Meniscus Tear: Should I Have Surgery?

A meniscus tear is a common knee injury. The meniscus is a rubbery, C-shaped disc that cushions your knee. Each knee has two menisci (plural of meniscus) -one at the outer edge of the knee and one at the inner edge. The menisci keep your knee steady by balancing your weight across the knee. A torn meniscus can prevent your knee from working right.

A meniscus tear is usually caused by twisting or turning, often with the foot planted while the knee is bent. These tears can occur when you lift something heavy or play sports. As you get older, your meniscus gets worn. This can make it tear more easily.

If you are older, you may not know what you did to cause the tear. Or you may only remember feeling pain after you got up from a squatting position, for example. Pain and slight swelling are often the only symptoms.

There are three types of meniscus tears, each increasing in severity. The more serious the tear, the more severe the symptoms.

With a minor tear, you may have slight pain and swelling. This usually goes away in 2 or 3 weeks.

With a moderate tear, you may feel pain at the side or center of your knee. Swelling slowly gets worse over 2 or 3 days. This may make your knee feel stiff and limit how well you can bend your knee. Usually you are still able to walk. You might feel a sharp pain when you twist your knee or squat. These symptoms go away but can come back if you twist or overuse your knee.

In severe tears, pieces of the torn meniscus can move into the joint space. This can make your knee catch, pop, or lock. You may not be able to straighten it. Your knee may feel "wobbly" or buckle without warning. It may swell and become stiff right after the injury or within 2 or 3 days.

There are two basic types of treatment for a torn meniscus-nonsurgical treatment and surgery.

• With nonsurgical treatment, you use rest, ice, compression, and elevation, and you have physical therapy. You may wear a knee brace for a short time.
• With surgery, you can have one of the following:
  • Surgical repair to sew the tear together.
  • Partial meniscectomy, which is surgery to remove the torn section of the meniscus.
  • Total meniscectomy, which is surgery to remove the entire meniscus. This surgery is not usually done, because it increases the risk of osteoarthritis in the knee.

When possible, it's better to fix the meniscus than to remove it. If the meniscus can be fixed, you have a lower risk of future joint problems.¹

Your doctor will likely suggest the treatment that he or she thinks will work best for you based on where the tear is, the pattern of the tear, and how big it is. Your age, your health, and your activity level may also affect your treatment options. In some cases, the surgeon makes the final decision during surgery, when he or she can see how strong the meniscus is, where the tear is, and how big the tear is.

• If you have a small tear at the outer edge of the meniscus (in what doctors call the red zone ), you may want to try home treatment. These tears often heal with rest.
• If you have a moderate to large tear at the outer edge of the meniscus (red zone), you may want to think about surgery. These kinds of tears tend to heal well after surgery.
• If you have a tear that spreads from the red zone into the inner two-thirds of the meniscus (called the white zone ), your decision is harder. Surgery to repair these kinds of tears may not work. You may need a partial meniscectomy instead.
• If you have a tear in the white zone of the meniscus, repair surgery usually isn't done, because the meniscus may not heal. But partial meniscectomy may be done if torn pieces of meniscus are causing pain and swelling.

Some kinds of tears can't be fixed. Radial tears sometimes can be fixed, but it depends on where they are. Most of the time, horizontal , long-standing, and degenerative tears-those caused by years of wear and tear-can't be fixed. The older you are, the less likely it is that your tear can be repaired. For these kinds of tears, you may need to have part or all of the meniscus removed.

When possible, meniscus surgery is done using arthroscopy instead of open surgery. During arthroscopy, your doctor puts a lighted tube with a tiny camera-called an arthroscope, or scope-and surgical tools through small incisions.

In a young person, surgery to fix the tear may be the first choice, because it may restore use of the knee.

Surgery has risks, including infection, a blood clot in the leg, damage to nerves or blood vessels, and the risks of anesthesia. After surgery you may still have pain and joint stiffness.

Surgery to repair tears in the meniscus relieves symptoms 85% of the time. This means that of 100 people who have this surgery, 85 have relief from pain and can use their knee normally, while 15 do not.²

Meniscus repair is most successful:

• In younger people.
• In knees that have good stability.
• In longitudinal tears or in radial tears that occur in the red zone .
• If the repair is done in the first few weeks after the injury.

Surgery to remove part of the meniscus (meniscectomy) is better at keeping your knee stable than surgery to remove all of the meniscus. Partial removal also allows a quicker and more complete recovery than total removal.

Removing the whole meniscus typically reduces some symptoms. But losing the meniscus reduces the cushioning and stability of the joint. Most people, especially if they are young or active, are not satisfied with a total meniscectomy. This is why surgeons try to remove as little of the meniscus as possible.

Studies of partial meniscectomy have shown that 78% to 88% of people have good results from partial meniscectomy. This means that 78 to 88 people out of 100 people who have this surgery have reduced symptoms and are able to return to most or all of their activities.²

Small tears found at the outer edge of the meniscus often heal with rest. Instead of surgery, you may try rest, ice, compression, and elevation. You may wear a knee brace. You can try over-the-counter medicine such as ibuprofen or naproxen to help with pain and to reduce swelling.

If your symptoms go away, your doctor may suggest exercises to build up your quadriceps and hamstring muscles and increase your flexibility. It's important to follow your doctor's guidelines so that you don't hurt yourself again.

Your doctor may recommend surgery because:

• You still have pain after trying other treatment, such as rest and physical therapy.
• Your knee "locks up" instead of working normally.
• You may be able to reduce the risk of future joint problems (osteoarthritis).
• You are an active person and your tear is in the red-to-white zone . Surgery can help return your knee to normal.