I have a meniscus tear, now what?
Many patients who come to my clinic with an MRI that shows a meniscus tear are looking for advice on what to do next. Another physician may have told them that they need surgery because the MRI is abnormal. Some people just want another opinion. Not all meniscus tears need surgery.
I first want to understand the patient’s symptoms, and I look to see if the knee is locking, catching, or if it feels unstable. Meniscus tears that are unstable create these problems, which may indicate that more damage is being done to the articular cartilage in the rest of the knee. An additional concern here is that the knee could give way at a bad time, causing a fall or buckle leading to another injury. Be careful.
Should I have meniscus surgery?
That depends. How much trouble are you having? How long has it been bothering you? What are your expectations? All of these are important questions to consider when deciding if a meniscus surgery is for you.
Many tears are more subtle degenerative meniscus tears. These may not cause many symptoms other than a vague ache deep in the knee. There may be a catching episode infrequently, but these patients are often functioning pretty well if they don’t have to bend or twist a lot. A lot of the ache in the knee may be from underlying arthritis in the knee too. This will not necessarily get better with arthroscopic meniscus surgery and you may need to consider other treatments such as visco-supplementation injections. While intra articular steroid injections have been the mainstay of pain-relieving treatments, our current research shows that steroids are not good for your cartilage and should be used sparingly. We now have multiple biologic injection therapies with promising results. However, many patients have so much arthritic loss of cartilage in addition to their meniscus tear that knee replacement may be the best definitive option.
I like to review how long the symptoms have been present. While an acute sports injury may tear the meniscus and cause pain and swelling, if it is a small stable tear a trial of rest, ice, compression, and elevation may be the first thing to do. I think most patients should give these injuries a little time and possibly some rehabilitation or physical therapy to see how much trouble they will have. Certainly, if there are continued symptoms after a few weeks it may be necessary to proceed with surgery to get them back to their activities.
Other patients may have had knee pain for months or years, but it doesn’t limit them other than once or twice a year. They probably have a degenerative meniscus tear and can be patient on deciding when to have surgery, waiting until the pain interferes with their activities on a more consistent basis.
Lastly, I think having the right expectations about what surgery will do is most important. A well informed patient working with a surgeon who is willing to communicate goes a long way to getting a good result. Many patients want to have meniscus surgery and go back to their activities the day after surgery. Unfortunately, you can’t rush mother nature. It will usually take a couple of days of rest immediately after surgery, followed by a couple of weeks of soreness before everyday activities feel comfortable. Good rehabilitation with a therapist after surgery will also help to get them back faster. It may take several weeks to return to their sports or job if a lot of walking and activity are required. It may take longer if the meniscus is repaired.
Dewey Jones, MD is an orthopaedic surgeon who practices at Southlake Orthopaedics Sports Medicine & Spine Center.
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