Meniscus Tear: Symptoms, Diagnosis and Arthroscopy

The menisci are cartilage pads in the knee joint that work as shock absorbers and stabilizers. Meniscus damage is one of the most common knee injuries in athletes, but ordinary people suffer from it too: it is enough to turn sharply on a bent leg or to squat. Let’s look at how a tear shows itself, how it is diagnosed and what treatment options there are.

What a Meniscus Tear of the Knee Joint Is and Why It Occurs

Each knee has two menisci: the inner (medial) and the outer (lateral). The medial one is damaged more often because it is less mobile. A meniscus tears during a sharp twist of the knee with the foot planted, a fall, lifting heavy objects or a deep squat. In older people the tissue changes over the years, and a tear can occur even under ordinary load — this is degenerative damage.

By shape, tears can be linear, horizontal, radial, flap-type and “bucket-handle” type. Whether the meniscus can be saved depends on the type. On MRI, doctors assess the degree of damage: in grades one and two the structure of the tissue changes without the tear reaching the surface, in grade three the tear reaches the edge of the meniscus. It is grade three that more often requires surgical treatment.

Symptoms of Meniscus Damage and Tear: How the Knee Hurts

The signs of a meniscus tear appear right after the injury or build up over several days: pain along the joint line, swelling, a feeling of instability, clicking. The pain gets worse when squatting, climbing stairs and turning.

How to Tell the Meniscus Is Damaged After an Injury

• pain on the inner or outer side of the knee that gets worse under load;
• swelling of the joint a few hours after the injury;
• clicking and a feeling of “catching” during movements;
• being unable to bend or straighten the leg fully;
• a feeling that the knee “gives way.”

A small-degree meniscus tear shows itself only as pain during certain movements, and many people put up with it for months until the condition gets worse. What does a torn meniscus look like from the outside? Often like nothing: the knee looks ordinary, but swelling and limited movement appear after exertion. If you have injured your knee and the pain does not go away for more than 1–2 weeks, it is better to see a doctor rather than wait for everything to pass on its own.

In Which Cases You Must Not Put Off Seeing a Doctor

See a trauma doctor urgently if the knee has locked and the leg does not straighten, marked swelling has appeared, you cannot step on the leg, or the knee “pops out.” Locking means that a torn-off fragment of the meniscus has got between the joint surfaces. You must not walk on such a knee, squat or try to “walk it off”: with every step the torn fragment injures the cartilage. Until you are examined, limit the load, use crutches or a cane, apply cold for 15–20 minutes and raise the leg.

Diagnosis of a Meniscus Tear at Helyos: Examination, X-Ray and Arthroscopy

Diagnosis begins with an examination and special tests: the doctor checks the mobility of the joint and pain on rotation. The menisci cannot be seen on an X-ray, but it is needed to rule out a fracture and arthrosis. The most informative method is MRI: it shows the degree of damage, the shape of the tear and the condition of the ligaments. If the diagnosis remains unclear on MRI and the pain and locking do not go away, the patient may be offered a diagnostic arthroscopy. Arthroscopy is both diagnosis and treatment at once: through small punctures the doctor examines the joint with a camera and, if necessary, repairs the damage.

Treatment of a Meniscus Tear: When You Can Manage Without Surgery

If the tear is small and the joint is stable, you can start with conservative treatment. The choice of method depends on age, the type of tear and lifestyle.

Arthroscopy for a Meniscus Tear: Repair or Meniscectomy

With conservative treatment you must not do deep squats, run, jump or twist the knee: even a small load can enlarge the tear. If treatment has not helped, or there is locking, the doctor offers an arthroscopic operation. The surgeon makes two or three small incisions and inserts a camera and instruments. When it is possible, they try to save the meniscus and suture it: meniscus repair helps preserve its shock-absorbing function and reduces the risk of arthrosis. If the tissue is badly destroyed, a meniscectomy is performed — the damaged part is removed. Both types of intervention are part of the surgery in orthopedics and traumatology department.

Recovery After Arthroscopy and Meniscus Surgery

After a meniscectomy, putting weight on the leg is more often allowed in the first days, and people return to sports after 4–8 weeks. After a repair it takes longer: for several weeks you walk on crutches, bending is limited, and you return to sports after 4–6 months. In any case rehabilitation is needed: exercises to strengthen the thigh muscles and to restore mobility and balance. The consultation and treatment plan are given by an orthopedic and trauma doctor.