If It’s Aint Broke, Don’t Fix It
If you were told you had a meniscus tear either by physical evaluation or by testing such as MRI should you have a surgical repair? If it’s not very painful, not locking and not changing functional tolerance, I say “No”.
Exam Findings – We evaluate using physical findings. Physical exam is as important as testing. You may have a positive test but no other symptoms. Symptoms such at locking or catching and high level of joint effusion (fluid) are as telling as tests when considering management strategies. Increased levels of effusion indicate severity of injury.
Common Symptoms: Popping, swelling and stiffness. Pain, especially when twisting or rotating your knee. Difficulty or inability straightening your knee fully or experiencing what feels like your knee were locked in place.
Location: The location (zone) of the tear is one of the important factors in determining treatment. Tears at the outer edge of the meniscus (red zone) tend to heal well because there is good blood supply. Minor tears may heal on their own with a brace and a period of rest. If they do not heal or if repair is deemed necessary, the tear can be sewn together. This repair is usually successful in the red zone.
The inner two-thirds (white zone) of the meniscus does not have a good blood supply, so it does not heal well either on its own or after repair. Typically the torn portion is removed (partial meniscectomy) and the edges of the remaining meniscus are shaved to make the meniscus smooth and limit catching.
Type of Tear: Also, the pattern of the tear may determine whether a tear can be repaired. Longitudinal tears are often repairable. Radial tears may be repairable depending on where they are located. Horizontal and flap (oblique) tears are generally not repairable.
Another factor when considering treatment is that repairs to the lateral meniscus (on the outer side of knee) typically heal better than repairs to the medial meniscus (on the inner side of the knee).
Physical Therapy: In many instance we can manage meniscal tears without the risk of surgery and the after effects of surgery. Meniscal rehabilitation can range from 4 weeks to 4 months. Typically we see results to independent programs by 8 weeks. High repetition low intensity exercise with decreased weight bearing can help heal meniscus tears and improve joint effusion. Muscle training to improve support about the knee and keep proper alignment through the entire limb. Modalities and NMES for muscle activation are effective treatments to restore normal function.