The meniscus plays a vital part in protecting and cushioning the knee joint. Whether it tears with abrupt trauma or gradually thins out and shreds, the consequences often hinder the functions of daily life. Suddenly you may face meniscus surgery. Sometimes it rips unexpectedly – a jump, a twist, a pop – while other times it wears thin and degenerates over time.
How the Meniscus Works
Each knee has two pieces of cartilage shaped like a letter C that form a pad between the bones of the knee joint. In fact, the meniscus is actually a Greek word for crescent. The inner, or medial, the meniscus is found in the middle of the knee while the outer, or lateral, meniscus lies along the exterior edge of the joint. These menisci support the knee joints to keep them steady and operating effortlessly so you can dance or hike up and down steep trails without collapsing.
A rich blood supply flows to the outer edges of the meniscus, and small tears to this area often may repair themselves with time and rest. The medial, or inner, meniscus does not receive an adequate blood flow and therefore is not likely to heal on its own.
Causes of Meniscus Tears
Two types of problems may cause damaging tears to the meniscus.
The first involves a sharp twisting motion to the knee, jumping or a hard impact. Although often associated with athletic injuries in sports such as football or volleyball, this type of damage also occurs with certain types of physical labor, an unfortunate fall or even a physical attack or fight. These traumatic events may cause a severe tear even in a young person with a healthy meniscus.
The second cause of damage may occur over time. As the body ages, the meniscus begins to deteriorate, and the problem worsens as the years go by. The meniscus thins and becomes less flexible and resilient. Bending over wrong or taking a misstep off a curb may provide enough stress to tear an already weakened meniscus. Sometimes an older person may not even recall a specific event that caused the knee pain or problem.
Occasionally the two conditions may collide. Athletic persons in their late thirties or early forties may not realize the elasticity of their meniscus has already started to decline, and they continue to put extreme pressure on their knee joints. This may result in a serious tear to the meniscus.
Diagnosing a Torn Meniscus
Whether a painful knee injury occurs suddenly as the result of a traumatic accident or the exact point of impairment remains unclear, some common symptoms may indicate a meniscus tear. Keep in mind that damage to other parts of the knee, such as the anterior cruciate ligament (ACL), may accompany a torn meniscus as the result of an injury.
The following situations often result from a tear in the meniscus
- A popping noise or phenomenon occurs at the time of injury
- The knee starts to swell
- It becomes difficult to bend or straighten the leg
- The knee may lock up or even collapse
- Mild pain in the knee progressively becomes more intense and inflamed
If you experience any of these symptoms, you should see a physician or orthopedic specialist as soon as possible. The doctor will thoroughly examine your knee, ask questions about the injury and perhaps complete x-rays to rule out fractures or other damage. He or she may also order an MRI scan to determine the extent of the damage and the location and type of tear. This will help evaluate the severity of the tear and indicate a treatment plan.
Treatment Options for a Torn Meniscus
Treatment choices depend on the seriousness of the tear, the severity of your symptoms and the time you have for recovery. They also depend to some extent on your age, general health and level of activity.
Some people are more willing to put up with low or moderate pain, knee stiffness and lack of mobility for a while to give the injury time for recovery. Others may prefer to seek active treatment to get on the road to renewal as soon as possible.
The first treatment for a minor meniscus tear, especially in the outer layer of the meniscus that receives good blood flow, might be icing the knee shortly after the injury and keeping the leg elevated. Your physician may advise you on the length and duration of these home treatments and any other steps you should take to give the tear a chance to heal.
Physical therapy would be the next line of defense in treating a minor or moderate meniscus tear. This may involve specific exercises to improve balance, increase the range of motion and strengthen muscles. The therapist may also recommend joint compression and home exercises to continue the healing process.
If you have a severely torn meniscus, perhaps with floating pieces of cartilage locking your knee joint, you may need to consider meniscus surgery.
Things To Consider Before Having Meniscus Surgery
First, remember that surgery should always be a last resort. While treatment for meniscus tears often involved surgery in the past, recent studies have shown physical therapy often works just as well. Make sure you have exhausted all other treatment options and given them a good try and time to work. Ask your physician and physical therapist for any other treatment possibilities they could recommend.
Risks of Meniscus Surgery
Make sure to weigh the risks of meniscus surgery. These include the risks associated with anesthesia and infections. Also, permanent stiffness in the knee, nerve damage and the danger of blood clots in the leg. In addition, the surgery may raise the likelihood of needing a knee replacement somewhere down the road.
Discuss the details of your meniscus tear with your surgeon. And make sure you understand the size, location, and shape of the tear. Ask the surgeon about the expectations after the meniscus repair. Especially if you are older and your meniscus has already thinned. These factors can make cartilage repair more challenging.
Preparing for Meniscus Surgery
Your doctor or the nurse will give you complete instructions on the preparations you need to make before surgery. You may need an examination with an electrocardiogram (EKG) from your family physician to clear you for the procedure. The doctor may also require blood tests and chest x-rays. In order to safeguard against infections, the doctor may ask you to shower at home. With a special antibacterial soap right before you come in for the surgery.
Ask if you will need crutches, a walker or any other special equipment after the surgery. If you do, acquire them ahead of time and practice using them. This will save you frustration when you are recovering. Also, request prescriptions for any pain medications the physician wants you to use after surgery. And get them filled in advance.
What Happens During Meniscus Surgery
Arthroscopic surgery to repair or remove part of the torn meniscus usually takes only an hour or less to complete. The surgeon makes several small incisions in the knee and inserts an instrument with a camera on the end. So he can see the location and extent of the damage to the meniscus. He will trim away the damaged portion of the meniscus with his instrument. And remove any loose pieces so they won't cause further problems. In most cases, the patient can go home the same day of the procedure.
Follow-Up Care and Physical Therapy
Following instructions after surgery and fully participating in physical therapy provides the best chance for a full and relatively fast recovery. Be sure you completely understand the doctor's and therapist's directives and take the time to ask questions.
If the surgeon removed all or part of the meniscus, you will need at least one month to recuperate fully. If he or she actually repaired the meniscus, you may need up to three months to recover since you may have to keep weight off the knee longer by using crutches. This will give the repaired meniscus extra time to heal. The doctor may also use a knee brace or cast to stabilize your leg.
A structured plan of physical therapy will help strengthen the muscles and increase the range of motion after surgery. The immediate goals following the procedure include straightening the leg, working on motor control and taking steps to help reduce swelling. Later therapies will work on standing and walking until the patient returns to a normal gait. The final steps would involve advanced therapy and exercise for patients who want to return to intense athletic activities.
Getting Back to a Normal Life After a Meniscus Surgery
The most important thing to remember as you complete your rehabilitation is to avoid doing too much too quickly. Take time to rest between exercise sessions and stop immediately if you feel a lot of pain. The therapist should be able to coach you on how to stretch yourself each day without going over your limitations. Although it's important to keep moving ahead with your recovery, it is better to take a little extra time than to overdo and damage your knee joint any further.
Suffering a torn meniscus is always difficult, but with perseverance, you can get through it. You reviewed all your options, researched surgeons and procedures, and followed recovery instructions and therapies to the letter. Now is the time to reap the benefits of a successful meniscus surgery and get back to enjoying your daily life.
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