Meniscal Tears by Dr. Gregg Foos

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Dr. Foos: Hi, this is Dr. Gregg Foos. I'm here to talk to you quickly about meniscal tears in the knee. The meniscus is a flap of cartilage inside our knee joint that's very important to the way the knee works. It is one of the more common injuries and problems that we see in people. And although some people can tell us exactly how their meniscal tear occurs, more times than not, we see people who develop pain and can't really put a finger on the exact injury that they may have had. Meniscal tears can occur in a wide range of people, including younger patients typically playing sports or having twisting injuries to their knee. They can also occur as we get older and as the meniscus tends to dry out and become a little less resilient inside the knee, and we get cracks and tears that can lead to problems.

Now, in understanding meniscal tears, you have to understand a little bit about the anatomy of the knee. When we look at a knee, there's two types of cartilage. The articular cartilage inside the knee is what we see on the end of the bone. Typically, if you look at a chicken bone, you'll see the white cushiony covering on the end of the bone, that's articular cartilage. That's the true cushion for our knee joint. The meniscus is a separate flap of cartilage inside the knee joint, and it's the semi-circular flap that you see here. The point of that is to create a bigger dish that the bone will actually sit in, and what it does it increases the contact between the bone above and the bone below. So the meniscus is really an important structure for a knee. What we do know is that when tears occur, typically people will get mechanical symptoms, something catching, a sharp feeling of pain on the inner or outer side of the knee because we have a meniscus on both sides. When that occurs, an MRI is very helpful for us to be able to look to see if somebody has a tear or not. MRIs are about 90% to 95% accurate as far as making a diagnosis of a meniscal tear.

Treatment for meniscal tears, one of the problems that we see in the meniscus with the exception of very young people is the meniscus has a poor blood supply to it. Now, when we cut our skin, we'll bleed. That bleeding brings in cells that create healing. In the case of a meniscus, the meniscus gets its nutrients from the fluid that bathes our knee joint. So those blood cells don't get there as easily such that it's very poor as far as its ability to heal itself. So, with meniscal tears, we create a flap of cartilage inside our knee joint that's catching and rubbing and very many times that simple treatments, like physical therapy, injections, medications, are not too helpful because it's a mechanical catching inside the knee joint.

Oftentimes, these kinds of injuries will come to need for an arthroscopic surgery, which is basically a small surgery where through some tiny incisions we can insert a camera inside the knee joint. This allows us to find the tears and treat them. The tears can be treated in different ways. In some cases, particularly in younger patients, we can attempt to repair that, meaning suture the meniscus back into place. But more times than not, as we get older and the blood supply becomes poor, these require some type of resection or removal of that flap of cartilage. In the 1960s and 1970s when those surgeries were done through a big open incision, we found that removing your whole meniscus can be damaging to the cartilage on the ends of the bones. That meniscus serves as a shock absorber to protect the cartilage. So that removing the whole meniscus is something we'd like to avoid. So the arthroscopic techniques allow us to just take out small little pieces that may be torn, leaving the rest of the meniscus to continue to serve as that shock absorber. Meniscal surgeries are typically short surgeries. They typically last for about half an hour, maybe 45 minutes, and the recoveries, because the incisions are so small, tend to be fairly quick. Most of our patients can oftentimes be back playing sports, running within four to six weeks.

So meniscal tears can occur at any age, both younger and older, and MRIs can be helpful as far as making the diagnosis, as is a clinical exam. So, if somebody suspects they may have a meniscal tear, is having sharp pain on the inner or outer side of the knee, evaluation by an orthopaedist and appropriate diagnosis and treatment is helpful. Hopefully, this video will help you with your understanding of the knee. Thank you very much. Have a nice day.

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