Meniscus Tear

Once a rare diagnosis in the pediatric and adolescents athlete, a torn meniscus is now more commonly recognized. It is seen in sports such as football, soccer, basketball and hockey. Meniscus tears can range from minor to severe, depending on the extent of the damage, and they can make it difficult for the knee to function properly. 

What is a Meniscus Tear:

The meniscus is the tissue that cushions and stabilizes the femur (thigh bone) as it moves on the tibia (shin bone). It is made from thick cartilage (called fibrocartilage), which provides durability and is in a C-shape on the medial (inner) side of the knee and a more circular shape on the lateral (outer) side. It is most commonly injured with a twisting mechanism of the knee while playing sports.  

When the meniscus tears in the knee it can be very painful. The true incidence of acute meniscal tears in adolescents and children is not known. They are often associated with injuries to the ACL. There is concern the number of meniscal tears in the growing athlete is increasing with increased participation in sports and an increased awareness of this injury in kids.  

The function of the meniscus is well understood. It is important in load sharing, shock absorption and stability.  Multiple biomechanical studies have shown the protective effects of a functional meniscus. A torn or meniscus that has been treated with menisectomy (partial removal), have increased risk for the development of early osteoarthritis.  

What are the signs and symptoms of a Meniscus Tear? 

• Knee swelling 
• Popping sound with knee motion 
• Tenderness around the joint line 
• The knee “locks up” or gets stuck 
• The knee might not completely straighten 
• Knee pain with activity 
• Difficulty with stairs and getting up from a seated position 

After a meniscus tear, many patients are able to walk and put weight down. Some athletes even try and play through the injury. However, with continued use, inflammation will occur in the knee. This can cause feelings of pain, tightness and swelling in the knee. If the tear is large enough it can flip over and get stuck- causing a locked knee.  

How is the diagnosis of a Meniscal Tear made? 

Your physician will perform a thorough physical examination, focusing on the movement of the knee and areas of tenderness. There are special physical exam tests to perform to help with the diagnosis. Imaging will also be utilized. Traditionally, plain xrays of the knee are obtained to help exclude other diagnoses. Often a MRI is ordered, (magnetic resonance imaging) which uses large magnets to create images of the inside of the knee. MRI can be very helpful for your physician to confirm the diagnosis of a meniscal tear. 

What is the treatment for Meniscal Tears?

How is an acute traumatic Meniscal Tear treated? 

Treatment for meniscal tears focuses on controlling pain and inflammation. Initial management of meniscus tears involves the common approach in sports medicine of RICE, which stands for Rest, Ice, Compression and Elevation of the involved leg. If needed, pain medication can also be prescribed. Often, crutches can be used to help your athlete get around.  

Management of meniscal tears depends on the location and size of the tear and also for how long the tear has been present. Small tears that are on the periphery with good blood supply may require nothing more than rest to heal. Other tears do not have the same potential to heal on their own and require surgery.  

If the decision is made to address the mensical tear surgically, the primary goal of meniscus tears in the young athlete is to preserve as much of the meniscus as possible. Every attempt will be made to fix the meniscus. Some tears however, are not repairable and parts of the torn meniscus will be trimmed back to a stable base.  

How are discoid Meniscus Tears treated? 

Many of the same principles apply for tears involving the discoid meniscus. When tears are symptomatic and causing pain, locking or feelings of instability, surgery can be helpful. However some of the surgical strategies differ from the acute non-discoid meniscus tears as the surgeon will aim to re-shape or “saucerize” the meniscus. 

What happens after surgery? 

We will have your athlete start in physical therapy with the goals to decrease swelling and work on strengthening the quadriceps. If the meniscus is repaired we recommend between 4-6 weeks of toe touch weight bearing with crutches. Also, with some repairs we may limit the motion allowed from 0-90 degrees for 3-4 weeks. 

If the meniscus is trimmed (partial menisectomy) weight bearing is allowed immediately and return to activity is dictated by recovery and strengthening of the quadriceps muscle 

Will my child be able to return to sports? 

The good news is that most growing athletes are able to recover and return to previous activities after most meniscus tears in a few months. It is important that your athlete rest and heal and follow the guidelines and protocols established by your doctor and implemented with the help of your physical therapist. 

Helpful Terms to Know: 

• Menisci - plural of meniscus 
• Acute tears of the meniscus - often the result of a twisting injury while playing sports. These tears can occur in different places in the meniscus and have different tear patterns. Meniscus tears can also occur many times in conjunction with a tear of the ACL (anterior cruciate ligament) the lateral (outer) side with acute ACL injuries and the medial (inner) side with chronic ACL tears. 
• Discoid meniscus - A congenital anatomic variant is seen almost exclusively on the lateral (outer) side of the knee. This results in a thickened meniscus that typically covers more of the lateral tibia (shin bone) than a normal meniscus. There are different kinds of discoid meniscus seen (three main types) and these can be susceptible to tearing. It should be noted that an asymptomatic discoid meniscus requires no treatment.