Knee

Surgical Intervention Strategies for Meniscus Tears and Their Alternatives

By November 26, 2019 No Comments

Our knees are a crucial part of many functions. One of the most important aspects of the knee is the meniscus, which keeps the thigh bone and shin bone from rubbing against one another. This soft cartilage can become torn, however, leading to pain and discomfort. A knee injury has the potential to derail many daily functions from driving to walking. Once an injury begins to disrupt daily life, consult a doctor to find out what is happening and how to resolve the issue. Read on to learn more about meniscus tears, how they are conventionally treated, and what alternative therapies exist that may hel without the need for surgery.

Anatomy of the Knee
Inside the knee joint, you will find four major structures: the femur, patella, meniscus, and tibia. The femur is the thigh bone, the patella is the kneecap, and the tibia is the shin bone. The meniscus is two pieces of cartilage between the femur and tibia that works to cushion the bones during activity so that they don’t collide. Every joint in the body has a piece of cartilage between the bones for this reason; they serve a very important role in the body’s ability to function.

Injury to the Meniscus
Due to the important location of the meniscus, it is prone to tearing. Individuals who participate in sports that involve changing direction quickly, such as tennis or basketball, are at a higher risk. Tears in the meniscus can begin as a small tear and increase over time, or a significant tear can occur all at once. There are several different types of meniscus tears. Diagnostic techniques can help determine the type of tear. The type and severity of the tear will determine the recovery process.

Causes
A tear in the meniscus can be caused by many factors. The most common reason someone experiences a meniscus tear is because of an injury. These occur most often during sports or exercise, but depending on an individual’s overall health, they can also occur from a task as simple as walking around or standing up. It is more likely that a tear will occur if an individual is experiencing degeneration in the joint. Degeneration is what happens when soft tissue is worn down over time and slowly becomes smaller. Conditions such as arthritis are a result of severe degeneration – when cartilage can no longer protect bones, they begin to rub against one another, causing damage to the bone integrity and pain in the area.

Signs and Symptoms
Tearing the meniscus can feel like a sharp pain, or cause no sensation at all initially. Some individuals can hear or feel a “popping” sensation as the cartilage tears. It may not be readily apparent that a tear has occurred, but the knee typically becomes painful and swollen in the days following the injury. Some individuals may continue to exercise without yet knowing that they have a tear. Common symptoms of a meniscus tear are:

  • Pain in the knee
  • Swelling
  • Inability to bend the knee
  • Weakness or inability to put weight on knee
  • Stiffness

Symptoms can be chronic or only occur during certain activities depending on the severity of the tear. Once the symptoms begin to impact daily life, a doctor should be consulted.

Diagnosing a Meniscus Tear
Consulting with a doctor allows the recovery process to begin. They will ask about symptoms and family history, and it is important to be as honest as possible during this meeting. Symptoms that may not seem relevant could be important indicators of what is causing pain. They may observe how a patient walks, squats, or how far they can move their knee. Talking and observation alone cannot often result in an accurate diagnosis, however, so doctors turn to proven diagnostic techniques to be certain of the cause:

  • McMurray Test: with the patient lying on their back, doctors will bend the knee in a way that indicated a meniscus tear. Doctors will listen for a popping or clicking sound, often indicative of a tear. This test is often accurate if performed correctly, though some doctors prefer to use imaging techniques to be certain.
  • MRI: Magnetic Resonance Imaging can create an image of a patient’s internal soft tissue. If there is a tear in the meniscus or any other soft tissue, an MRI can most likely indicate it.
  • X-Ray: these are not often used for meniscus tears as they do not show soft tissue. They are useful for determining abnormalities in the bone, which could be contributing to knee pain.

There are sometimes more than one condition occurring simultaneously. Doing more than one diagnostic test can indicate all of the causes of knee pain. Knowing exactly what is going on under the surface allows doctors to create an effective recovery plan that is individual to each patient’s needs.

Recovering From a Meniscus Tear
The recovery process will vary depending on the severity of the tear, where it is located, and how the tear is positioned in relation to the cartilage and bone. Some minor tears do not require surgery, but in many cases this injury leads to surgical intervention. Nonsurgical treatments may include:

  • RICE Method: Rest, Ice, Compression, and Elevation. Resting the injury allows it to heal without added stress. Icing the knee can reduce inflammation, swelling, and pain. Compression prevents further damage and blood loss by reducing swelling. Elevating the injury can prevent blood clots and reduce swelling – the knee must be above the heart, which can be achieved by laying down and placing a pillow under the knee.
  • Anti-Inflammatory Medication: over-the-counter drugs such as Ibuprofen or Naproxen can reduce inflammation and pain.
  • Physical Therapy: the goals of physical therapy are to restrengthen muscles, which in turn provides more support for the joint. The exercises in physical therapy can also improve blood flow, which sends the body’s healing properties to the injury and can lead to repair over time.

These treatments have the potential to heal minor injuries, but may not always work. Once these have been attempted with little to no pain relief, doctors will often turn to surgery to repair an injury. In some cases, the injury is so severe initially that surgery is the first option.

Surgical Techniques for Meniscus Tear
Making the decision to undergo surgery can be life-altering. Even minimally invasive procedures can have a long and arduous recovery process. Some procedures have a short recovery period that is minimally difficult, but the decision to have surgery should not be taken lightly. The techniques used today have a relatively low risk due to how commonly they are performed and how thoroughly they have been studied. There are several types of surgery that may be done to repair a torn meniscus. It is important to discuss with doctors and surgeons to ensure that the patient is as informed as possible before making the decision. The most common type of knee surgery is called Arthroscopy. Arthroscopy is considered minimally invasive because it involves small incisions that allow a camera with a light to locate the injury. Once the injury has been found, surgeons enter the knee with the small tools that are necessary to make repairs. Types of arthroscopy that may be used are:

  • Arthroscopic or Meniscus Repair: doctors can help the meniscus to heal by stitching the torn meniscus back together. This form of surgery requires that the meniscus heal and therefore has a longer recovery time. The stitches used can be infused with stem cells or platelet-rich plasma, or be plain stitches. Either way, they must be able to dissolve in the body over time.
  • Partial Meniscectomy: using an arthroscope, doctors can cut away parts of the meniscus that would not be able to heal on their own or with stitches. The parts that are cut away are damaged or injured tissues that are causing pain by lingering in the body and not serving their proper function of cushioning.
  • Total Meniscectomy: doctors and surgeons may choose to remove the meniscus completely. This surgery is not often necessary as it is considered quite drastic. Most surgeons prefer to perform a partial meniscectomy unless it is absolutely necessary to remove the entire meniscus.

Each surgery comes with its set of risks, mainly involving infection and anesthesia. There are different types of anesthesia, so it is important to discuss with doctors and surgeons about what type will be used and how it may affect a patient.

The recovery time for knee arthroscopy will vary based on the severity of the injury and the patient’s general health. Once the surgery is complete, doctors will have a recovery plan set that ensures each patient can heal as quickly as possible. Post operative plans often include the use of a walker, cane, crutches, or other assistive devices that help pain levels by reducing the amount of pressure on the knee. Recovery also involves physical therapy or certain exercises that will ensure that the knee heals properly.

The recovery time for knee surgery is typically short. Most patients report decreased pain and an ability to walk within two weeks. In approximately two months, patients can begin to enjoy exercise again. This may vary depending on the severity of the injury and the patient’s commitment to the recovery process. Though this recovery time is short relative to more invasive surgeries, some patients cannot afford to take so much time off of work, let alone the hospital and post-operative bills. Before making the decision to undergo surgery, it is important to consider all of the options on the market that may help heal the injury.

Alternative Therapies for Recovery: Regenerative Medicine
The burgeoning field of regenerative medicine offers new hope to patients suffering from meniscus tears. These therapies work particularly well on soft tissue, which gives them an advantage for repairing this specific injury. There are two types of regenerative therapy offered at CELLAXYS:

  • Stem Cell Therapy: stem cell therapy begins with taking cells from a patient’s fat tissue, blood cells, or bone marrow. These cells are then processed so that they are concentrated and reinjected into the injury site. These cells contain healing properties that the body is already using naturally to repair minor damages. Increasing the concentration of these cells could lead to a faster recovery.
  • Platelet-Rich Plasma (PRP) Therapy: this form of therapy begins with a simple blood draw. The patient’s blood is then placed in a centrifuge to isolate the platelets from other components in the blood. Once the solution is processed, it is injected into the injury site. Platelets contain proteins and healing factors that the body already uses to repair damage. Undergoing this form of therapy can allow an injury or tear to heal more quickly with an increased amount of healing properties.

These therapies are performed as outpatient procedures. The recovery time is much shorter than surgery, it is nonexistent. Patients who receive these injections can almost always immediately return to normal activities. The most common side effect is pain at the injection site which mostly goes away in one to two days.

Individuals suffering from chronic pain can experience a great disruption of daily life, but a treatment that offers to help with pain and healing the injury may be the answer for those who cannot take the time to undergo surgery. In some cases, these procedures heal the injury to the point where surgery is no longer necessary.

Meniscus tear injuries may still need surgical intervention depending on the severity of the tear. Regenerative medicine can also be used alongside surgery. Some patients decide to use regenerative medicine as a sort of “boost” to help their injury heal post-operation. Either way, pain is reduced which can increase enjoyment of life.

Conclusion
Having a meniscus tear is not the end of the world, though it can be painful and disrupt daily life. Receiving a proper diagnosis is important, as there may be other issues occurring in the knee simultaneously. It is important to maintain an open line of communication with doctors throughout the process of diagnosis, treatment, and recovery. Surgery may be necessary depending on the degree of injury, but in some cases it can be prevented through the use of new treatments such as stem cell therapy or PRP therapy. Even if surgery is unavoidable, these therapies offer pain relief and help with healing the injury post operation. A shorter recovery time means more time spent enjoying life pain-free.

Dr. Matthew HC Otten

Dr. Matthew HC Otten

Director of Orthopedic & Orthobiologics
Fellowship-trained & Board Certified in Sports medicine
Director Angiography at Harvard Clinical Research Institute
Michigan Stage University Alumni