The Basics
The menisci are two fibro-cartilaginous disks located in the knee that play a major role in stability and shock absorption. The menisci also help in providing nutrition to the cartilage and lubrication to the joint.
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The meniscus can be injured with acute trauma to the knee or due to degenerative changes in older populations. The meniscus is most commonly injured in sporting activities that involve cutting or pivoting movements.
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Risk factors for meniscus injuries include ACL deficient knees and high energy sporting activities.
Signs and symptoms
Initial symptoms of an acute meniscus injury may include a popping feeling, knee swelling, pain and stiffness. You may also experience locking, popping or clicking of the knee. You may feel instability in your knee and have decreased range of motion of the joint.
Diagnosis can be made on physical exam with tenderness to palpation of the joint line where the meniscus is and a positive McMurray exam. Additional imaging with MRI may be warranted to aid in diagnosis and for pre-surgical planning.
Treatment
Treatment of meniscus injuries is often dependent on the type of tear as well as your age and activity level.
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Some types of meniscus tears can be treated conservatively with activity modification, bracing, anti-inflammatories and physical therapy. Your provider may recommend joint aspiration and a steroid injection as part of the initial treatment of this injury.
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In young active athletes and complex meniscus tears, operative management may be indicated. Common tears that often require surgical management include bucket handle tears and tears involving the posterior or anterior horns of the meniscus. Patients who fail conservative management and continue to have symptoms of locking popping or clicking may also require surgical management to relieve symptoms.
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Knee Arthroscopy
Surgical management of meniscal injuries is performed via knee arthroscopy in which the surgeon will insert a camera and small instruments through portals made in the knee. This allows the surgeon to definitevely diagnose and treat meniscus injuries via partial menisectomy or repair with sutures.
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Other procedures that may be indicated at the time of knee arthroscopy may include chondroplasty and microfracture. Chondroplasty is when the surgeon smooths and reshapes damaged cartilage inside the knee. A microfracture procedure may be indicated to treat large chondral lesions. During a microfracture procedure, your surgeon will make small holes at the base of the articular cartilage to promote healing.
