InjurY Meniscus Tear
Mechanism of Injury
Typically occurs as a non-contact injury with a planted foot on the ground. Many times the athlete is shifting directions, where the body is moving in one direction and the knee is moving in the opposite direction. The athlete may occasionally report a "pop". Another type of meniscus tear, called a degenerative tear, can occur over time due to wear and tear in the knee joint. However this post will specifically discuss traumatic meniscal tears.
Physical Examination
At the immediate time of injury, the athlete may have sharp pain in the knee. With large tears, athletes will usually have dramatic swelling and fluid over the entire knee. The swelling can be described as "like a water balloon" or "like a grapefruit" and should be apparent within the first 24 hours of the injury. The athlete may feel as though the knee is getting stuck when trying to flex or extend the leg. Keep in mind, very subtle tears may not have obvious symptoms and are not always apparent to the untrained eye. If a meniscus tear is suspected, an MRI is the study of choice to confirm the presence of a tear. A common technique for evaluating a meniscus tear is to perform a McMurray's test which involves flexing the knee with your fingers on the joint line and rotating the joint looking for a "clunk" or sharp pain.
Treatment
In general, the recommendation for a meniscus tear varies depending upon the type of tear, location of the tear and the age of the patient. If the tear is large and the patient is younger, the surgeon will likely attempt to repair the meniscus and allow it to heal. Younger patients have a much better chance of the meniscus healing after a repair than older patients. On the other hand, if the tear is small or the patient is older, then the surgeon will likely remove the torn part of the meniscus. The procedure for removal of the torn portion of the meniscus is called a meniscectomy. On rare occasions, if the tear is very small and on the edge of the meniscus, a conservative non-operative approach can be considered.
Return To Play
An athlete who is treated with meniscectomy surgery is expected to be able to return back to full activity in about 4 to 6 weeks. At the professional and college level, an aggressive protocol may return an athlete even sooner. On the other hand, those who undergo surgery to repair the meniscus, typically are returned back to play at 3 - 4 months.
Sports Considerations
The current data demonstrates that the more meniscus that is removed, the higher the risk for developing arthritis in the future. Although it may sound tempting to opt for the meniscectomy in order to significantly reduce down time, it may not be the best choice. If repair of the meniscus is possible and appropriate for the situation, it should definitely be considered to protect the long term health of the knee.
Front View of Knee
Knee cap pushed aside to see in to the knee showing medial meniscus tear
