Meniscal tear
Bucket handle tear meniscus
What is meniscus?
Meniscus (commonly referred as cartilage) is a
wedge shaped disc of shock absorbing structure
between thighbone and shinbone. It is important
for loading, stability, proprioception (perception of
balance) and lubrication of knee joint.
Why does meniscus tear?
Ash Acharya MS, MCh, FRCS (Trauma & Orth)
Ash Acharya
MS, MCh, FRCS (Trauma & Orth)
Consultant
Trauma
&
Consultant Surgeon
Trauma &
Orthapedic
Orthopaedic Surgeon
Private Hospital
Private
Hospital
Spire
Cheshire
Hospital
Spire
Cheshire
Fir
Tree
Close Hospital
Fir Tree Close
Stretton
Stretton
Warrington
Warrington
Cheshire
Ash Acharya MS, MCh, FRCS (Trauma & Orth)
WA4
4LU
Cheshire
Consultant Trauma &
TWA4
01925
215018 Surgeon
4LU
Orthopaedic
01925
215087
T 01925
215018
F 01925
215039
01925
215087
Private
Hospital
EF stephanie.cartwright
01925
215039
Spire
Cheshire Hospital
@spirehealthcare.com
E stepahnie.cartwright
Fir Tree Close
@spirehealthcare.com
Stretton
NHS Hospital
Warrington
Warrington
and Halton Hospitals
NHS Hospital
Cheshire
Lovely
Lane
Warrington
and Halton Hospitals
WA4 4LU
Warrington
LovelyTLane
01925 215018
Cheshire
Warrington
01925 215087
WA5 1QG
Cheshire
F 01925
215039
T 01925
662919
WA5 1QG
E
stepahnie.cartwright
F 01925 662211
01925
662919
@spirehealthcare.com
ET [email protected]
F 01925 662211
E [email protected]
NHS Hospital
NHS
Hospital
Warrington
and Halton
Hospitals
Cheshire
and Merseyside
Treatment
CentreLovely Lane
Warrington
Earls Way
Cheshire
Runcorn
WA5 1QG
Cheshire
WA7 2HH
T 01925 662919
T 01928
793752
F 01925
662211
F 01925
662211
E [email protected]
E [email protected]
In young patients, sports related injurys such
as twisting injury or severe trauma can cause
meniscal tear. With aging, menisci can tear with
trivial injury such as twisting or squatting.
What are the symptoms of meniscal
tear?
A patient with recent meniscal tear usually
presents with sudden pain, swelling, stiffness
and reduced movements. Older tears can cause
locking, snapping, reduced movements, swelling
and wasting of quadriceps muscle. Occasionally
torn cartilage can cause a block to movement of
the knee or sensation of giving way.
How is the tear diagnosed?
In the majority of the cases, history and clinical
examination can be sufficient to make a diagnosis
of torn cartilage. Examination is performed to
evaluate if there is fluid in the joint (effusion). The
knee is checked for tenderness along the joint line
where meniscus sits. McMurray’s test is another
commonly performed test. During this the knee
is bent fully, then straightened and rotated. The
joint line is palpated as the knee moves. Pain and
clicking during this test suggests torn cartilage.
What investigation is needed?
Plain x-rays are required to evaluate the bony
structure of the knee. This is useful to rule out
arthritis and most of the loose bodies.
MRI scans are now increasingly performed for
knee pain. MRI is very sensitive tool and can give
excellent details of the state of soft tissues in
the knee. However it is best practice to combine
the information gained from the scan with careful
clinical examination. A MRI scan is not indicated
when unequivocal clinical symptoms and signs
are present. Insurance companies however
may require a scan prior to surgery to obtain
authorisation.
What is the treatment for torn
cartilage?
Not all cartilage tears need treatment. In the
initial phase after injury, rest, ice, compression,
elevation and anti-inflammatory medicine is
useful. In low demand patients with recent history,
one off injection of steroid can be very helpful.
Occasionally minor frayed inner margin of outer
meniscus is identified on a MRI scan. This does not
need trimming.
Operation is needed for ongoing pain and
mechanical symptoms. Type of surgery depends on:
•
•
•
•
•
•
Age of the patient
Location and type of tear
Size of tear
Age of tear
Associated injuries
Activity level of the patient
The options during knee arthroscopy are:
• Trimming of torn cartilage
• Meniscal repair
• Freshening of tear
• No treatment
Trimming of torn cartilage is the most commonly
performed keyhole surgery. It involves removal
of unstable, torn and degenerate cartilage. Older
patients especially with inside cartilage tear
benefit by generous trimming of cartilage to
prevent possible future recurrence.
Since menisci are very important in protecting
joint cartilage, it is best to repair a torn meniscus
when possible. Chances of success are best in
young patients with a recent tear in the periphery
of the cartilage and normal tissues. If ACL
reconstruction is performed at the same time, the
chances of meniscus healing improve. However,
it is a more extensive procedure than simple
trimming and has more risks and complications.
Rehabilitation following repair is slow and
prolonged. You will need a brace for six weeks
following repair.
Some small tears of cartilage in an otherwise
stable knee can be left alone after freshening
of edge or needling. However this can only be
identified during keyhole surgery.
What is the recovery time?
Meniscal trimming: Crutches are typically not
needed. Patients with desk job can return to work
even before two weeks. Patients with manual job
may need two or three weeks off work.
Meniscal repair: Brace and crutches are needed
for six weeks. Range of movement is gradually
adjusted in the brace. Deep bending is avoided for
four months and contact sports for nine months.
For further information please refer to:
http://orthoinfo.aaos.org/topic.cfm?topic=A00358
http://www.bupa.co.uk/running/injury-preventionand-recovery/injuries/meniscal-injuries/
T 01925 215018 E [email protected] www.acharya.co.uk