Meniscal tears and knee arthroscopy
The meniscus is a piece of cartilage located in the knee joint. Acting as a shock absorber between the femur (thigh bone) and the tibia (shinbone), it distributes impact and stabilises the knee.
Meniscal tears are one of the most common knee injuries. They can result from any activity that causes forceful twisting or rotation of the knee, such as a sudden change in direction (common in many sports). Kneeling, deep squatting, heavy lifting, and falls can also rupture the meniscus, especially in older adults.
Meniscal tear symptoms & treatment
Meniscal tears present as pain within the knee joint. This often accompanied by swelling and a locking or catching sensation – you may be unable to fully bend or extend the knee due to pain or stiffness. The knee may be unable to support your weight, causing a limp or collapse on attempts to walk.
Meniscus injury treatment
Stable or short tears that aren’t displaced may settle with rest alone. In this case, your doctor may recommend non-steroidal anti-inflammatory medications (NSAIDs) to reduce pain and swelling.
Larger tears typically do not heal on their own and require surgical intervention. The preferred approach is via knee arthroscopy.
Knee arthroscopy surgery for meniscal tears
‘Arthroscopy’ refers to the use of specialised tools to perform a surgery through small openings. There are several ways to manage meniscal tears.
One approach is meniscal repair. The surgeon uses specialised, tiny tools to stitch the torn edges of the meniscus back together. This procedure is very common and in most cases successfully restores normal function.
A partial meniscectomy may be used to treat meniscal tears which are unlikely to heal with repair. This involves trimming away and removing the damaged part of the meniscus, reducing friction and the resulting pain. It may be accompanied by a meniscal transplant (graft) to replace the removed cartilage, although this is not usually the case.
Indications for arthroscopic surgery
The shape, size, and location of the tear is assessed when determining suitability for arthroscopic intervention.
Larger meniscal tears located in the vascular zone (the part of the meniscus with blood flow) are the best candidates for arthroscopic meniscal repair surgery. Tears located in posterior horn (the back third) of the meniscus may be inaccessible via arthroscopy, and best managed by open surgical repair.
Some tears – such as ones caused by wear-and-tear or positioned horizontally – may not heal, even with surgery. In this case, an arthroscopic partial meniscectomy surgery may be performed instead.
Recovering from knee arthroscopy
As knee surgery is a minimally invasive procedure, you generally will not need to remain in the hospital overnight and can go home the day of the surgery.
Driving within 24 hours of receiving a general anaesthetic is not recommended. Following this period, you can generally resume driving once you feel confident in bearing weight on your leg. Most patients can do this around a week after surgery, although it varies from person to person.
Dr Jonathan Cabot will discuss the need for any walking aids.
Frequently asked questions
Common meniscal tear symptoms include:
- Pain in the knee, especially along the joint line, that may worsen with twisting, squatting, or other movements.
- Swelling that typically develops within a few hours or days after the injury.
- Stiffness and limited range of motion in the knee.
- A popping or clicking sensation during knee movement.
- Locking or catching of the knee, where the knee may get stuck in a bent position.
- Feeling of instability or giving way of the knee.
Diagnosis:
- Physical Examination: Dr Jonathan Cabot may perform tests like the McMurray test, Apley test, or Thessaly test to detect a meniscal tear.
- Imaging: An MRI is the gold standard for diagnosing a meniscal tear, as it provides detailed images of the knee’s soft tissues.
- X-rays: May be used to rule out bone fractures, but they do not show meniscal damage.
Treatment:
- Non-surgical: Initial treatment often includes RICE (Rest, Ice, Compression, Elevation), physical therapy, and possibly anti-inflammatory medications.
- Surgical: If symptoms persist, are severe, or the tear is large, knee arthroscopy may be required to repair or remove the damaged part of the meniscus.
Knee arthroscopy for meniscus is typically recommended when:
- The meniscal tear is causing significant pain, swelling, or mechanical symptoms like locking or catching.
- Non-surgical treatments have failed to relieve symptoms after several weeks.
- The tear is large, complex, or located in an area of the meniscus with poor blood supply (which has limited healing potential).
- There are associated knee injuries, such as ACL tears, that require surgical intervention.
Meniscal repair involves stitching the torn meniscus back together to allow it to heal. It is typically recommended for tears in the outer third of the meniscus (the “red” zone), which has a good blood supply and better healing potential. Meniscus repair is designed to preserve as much of the meniscus as possible, which is important for long-term knee health.
Partial meniscectomy surgery involves trimming and removing the damaged portion of the meniscus. It is often performed when the tear is in the inner two-thirds (the “white” zone), where the blood supply is poor and healing is less likely. This procedure aims to relieve symptoms by removing the torn fragment but sacrifices some of the meniscus.
How long does it take to recover from knee arthroscopy?
Recovery time after arthroscopic knee surgery depends on the specific procedure performed:
- Meniscus Tear: Recovery may take 3-6 months, as the meniscus needs time to heal. Patients usually need to avoid weight-bearing activities for several weeks.
- Partial Meniscectomy: Recovery is typically quicker, with patients returning to normal activities in 4-6 weeks. Full return to sports or high-impact activities may take longer, depending on the extent of the surgery and rehabilitation.
Tears in the outer third of the meniscus may heal without surgery because of the better blood supply. Treating meniscal tears without surgery typically involves rest, physical therapy, and possibly bracing. Tears in the inner two-thirds are less likely to heal on their own due to poor blood supply. Non-surgical treatments may still be attempted, but surgery is often necessary if symptoms persist.
While knee arthroscopy is generally safe, some risks may include:
- Infection: Though rare, there’s a small risk of infection at the surgical site.
- Blood Clots: Deep vein thrombosis (DVT) can occur, especially if the patient is immobile for extended periods.
- Knee Stiffness or Loss of Motion: Post-surgery, some patients may experience stiffness or reduced range of motion.
- Nerve or Blood Vessel Injury: There’s a minimal risk of damage to surrounding nerves or blood vessels.
- Continued Pain or Instability: In some cases, the surgery may not fully relieve symptoms, or other knee problems may persist.
- Re-tear of the Meniscus: Even after repair, there’s a risk of re-injury, especially if the knee is subjected to significant stress or trauma.
If you’re experiencing pain, swelling, and a locking or catching sensation in the knee joint and are unable to fully extend your knee, you may have a meniscal tear and require knee arthroscopy surgery.