Knee Resilience Unleashed: Navigating Meniscus Tears with Expert Care

When you hear that an athlete has torn a cartilage in his knee, the problem is most likely a tear in the meniscus. This is one of the most common knee injuries and can happen at any age, and people who play contact sports are most at risk.

The knee joint is formed by the meeting of three different bones: the thighbone (femur), the shinbone (tibia) and the kneecap (patella). There are two strong and rubbery wedge-shaped pieces of cartilage between the thighbone and the shinbone called meniscus. These are like ‘shock absorbers’ for your knee joint; they cushion it against impact and keep it stable.

The meniscus can tear in different ways and doctors classify the tears by what they look like and where they appear in the meniscus. The most frequent types of tear are bucket handle, flap and radial. Athletes who tear the meniscus during sporting activities often incur other injuries, such as tears in the anterior cruciate ligament.

The most common cause of sudden tears in the meniscus is a sporting injury. A player may tear the meniscus by squatting and twisting his knee or during contact with another player, for example in a rugby tackle.

Over time, the cartilage in the knee weakens and becomes less thick. This can lead to degenerative tears in the meniscus in elderly people. Because the meniscus has weakened with age, a simple movement of the knee, like a slight twist when getting out of a car, can cause a tear.

Sometimes, a person can hear a ‘pop’ when the meniscus tears, but not always. You can continue to walk and play sports with a meniscus tear and many athletes might continue playing to the end of the game. If the meniscus is torn, the knee will become stiff and swollen over the next two to three days.

Commonly, you will experience the following symptoms if you have torn the meniscus:

• Swollen and stiff knee
• Painful knee
• Your knee will ‘catch’ or ‘lock’ in position
• You will be unable to achieve your usual range of knee movement
• You may feel that your knee is ‘giving way’

If you do not get medical treatment, your knee may slip, pop or lock due to a piece of the meniscus coming loose and drifting into the joint.

Firstly, the doctor will inquire about your symptoms and your relevant medical history. Then, he or she will examine your knee to check for tenderness along the joint line. This is where the meniscus is and a feeling of tenderness is often a sign of a torn meniscus.

You doctor will usually perform the McMurray Test, which involves your doctor bending, straightening and then rotating your knee. If you have torn the meniscus, there will be a clicking sound when he performs this movement because strain will have been put on the meniscus. The clicking sound will happen every time the doctor performs the movement.

Your symptoms may have been caused by other types of knee injuries, so your doctor may obtain an x-ray to check that your symptoms are not caused by, for example, osteoarthritis. An MRI scan will show soft tissue like the meniscus and may be used to confirm the diagnosis of a meniscus tear.

Treatment varies according to the location of the tear, the type of tear and the extent. A tear in the outer third part of the meniscus may heal itself as that part of the meniscus, the ‘red zone,’ has a plentiful blood supply. A longitudinal tear is an example of a tear in this zone and can often be repaired by surgery.

There is no blood supply, however, to the inner two thirds of the meniscus. Tears in this ‘white zone’ cannot heal due to a lack of the nutrients found in blood. Tears in this area may be complex tears in thin, worn cartilage. As they cannot heal, they are frequently trimmed away surgically.

The treatment plan your doctor prepares for you will depend on your physical condition, your level of activity, your age and any other injuries you may have suffered, as well as the type of tear.

Non-surgical treatment

The tear may heal itself if it is small and in the outer third of the meniscus. If the knee is stable and other symptoms subside, there may be no need for surgical intervention.

The RICE protocol

RICE stands for REST, ICE, COMPRESSION and ELEVATION. For most sports-related injuries, this protocol is an effective treatment.

• REST – Take a break from the activity that led to your injury. Crutches may be recommended so that you can take your weight off the injured knee.
• ICE – You should not put ice directly onto your skin, but several times a day, apply an ice pack for twenty minutes at a time.
• COMPRESSION – An elastic compression bandage will prevent additional swelling and blood loss.
• ELEVATION – raising your leg higher than your heart when you are lying down and resting will reduce swelling.

You may also use non-steroidal anti-inflammatory medicines like ibuprofen or aspirin to reduce pain and swelling.

Surgical Treatment

Arthroscopic surgery may be recommended if your symptoms fail to alleviate with non-surgical treatment.

In knee arthroscopy, a clear picture of the inside of your knee is captured by a tiny camera inserted through a cut (portal) in the knee; the tear is then repaired or trimmed with miniature surgical instruments inserted through other portals.

• Partial meniscectomy involves trimming away the damaged meniscus tissue.

• Meniscus repair – depending upon the type of tear, it may be possible to repair the meniscus by stitching the pieces back together (suturing). Whether or not this is possible depends on the condition of the meniscus. Recovery from this type of surgery takes longer than from trimming away damaged tissue, as the repaired meniscus needs time to heal.

To help with your rehabilitation after surgery, you may be given a knee brace or a cast to immobilize the knee. After a meniscus repair, you need to keep your weight off of your knee for about a month so you will need to use crutches when walking.

Once you have started to heal satisfactorily, you will need to exercise the knee to improve flexibility and strength. In the beginning, the focus will be on increasing mobility and later, strengthening exercises will be recommended. In most cases, you can do exercises to rehabilitate yourself at home, although your doctor may advise some physical therapy. Normally, recovery after a meniscectomy will take about three to four weeks, but it will take around three months to fully recover from a meniscus repair.

With proper treatment and rehabilitation, the majority of patients are able to recover from these very common injuries and attain their pre-injury level of abilities.

The Sports and Orthopedic Center also reaches out to anyone suffering from orthopedic injuries, or from acute or chronic damage to bones and joints. Our center brings together a highly accomplished team of 38 orthopedic surgeons, physical therapists and sports injury and physical rehabilitation experts. We pair these experienced experts with the latest orthopedic and physical rehabilitation equipment, ensuring all patients receive the best possible care. 

Samitivej has a team ready to help and provide services for:

• Treatment Plan Consultation with a doctor via online video-call (second opinion)
• Treatment Planning if you have medical records or a price estimate from another hospital 
• Cost Planning by our Appraisals Team with price guarantee (only for procedure packages without complications)
• Check Initial Coverage Eligibility with Thai and international insurance companies (only for insurance companies in contract with the Hospital)

• Online Consultation: Patients can consult a specialist doctor by submitting a medical report and participating in a video call regarding treatment plans via Samitivej Virtual Hospital.
• Samitivej PACE: The access link to this application will be sent to patients so they can forward it to their relatives to use for real-time monitoring during surgery. They can check the patient’s status at any time, for instance, while they are waiting to enter the operating room or patient recovery rooms.

• Samitivej PROMPT: This service is provided to patients to send a message to their doctor and choose the times of day during in which they do not wish to be disturbed. It also displays initial hospital bill.
• Online Follow-up Appointment: Patients may change their on-site follow-up appointment to a video call at the discretion of the doctor in charge of treatment.