Meniscus Tears

Since we can all laugh at ourselves, I will share an old crack about Orthopedists—strong as an Ox and twice as smart.

Well, maybe there was a time when many muscular medical students in the lower half of their class went into orthopedic surgery, but that certainly has changed. The orthopedists that I have known throughout my career have been plenty smart.

To prove this, two of the major medical advances of the past hundred years have been in our field: total joint replacements and arthroscopic surgery.

Presently, other surgeons do arthroscopic type surgery –general surgeons now remove the gall bladder and the appendix with a laproscope, thus avoiding the large abdominal incisions of the past. Yet, orthopedic knee and shoulder arthroscopic (arthro meaning joint) surgery was routinely performed decades before general surgeons started doing similar surgery on the belly.

When I trained in the 70’s, a patient with a torn meniscus(torn cartilage) would have the knee cut open with a two-three inch incision at surgery and the entire meniscus would be removed. The patient would eventually go home two to five days later on crutches and require a month or two to recover.

Now the meniscus tear is treated in an outpatient surgical center requiring only several hours stay. The tear is removed with micro instruments through three tiny ¼ inch cuts (one stitch each) and most of my patients are walking without crutches, or a limp, for that matter, within a week of the surgery.

What a great medical advance in the past thirty years!

Nor, do we remove the entire meniscus as we used to. This is bad and can eventually cause degenerative arthritis as the result of bone on bone contact. Now, we only remove the portion of the meniscus that is torn and we preserve the uninvolved remainder. This works out just fine, and most people do very well and recover quickly. Sometimes, rarely, the meniscus tear can be repaired.

The knee has two meniscui –medial and lateral. They are half-moon shaped. They have various functions, but they are basically shock absorbers to prevent bone on bone contact in the knee joint. They are rubbery in quality and with stress, torque, or a twisting mechanism, they can be torn. A torn meniscus can cause pain, clicking, or interfere with motion(locking –as the knee can get stuck and unable to fully extend).

The perimeter of the meniscus does have blood supply (red zone) and tears in this outer rim and be repaired and can heal. More commonly, the tears are through the inner, avascular 2/3’s of the meniscus and are not repairable. These tears are simply removed.

My patients go home on crutches and pain killers after the surgery and most can walk without crutches within 4-5 days. Almost all walk normally and bend their knee fully two weeks later when the stitches are removed. Some require physical therapy; many do not. But knee exercises hasten the recovery. I have had patients return to sedentary work within days of the surgery, but full return to sports can require weeks or even months.

Younger people do great. Older individuals with arthritis in their knee may not fare as well as due to the arthritic pain, but many improve enough to be satisfied.

Please note: these articles are for general information. They are not intended to serve as medical advice or treatment for a specific problem. Diagnosis and treatment of a problem can only be accomplished in person by a qualified physician.