Ask Dr. Geier – Meniscus Tears

I mentioned in last week’s Ask Dr. Geier Monday column that over the summer months I would be focusing on more wellness and fitness posts. Another focus of mine for the next two or three months will be to get out in the community and speak to sports groups about injuries in sports and ideas for injury prevention and wellness. If you play a sport or have kids that play a sport and would be interested in having me speak to the players, teams, coaches, and parents, please contact me. I enjoy getting out to meet people and answer questions people have.

This week’s Ask Dr. Geier column addresses one of the most common problems I see – meniscus tears. Unfortunately they are one of the most common injuries that keep people from sports and exercise.

As always, please keep in mind my disclaimer about giving specific medical advice online or by email.

David

Andrew in Aiken, South Carolina asks:

What are the treatment options for a degenerative meniscal tear?

This might seem like a very simple question, but it unfortunately can be a more complicated answer than you might think. And since arthroscopy of the knee for meniscus tears is often listed as the most common operation performed in all of orthopaedics, I think it applies to many of you.

First of all, it is true that meniscus tears generally do not heal by themselves. Yes, there are exceptions, but for purposes of this post, they don’t. That doesn’t mean that every patient with a meniscus tear needs surgery. Some people have them and don’t even know it. The key is to determine if the meniscus tear is what is actually causing a patient to have pain.

Older patients often have wear and tear of the articular cartilage lining on the ends of the femur and tibia (essentially arthritis of the knee) as well as a degenerative meniscus tear. That makes sense when you think about it, since the meniscus is a shock absorber. If it is torn, more stress might be transferred to the bones and cartilage, causing damage to those structures.

Trying to know if knee pain is coming from the meniscus or articular cartilage can be more difficult than you might think. The location and type of pain can be very similar. Sometimes a patient will note having a dull pain for years before starting to have a sharp, very localized pain recently. That could be a sign that they had arthritis pain before developing a new meniscus tear. And ordering an MRI only shows you that a meniscus tear exists, but it doesn’t tell the physician that the meniscus tear is painful.

The reason that the true source of pain matters is that arthroscopy of the knee and trimming out the torn part of the meniscus only relieve pain from the meniscus tear. “Cleaning up” the damage to the articular cartilage might provide some short-term relief, but studies have shown that it does little to provide long-term relief. I equate it to a pothole in a road. Smoothing out the pothole might make it smoother, but you are not filling in the hole. So, if a meniscus tear is causing most of the patient’s pain, surgery to scope the knee and trim out part of the meniscus can be very effective. But if there is a significant amount of arthritis in the knee, surgery might not provide complete relief.

Surgery for a recurrent meniscus tear?

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If you have a degenerative meniscus tear, I would recommend that you discuss your knee and your symptoms with an orthopaedic surgeon who specializes in arthroscopic surgery and sports medicine and discuss whether surgery is the appropriate intervention for you.

Tags: arthritis arthroscopic surgery Ask Dr. Geier knee knee surgery meniscus meniscus tear