Only a doctor can determine whether a knee injury is a torn meniscus and whether it is accompanied by other knee injuries. A history, physical examination, and imaging tests, specifically x-rays and an MRI, are commonly used in patients suspected of having a meniscus tear. An x-ray can identify evidence of arthritis in the knee joint, while an MRI allows doctors to actually visualize the meniscus. All of this information can be used to determine what treatment is needed.
For some individuals with a torn meniscus, conservative treatment, which includes rest, ice, and medication, can be enough to relieve the pain and allow the meniscus to heal on its own. A doctor takes several factors into account when making a treatment decision, including the type of tear (there are more than half a dozen types), how active the patient is, and how the patient responds to simple meniscus treatment.
In other cases, however, a torn meniscus requires surgery. Meniscus surgery may involve trimming the torn part of the meniscus or repairing the tear (sometimes referred to as a partial meniscectomy), or removing the damaged meniscus (complete meniscectomy) and getting a meniscus transplant (new cartilage from a cadaver) or a collagen meniscus implant.
Arthroscopy for a Torn Meniscus
Arthroscopic surgery is the recommended treatment for meniscus tears. Because meniscus repair is feasible only when the meniscus tear is in an area that has an adequate blood supply, most meniscus tears are treated with arthroscopic meniscectomy. This is the simplest approach and has good short-term results, but it can result in the development of arthritis ten to twenty years later unless a patient receives a new meniscus (meniscus replacement) after a complete meniscectomy. Meniscus replacement is usually reserved for young, active patients who have had most of their meniscus removed previously and who develop knee pain without advanced degeneration of the cartilage.
Arthroscopic surgery for a meniscus tear takes 60 to 90 minutes, depending on the extent of the damage, and is done under general or spinal anesthesia. You have a better chance of healing if you have arthroscopic surgery within two months of your injury and ACL reconstruction is done at the same time. About 90 percent of patients experience good results from arthroscopic surgery for a meniscus tear. The complication rate is less than 2 percent, and the most common complication is injury to skin nerves, which resolves itself within a few months in most cases. Knee stiffness, infections, and blood clots are uncommon.
Other Types of Meniscus Problems
Two other less common types of meniscus problems include a discoid meniscus and a meniscal cyst. An individual may be born with a discoid meniscus, in which the meniscus is flat and round rather than C-shaped. Symptoms such as pain, clicking in the knee, and giving way begin in childhood. Surgery to trim the meniscus to a normal shape can be done. A meniscal cyst is a bulge that usually arises from a meniscus tear. Arthroscopic surgery is generally performed, and if a tear is found, the surgeon can do a partial meniscectomy and decompress the cyst. If there is no meniscus tear, the cyst can be decompressed from outside the knee.