The menisci are the knee’s gristle shock absorbers, separating the thigh bone’s femoral condyles from the tibial plateau (shin bone). The medial meniscus is on the inside side of the knee, and the lateral meniscus is on the outside side.

How do meniscal tears occur?

Meniscal tears are common in sports, and they usually occur when there has been a pivoting or twisting movement in the knee whilst the foot is in contact with the ground – for instance, during a rugby tackle.

Some people feel a swift onset of pain or experience a click or ‘crunch’ in the knee as the meniscus tears. If the injury to the knee is severe, other structures may also be damaged. Many people will have swelling in the knee and dislike loading the knee. Sometimes, bending the knee or going up and down stairs can feel difficult, and squatting down or kneeling may be painful. Turning over in bed may also awaken the pain.

If part of the meniscus tears and folds inside the knee, there can be true locking of the knee when the meniscus jams in the knee and prevents movement. Some people report a feeling of weakness in the knee, or the knee may give way.

As we age, the menisci do, too. The menisci lose their ‘rubberiness’, and their free edges fray, like the bottom of a pair of old jeans. This can lead to degenerative tearing over weeks and months, and the knee gradually becomes achy or painful.

How are meniscal tears diagnosed?

When you come to the clinic, I will want to hear about your knee problem, how an injury occurred, and how it affects you and your lifestyle. I will carefully examine you and your knee, and I’ll likely recommend MRI imaging to confirm whether there is damage to the meniscus or other knee structures.

Do meniscus tears heal?

The menisci are semi-circular-shaped wedges of fibrocartilage with a free front edge and a rather poor blood supply. The outer periphery of the meniscus has a good blood supply and is called the red zone, but there is little to no blood supply in the rest of the meniscus- known as the white zone. Each meniscus has a front part (aka the ‘anterior horn’) and a back part (the ‘posterior horn’), and most tears tend to occur in the posterior horn.

If tearing occurs within the red zone of the meniscus, the meniscus may heal on its own, but if it doesn’t, surgical repair has a high success rate in allowing it to heal. If the tear extends from the red zone into the white zone, there is a possibility that it may heal with surgery to repair it, but if tearing takes place purely within the white zone, it can’t heal and therefore can’t be repaired surgically.

Preserving the meniscus as much as possible is key – without its shock-absorbing function, the articular cartilage surfaces start to wear, leading to osteoarthritis.

Types of meniscal tears

There are several different types of meniscal tears, including:

  • Radial tears
  • Horizontal tears
  • Longitudinal tears
  • Flap tears
  • Bucket handle tears
  • Complex tears

Do all meniscal tears need surgery?

I prefer to see a person as soon as possible after their knee injury because if there is a meniscal tear, I want to address it before further damage occurs. If the meniscal quality allows me to repair it, I’ll do all I can to repair the meniscus rather than remove part of it.

If a person has sustained a tear in the ‘root’ of the meniscus, which is the anchor point of the meniscus, or if a bucket handle tear has occurred, I would be particularly likely to recommend arthroscopic (keyhole) surgical repair, especially if there are mechanical symptoms, such as locking or restriction of knee movement.

In cases where there has been tearing of the lateral meniscus (for example, when it occurred with an anterior cruciate ligament – ACL- tear), I would recommend repairing the lateral meniscus (if possible) at the time of the ACL reconstruction.

Some meniscal changes seen on MRI scanning occur without trauma (so-called ‘atraumatic’ or ‘degenerative’ meniscal tears) and may cause irritation or swelling of the knee but may even be symptom-free. We tend to treat these conservatively.

Ramp lesions

A ramp lesion is a tear around the outside edge of the posterior horn of the medial meniscus, which is such that it detaches the meniscus from the posterior capsule at the back of the knee. They usually happen when the meniscus is torn in an injury that also tears the anterior cruciate ligament (ACL). They can be tricky to spot on an MRI, and so during meniscal surgery, it’s important that they are identified because, overall, they are surgically repairable. If a ramp lesion is found, I can usually repair it using a technique that carefully fixes the posterior capsule back onto the meniscus.

Meniscal root tears

The menisci is anchored to the tibia (shin bone) at the front and the back, called the root. Sometimes, the meniscus can be torn close to the root, or the root can be pulled off from the bone. When the root is torn, it is equivalent to losing your whole meniscus, and the meniscus will be squeezed out of the knee and no longer function. This can lead to osteoarthritis, which happens rapidly in some cases.

It is extremely important that this is identified early after injury and surgically repaired.

What is the recovery like after meniscal surgery?

Most meniscal surgery is carried out as a day-case procedure under a general anaesthetic. Two or three holes (known as portals) are made on the front and sides of the knee, and a camera (known as an arthroscope) and other instruments are introduced via the portals. At the end of the operation, the holes are sutured closed, and you will have dressings over the incisions, which you need to keep dry until you are seen again in the clinic at 10-14 days post-op.

I recommend patients start physio immediately and use crutches for a few days for comfort and confidence. If you have had a meniscal repair to repair a radial tear, or if your repair was of a medial meniscal root tear with an extrusion, I may advise you to be toe-touch weight-bearing for six weeks to protect the repair.

Regarding taking time off work, if you have a desk-based role, I recommend taking a couple of weeks off work, but if your occupation involves you being on your feet a lot or is very manual, you may need to take three or more months off work.

Once you can perform an emergency stop, you will be OK to drive, but this obviously depends on whether you can immediately weight-bear and whether you drive a manual or automatic car.

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