Paul G. Kiritsis, M.D
Dr. Kiritsis with his group of visiting Dutch surgeons on January 23, 2012. They observed several shoulder and knee replacements as well as an arthroscopic rotator cuff repair.
A meniscus is a C-shaped cartilage found in the knee that helps conform the round surface of the femur to the relatively flat surface of the tibia. There are 2 menisci in the knee, the medial and lateral meniscus. Their primary role is to absorb shock or disperse load that is applied to the knee during activities. Our knees see forces that exceed 4 to 7 times our body weight depending on the intensity of the activity. Unfortunately, the meniscus has a poor blood supply which not only increases it’s susceptibility to injury but also diminishes it’s ability to heal. Once torn, the meniscus will have a decreased ability to absorb shock and will also become a source of pain in the knee. The posterior horn of each meniscus has the most pain fibers but the capsule of the knee also plays a role in the pain cycle of a meniscus tear. The lateral meniscus plays a larger role in absorbing shock than the medial side and injuries to this meniscus often make for a difficult recovery. In addition, complete loss of the lateral meniscus can increase the contact stresses up to 600% in the lateral side of the knee. A medial meniscus tear will also increase contact stresses. Unfortunately, whether you tear your medial or lateral meniscus your knee will be predisposed to developing arthritis in the future.
Treatment options consist of non-operative and operative treatment. Non-operative treatments include medicine (like Advil or Alleve), bracing, physical therapy, and maybe an injection. These treatments will not cure your tear but they may make it less symptomatic for you. I do worry about steroid injections into a knee that has a torn meniscus. I am concerned that the tear could not only become larger but may also cause damage to the articular cartilage (“teflon coating”) of the knee. Surgical options include a meniscectomy and meniscal repair. Please see the meniscectomy video under the knee disorders section of my website. Meniscectomy is typically performed when the shape of the tear, quality of the tear or the vascularity of the tear are not conducive for a repair. I will typically perform a meniscal repair if I think the meniscus has a reasonable chance of healing. I will even be more aggressive with a repair in younger athletes. The recovery after a meniscectomy is typically much quicker and easier than with a repair. However, with any luck, a meniscus repair could restore your knees ability to absorb shock and reduce the risk of developing arthritis.