Meniscus Tear = Surgery - Myth Bust Monday

Today I've got a guest feature for the Myth Bust Monday series. This blog comes from Nima Mehran, M.D. Orthopaedic Surgeon & Sports Medicine Specialist who was previously medical staff with the Lakers, Kings, Dodgers and USC.

Do all meniscus tears need surgery?

Absolutely not!!! A tear on an MRI does not equate with needing surgery. This is a common misconception.

Let's discuss this more!

What is a Meniscus?

The meniscus is a C-shaped tissue between your femur (thigh bone) and your tibia (shin bone). Each knee has a medial (inner side) meniscus and a lateral (outer side) meniscus. The meniscus is composed of water, collagen, proteins and other cellular elements.

What is the function of a meniscus?

The meniscus is a shock absorber that helps optimize force transmission across the knee and protects the cartilage on the end of our femur and tibia. The medial meniscus is also a secondary stabilizer to the ACL as it can prevent anterior translation (forward shifting) of the tibia. 

Does the meniscus have good healing ability?

Tears in the outer 1/3 of the meniscus have healing potential because there is blood flow to that area. However, tears in the inner 2/3 generally do not heal well as a result of poor circulation.

Symptoms of meniscus tears?

Pain at the joint line of the medial or lateral side. 

Swelling, can be intermittent.

Mechanical symptoms such as locking or catching/clicking with pain.

Which meniscus is torn more often?

Lateral meniscus tears are more common with acute ACL tears. However, medial meniscus tears are most common especially in older patients with degenerative changes.

Surgery may be indicated if you have mechanical symptoms such as catching and/or locking. Conservative management should be attempted first in the majority of cases. This includes NSAIDs (anti-inflammatories), physical therapy, and possibly, injections. If you try conservative therapy and it doesn't bring the symptomatic relief desired and you do not have arthritis, you may then be a candidate for surgery.

When do you repair the meniscus and when do you remove the torn tissue (partial meniscectomy)?

The goal is always to save as much meniscus as possible, but that is not always possible. Generally, we try to repair the meniscus in younger patients (<40), with more acute tears (<6 weeks), and depending on tear location and pattern (repair is much more successful if the tear is vertical and in the outer ⅓ of the meniscus). Additionally, in patients who are having an ACL reconstructions, repairs are more likely to succeed due to the bleeding created by the reconstruction. Tears in areas of poor blood flow and patterns that are not amenable to repair are more likely to be excised (cut out). 

What happens to my knee if I lose my meniscus?

The meniscus is a force buffer for your knee and as you lose more of it, you have less ability to buffer forces. This can lead to faster development of osteoarthritis compared to an uninjured knee.

Dr. Nima Mehran, M.D.

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