people who do not want a meniscus surgery at this time because of upcoming sports seasons, competitions, or simply, they need to work and there is a waiting list to get the surgery. This article will focus on the research surround meniscus surgery. If you would like to focus on treatment plans please visit our articles. One of the primary reasons for a meniscal operation is to improve joint stability, yet meniscectomy often appears to have the opposite effect, as it elicits even more instability, crepitation, and degeneration than the meniscus injury produced prior to operation.
This is why reoperation rates after meniscectomy can be as high as documented in the research below. By the time a person has a damaged meniscus, many other tissues in their joint are also affected included ligaments and tendons that provide stability when strong or provide instability when compromised.
The whole knee joint needs to be treated not just the meniscus tear. The human meniscus is mobile, movable, stretchable and made up of fibrocartilage and has many functions including joint stabilization and the manufacturing of specific mediators of healing that go into the synovial fluid.
None of these functions can truly be reproduced by any other type of meniscus besides the persons own meniscus. Although there is some short term improvement after these surgeries in aspects such as pain control, the long term effects of meniscectomy, meniscal repair, and meniscal allograft transplantation reveal that symptoms, such as pain and instability, will persist for years afterward.
There are many ways meniscectomy accelerates the osteoarthritis process through the structural wear of the articular cartilage.
Meniscus tears are common injuries and can disrupt these protective properties, leading to an increased risk of articular cartilage damage and eventual osteoarthritis.
Certain tear patterns are often treated with arthroscopic partial meniscectomy, which can effectively relieve symptoms. However, removal of meniscal tissue can also diminish the ability of the meniscus to dissipate hoop stresses, resulting in altered biomechanics of the knee joint including increased contact pressures.
What are we seeing in this image? As mentioned above, the patient will be told that they will eventually develop knee problems.
The long-term side effect of meniscus surgery is that meniscectomies can worsen knee joint instability by negatively influencing other supporting knee structures by increasing contact stress on the cartilage. Joint instability is a common result of meniscectomy, which is not surprising when considering that the meniscus is a primary stabilizing component of the knee.
The knee mensicus provide maximum joint contact protection and thus, reduce the contact stresses on the load-bearing surface of the joint, much like a washer does to distribute the pressure of the nut or bolt evenly and to provide a smooth surface or a double rear wheel four wheel truck distributes less pressure on each tire than a normal two rear wheeled truck.
Common physical symptoms of instability after meniscectomy are crepitation, such as cracking or popping, and locking in the joint. On radiographic examination, this postoperative deterioration of the knee is evidenced by narrowing of the joint space between the thigh and shin bones or a flattening of the tibiofemoral surfaces. Biomechanically, the development of osteoarthritis can in part be explained by the increased stress placed on the tibia and femur post meniscectomy.
It is a known fact that reducing the size of contact area on a surface increases pressure in the remaining area. Therefore, by removing part of or the entire meniscus from the knee, the area through which weight is transmitted in the joint is reduced, thus increasing the pressure on both the tibia and the femur and their articular cartilage.
Among these elective procedures were arthroscopic partial meniscectomy. In this examination of effectiveness the doctors explored previously published research including review articles. A review article is a study where previous research is accumulated into one set of findings. Here is what these doctors found. How does this happen? Menisectomy increases friction dramatically during motion by depriving the joint of the ability to lubricate the articular cartilage properly.
This accelerates the breakdown of the articular cartilage between the femur and tibia and the patella and femur bones. When these metabolically active articular cartilage cells degenerate faster than they can regenerate, the result is accelerated breakdown degeneration within the joint.
This is not a recently discovered phenomena. It can be difficult to tell a patient to have patience when their knee hurts.
Most of the time when someone comes into our clinic for the first time they will report on the characteristic symptoms of meniscus related knee problems:. It is also difficult to convince an athlete that meniscus surgery may prevent them from returning to sports altogether. At this point, we will introduce the research from surgeons as a second opinion to our statements. One of the most vital but lessor known roles of the meniscus is to provide lubrication to the knee, which it accomplishes through diffusing spreading out synovial fluid across the joint.
Synovial fluid provides nutrition and acts as a protective measure for articular cartilages in the knee. The femoral condyle of the thigh bone in the knee is covered in a thin layer of articular cartilage, which serves to reduce motional friction and to withstand weight bearing.
This cartilage is very susceptible to injury both because of its lack of proximity to blood supply and the high level of stress placed on it by excessive motion. The meniscus, therefore, is able to provide a much-needed source of nutrition to the femoral and tibial articular cartilage by spreading fluid to that avascular area. This illustration demonstrates the reasoning often given to patients that meniscus surgery is the only way.
Menisci have two zones. A red zone tear lies within the blood-rich portion of the meniscus. Where there is a blood supply there is healing as blood brings the healing and growth factors needed for wound repair. The white zone meniscal tear is thought to be non-healing because there is no direct blood supply.
Many doctors do not believe the white zone meniscus tear can be repaired because of this. This is typically the part of the meniscus removed in meniscus surgery. Doctors writing in The Journal of the American Academy of Orthopaedic Surgeons 5 offer a very good rationale for why people still have meniscus surgery.
Here are some talking points of the research:. Most people that contact us already have a good understanding the frequent or long-term cortisone use has its challenges and risks. In March , research lead by Rush University Medical Center and published in the journal Arthroscopy 7 found that patients who received knee injections within one month prior to knee arthroscopic surgery developed postoperative infections at twice the rate of those who did not receive an injection.
This of course relates to an injection increasing the risk for surgical infection. But what about the overall impact of corticosteroids on the meniscus? It is well understood by most medical professionals and their patients that prolonged and long-term corticosteroid injections for knee pain can break down cartilage including the meniscus.
These findings do not support this treatment for patients with symptomatic knee osteoarthritis. In August of in the journal Scientific Reports 10 doctors expressed concerns about damaging the meniscus tissue with cortisone injections. For many people, one injection would be considered safe.
Here are the learning points of that research:. There is a lure to surgery. We see it every day in our offices. The long-standing belief that surgery will fix everything.
A recent paper from the University of Southern Denmark 11 wrote:. A January paper published in The archives of bone and joint surgery 12 offers this assessment of meniscus repair:. It is technically challenging and has a steep learning curve. General complications of arthroscopy such as venous thromboembolism, infection and vascular injury could occur.
Specific complication including nerve injuries, ligamentous injury, iatrogenic cartilage lesions, and poor suture techniques can happen during meniscal repair. The surgeon should depict and accept the eventual complications and address them as rapidly as possible. It is also important to form patients about potential complications.
Between and — research began appearing questioning not only the value of meniscus surgery but whether or not the surgery caused more harm than good. The summary is below. The research mentioned above and reported by the New York Times was not the first time the meniscus surgery controversy was reported in the international media.
Patients were randomly assigned to arthroscopic partial meniscectomy or sham surgery. Then a scoring system was designed to measure pain, symptom severity, and knee pain after exercise at 12 months after the procedure. Continuing forward, the lead researcher of this study Raine Sihvonen, MD published more papers on the problems of meniscus surgery.
In other words, the meniscus tear is the result of knee osteoarthritis development. If you remove the meniscus you accelerate the knee osteoarthritis. We will discuss this further below. In April , Dr. Sihvonen and colleagues wrote in the Annals of Internal Medicine 15 that removing parts of the meniscus did not appear to relieve the symptoms of knee pain and knee locking in surgical patients.
Many orthopedic surgeries in my opinion have a far worse outcome then patients anticipate primarily because they cannot return to the activities they love, such as running. When people have arthroscopy surgery I try to go over their surgical reports with them because often what they perceived what was done with the surgery was not done and other things were done that were detrimental and they had no idea they were done.
I have never as far as know seen an orthopedic operative report that showed a real meniscus repair, where the meniscus was sewn together and that was it. The typical report shows partial meniscectomy and no repair yet the patient believes it was a repair. Every arthroscopy report I have ever seen, has findings that reveal osteochondral lesions, chondromalacia, meniscus degeneration, articular cartilage lesions ligament injury and many others.
Remember anyone can have decreased pain by doing less, and unfortunately, many people who receive orthopedic surgeries end up doing less. Earlier in research published in the American Journal of Sports Medicine showed what little value meniscectomy has.
Researchers compared meniscectomy to nonoperative treatment for meniscus tears. At the two-year follow-up, there was no difference in pain relief, improved knee function, or patient satisfaction. Results also showed that meniscectomy did not provide better functional improvement than the nonoperative group.
But what was the difference between these two groups? One group of patients underwent invasive surgery, had tissue remove, and will likely experience long-term meniscus degeneration. The most serious of the long-term consequences is an acceleration of joint degeneration. In research from May , 17 doctors warned that the role of arthroscopic partial meniscectomy in reducing pain and improving function in patients with meniscal tears continues to remain controversial and that studies show no difference between arthroscopic partial meniscectomy and non-surgical treatment.
It reports on how military surgeons dealt with meniscal injury. The report reveals findings on nearly 30, meniscus surgeries. Basically, surgeons need to repair and save the meniscus. They also need to figure out how to do it. The goal of meniscectomy was to reduce pain, restore knee function, and prevent the development of osteoarthritis.
However, as medical research studied the long-term effects of this procedure, it became apparent in the medical community that meniscectomy was a primary cause of the sudden onset of knee osteoarthritis.
The meniscus was, in fact, an important component of the knee. The meniscus provides several vital functions including mechanical support, localized pressure distribution, and lubrication to the knee joint.
They are made of thick fibrous cartilage that allows them to function as a shock absorber between the upper and the lower leg bones. This research asks the same question we do, Why do we still perform meniscectomy? They, like us, agree that it is high time that the paradigm shifted, in favor of meniscal preservation. Medical research is broken up into levels of evidence. Level 1 being base evidence which means a researcher took existing research and combined it into a review of the literature.
Doctors and researchers grade this the lowest level of accredited research. The German doctors say too much level 1 evidence is being offered as a generalization of meniscus surgery. The complaint is some surgeries will help some patients and that every meniscus surgery is not a bad surgery and this research is not reflective of that. The ESSKA guidelines also say the treatment of degenerative meniscal lesions should start with conservative management.
In the case of persistent symptoms, surgery should be considered after 3 months.
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