What is a meniscal tear?
The meniscus is a specialised cartilage that helps cushion the knee (“shock absorbers”) and protects the cartilage lining the joint (i.e. the articular cartilage). It can tear as a result of an injury or fall, which can cause significant knee pain and other mechanical symptoms. Meniscal tears are commonly associated with other injuries such as ACL rupture. Unfortunately, meniscal tears do not heal. As the meniscus is an important structure, damage can lead to osteoarthritis of the knee in the long term.
What are the symptoms of a meniscal tear?
Knee pain is the predominant symptom usually followed by swelling within 24 hours. It may be difficult to walk for several days. These acute symptoms eventually resolve spontaneously. Other symptoms include: loss of full range of motion, inability to fully straighten the knee, pain with walking and tenderness along the joint line. Mechanical knee symptoms such as “clicking”, “catching” and “locking” may also be present. Painful instability may be present which can be difficult to distinguish from instability resulting from an ACL rupture.
How do you diagnose a meniscal tear?
A well-trained doctor or other paramedical professional will suspect a meniscal tear based on your symptoms and a thorough examination of your knee. The diagnosis can often be made on the history and examination alone.
X-rays are often normal or may show an associated fracture (broken bone) know as a “segond fracture” indicative of an ACL injury.
MRI may be required if the diagnosis is unclear or if other soft tissue injuries are suspected such as concomitant ligament injuries or articular cartilage injuries.
What are the causes of a meniscal tear?
The meniscus can tear primarily from any knee injury or fall. It can also tear secondary to an ACL rupture “causes of ACL rupture” (at the same time or delayed due to ongoing knee instability) or from degenerative changes.
What is the treatment for a meniscal tear?
A torn meniscus will not heal without surgery. Meniscal repair is performed via knee arthroscopy (i.e., keyhole surgery) with 2 small cuts (5-10 mm) on each side of the knee cap. However, not everyone requires surgery and treatment is tailored to the patient’s individual needs. The less active patient may be able to return to a quieter lifestyle without surgery. Surgery is advocated for the young, active patient, especially if the tear is “fresh” (i.e., less than 3 months), repairable and associated with an ACL injury.
Most meniscal tears, however are not repairable (i.e., cannot be sutured back together) and removal of the torn portion only (i.e., partial meniscectomy), leaving behind a stable remnant, is required.
Surgery is recommended for ongoing episodes of pain, instability, swelling and locking as further damage to important structures in the knee may result in early arthritis. Patients wishing to return to sports involving cutting or pivoting movements (e.g. soccer, football and netball, etc.) or with physical jobs involving cutting or pivoting movements (e.g. policeman, fireman, builders, etc.) will usually require surgery to restore function and stability.
Nonsurgical treatment involves physical therapy and rehabilitation to strengthen the quadriceps and hamstrings muscles to stabilise the knee and maintain range of movement.
When can I walk after meniscal surgery?
Full weight-bearing and walking is allowed immediately after a meniscectomy. Initially, this will be aided by crutches, but once you regain strength and mobility, the crutches can be discarded. If a meniscal repair is performed, a period of protected weight-bearing may be required.
When can I drive after meniscal surgery?
You should not drive for 48 hours after an anaesthetic. After 48 hours, your ability to drive will depend on the side you had your operation, left or right, and the type of vehicle you drive, manual or automatic. You can drive whenever you feel comfortable.
When can I return to work after meniscal surgery?
Your return to work will vary depending on the procedure performed and type of work you are engaged in. Most people can return to office work within 1 week. Labour intensive work however, may require you to take 2-3 weeks before returning to full duties.
When can I play after meniscal surgery?
You can recommence leisure activities or sports when the wound is healed, the knee swelling has subsided and range of movement is restored. This usually takes 2 weeks following a meniscectomy alone. If a meniscal repair was performed, it is best to delay leisure activities or sports for 6 weeks to allow the meniscus time to heal and repair.
How long will I take to heal after meniscal surgery?
The wounds take 7-10 days to heal. Most patients improve dramatically in the first 2 weeks. Occasionally, there are periods where the knee may become sore and then settle again. This is part of the normal healing process. If a meniscal repair was performed, it can take 3 months for it to heal fully.
How much pain will I experience after meniscal surgery?
Most patients are pleasantly surprised at how little pain they have after surgery. This is because the local anaesthetic is injected around the wound during the procedure and it is performed arthroscopically (i.e., keyhole surgery), which is less invasive. You will be provided with adequate analgesics to take at home.
What are the risks of having a knee arthroscopy for a meniscal repair?
Complications are not common, but can occur. Prior to making any decision to have surgery, it is important that you understand the potential risks so that you can make an informed decision regarding the advantages and disadvantages of surgery. The following list is by no means exhaustive, so it is important to discuss your concerns with your surgeon.
Specific risks of a knee arthroscopy for a meniscal repair:
- Joint stiffness
- Nerve or vessel damage: There are small nerves under the skin that cannot be avoided, and cutting them may lead to areas of numbness in the front of the knee. This area of numbness normally reduces in size with time and does not cause any functional problems with the knee. Very rarely, there can be damage to important nerves or vessels in the leg.
- Reflex sympathetic dystrophy: This is an extremely rare condition that is not entirely understood, but can cause unexplained, and excessive pain and stiffness after surgery (or even after trivial injury).
Other general surgical risks include: risk of infection, bleeding and clots in the leg (DVT) or lung postoperatively.
Apart from surgical risks, medical (including allergies) and anaesthetic complications can occur, and these can affect your general well-being and health.