Monday, May 25, 2015

Meniscus tears: When DO I need surgery?

We often hear of athletes tearing their knee cartilage-the common term for the meniscus. In an athlete, a torn meniscus most often happens from a twisting or rotating injury or getting hit on the side of the knee as might occur in a soccer or basketball game.

Meniscus tears: When DO I need surgery?


We often hear of athletes tearing their knee cartilage—the common term for the meniscus. In an athlete, a torn meniscus most often happens from a twisting or rotating injury or getting hit on the side of the knee as might occur in a soccer or basketball game. 

As we get older the meniscus becomes more brittle and it is not unusual to have meniscus damage in your 40s, 50s or 60s. In older adults, a meniscus is frequently torn as a result of activities involved in daily living such as squatting, kneeling, or lunging.

So how do you know if your meniscus is torn?

The first and most common symptom is sharp pain, catching, and locking. The knee can feel like it gets stuck at irregular times, sometimes with walking, sometimes standing from a seated position, and sometimes for no reason at all.  Frequently, there is swelling or fullness in the knee and often times the swelling is felt as pain in the back of the knee. 

The best test to tell if your knee has a torn meniscus it an MRI scan. This test is very sensitive and shows a lot of detail including the hard cartilage that coats the ends of the bone called articular cartilage, the soft cartilage known as the meniscus and all of the ligaments in the knee such as the ACL, the MCL and others. It also shows if there is fluid in the knee—a sign of an underlying problem.

In fact the test is so good that it often shows damage that might not actually be causing a problem. For example, we have seen situations where a patient complains of pain on the right side of the knee while the MRI shows damage of the meniscus on the left side. The difficulty arises because the patient thinks the problem is a torn meniscus when in fact that finding is just a source of confusion.

If I have a torn meniscus do I need to get it fixed?

Because not all tears cause pain or locking, not every tear needs surgery. In fact there are many times when we will allow a patient to continue their activity or sport if pain and swelling are minimal, and of course if there are no mechanical symptoms such as locking. The treatment for a symptomatic torn meniscus is to have arthroscopic surgery to either stitch the tear or remove the torn fragment if it is too damaged to stitch. The older you are, the less likely that your meniscus will heal if stitched.  

In some cases, athletes have to make a difficult decision. If a stitchable tear occurs during the season, they have to decide between having a piece of meniscus removed which would allow return to play in a week or two or to have the meniscus stitched which would require no athletics for three months or more. Of course the problem is that the knee works best for the rest of your life with as normal a meniscus as possible. The more meniscus that is removed, the greater the chance of developing arthritis later in life. 

The most difficult problem occurs in people over 40 who injure their knee in a minor way and the MRI shows a tear. The patient thinks the tear is an acute injury but in fact it is due to a degenerative process.  This degenerative process is wear and tear which is really an early onset of osteoarthritis. As the cartilage in the knee begins to wear over time, the knee can swell on occasion and can feel achy. Remember that as we age, many of us have meniscus tears and don’t even know it.

Results of arthroscopic surgery for meniscus tears

With just aching and swelling—and without catching and locking—surgery to treat the tear has a 50:50 success rate. The best option for this circumstance is a cortisone injection, anti-inflammatory medicine, and physical therapy. If you’re under 40 and have an acute meniscus tear that is not degenerative and have mechanical symptoms of catching and locking, the success rate for surgery has been shown to be 85 percent or better.

So, the symptoms associated with the meniscus tear are the biggest indicator of the appropriate treatment.  If you have catching or locking, surgery is indicated and is very successful. If it’s achy pain and intermittent swelling, conservative treatment of injections, medication, and physical therapy are the best treatment options.

Arthur Bartolozzi is Director of Sports Medicine at Aria 3B Orthopaedics.

Read more Sports Doc for Sports Medicine and Fitness.

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Whether you are a weekend warrior, an aging baby boomer, a student athlete or just someone who wants to stay active, this blog is for you. Read about our growing list of expert contributors here.

J. Ryan Bair, PT, DPT, SCS Founder and Owner of FLASH Sports Physical Therapy, Board Certified in Sports Physical Therapy
Brian Cammarota, MEd, ATC, CSCS, CES Partner at Symetrix Sports Performance
Ellen Casey, MD Physician with Drexel University Sports Medicine
Desirea D. Caucci, PT, DPT, OCS Co-owner of Conshohocken Physical Therapy, Board Certified Orthopedic Clinical Specialist
Michael G. Ciccotti, M.D. Head Team Physician for Phillies & St. Joe's; Rothman Institute
Julie Coté, PT, MPT, OCS, COMT Magee Rehabilitation Hospital
Justin D'Ancona
Peter F. DeLuca, M.D. Head Team Physician for Eagles, Head Orthopedic Surgeon for Flyers; Rothman Institute
Joel H. Fish, Ph.D. Director of The Center For Sport Psychology; Sports Psychology Consultant for 76ers & Flyers
R. Robert Franks, D.O. Team Physician for USA Wrestling, Consultant for Phillies; Rothman Institute
Ashley B. Greenblatt, ACE-CPT Certified Personal Trainer, The Sporting Club at The Bellevue
Brian Maher, BS, CSCS Owner, Philly Personal Training
Julia Mayberry, M.D. Attending Hand & Upper Extremity Surgeon, Main Line Hand Surgery P.C.
Jim McCrossin, ATC Strength and Conditioning Coach, Flyers and Phantoms
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Heather Moore, PT, DPT, CKTP Owner of Total Performance Physical Therapy, North Wales and Hatfield, PA
Kelly O'Shea Senior Producer,
Tracey Romero Sports Medicine Editor,
David Rubenstein, M.D. Sports Medicine Surgeon, Rothman Institute
Robert Senior Event coverage, Sports Doc contributor
Justin Shaginaw, MPT, ATC Athletic Trainer for US Soccer Federation; Aria 3B Orthopaedic Institute
Thomas Trojian MD, CAQSM, FACSM Associate Chief of the Division of Sports Medicine at Drexel University
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