MENISCUS TEARS
The meniscus is a C-shaped piece of tough, rubbery cartilage that acts as a shock absorber between the shinbone and the thighbone. It can be torn if you suddenly twist your knee while bearing weight on it. A torn meniscus is one of the most common knee injuries
If your child needs surgery or casting, our Fracture Care Clinic opens every day and you do not need an appointment. Surgery rooms get scheduled every morning, so your child receives the care and attention they need right away.
Meniscus Tears
A torn meniscus is a common injury to the knee that can cause pain, swelling, and difficulty with movement. The meniscus is a C-shaped piece of cartilage in the knee joint. It acts as a cushion between the thighbone and the shinbone. A tear in this cartilage can occur due to a sudden twist or turn of the knee. It can also result from wear and tear over time.
Types of Meniscus Tears
The meniscus is a C-shaped cartilage that provides a cushioning effect between the thigh bone and shin bone in the knee joint. It also stabilizes the knee joint and helps in shock absorption. However, due to various factors, the meniscus can tear, which can result in pain, swelling, and limited mobility. There are three types of meniscus tears, which include:
- Radial Tear: A radial tear runs perpendicular to the meniscus’s fibers. It can occur at any location along the meniscus and can vary in size and shape. Radial tears are often caused by trauma to the knee, such as sudden twisting or turning. This type of tear can also occur due to degeneration or wear and tear on the meniscus over time. Radial tears may cause locking or catching sensations in the knee joint, as well as pain and swelling.
- Horizontal Tear: A horizontal tear runs parallel to the joint surface. This type of tear can occur in the middle or outer edge of the meniscus, but it is less common than a radial tear. Horizontal tears can be caused by repetitive stress or wear and tear on the meniscus over time. They can also occur due to a sudden injury, such as a fall or direct blow to the knee. Horizontal tears can cause pain, swelling, and limited mobility in the knee joint.
- Flap Tear: A flap tear occurs when a portion of the meniscus becomes detached and flips over. This type of tear can be caused by trauma to the knee or degeneration of the meniscus over time. Flap tears can cause locking or catching sensations in the knee joint, as well as pain and swelling.
Identification of a Torn Meniscus
During the physical exam, the doctor checks the knee joint’s range of motion and examines for any swelling. The doctor presses on different parts of the joint to locate areas of pain and tenderness. Special tests like the McMurray or Apley’s compression test help assess stability and detect possible meniscus tears.
McMurray Test: You lie on your back while the doctor bends, rotates, and straightens your knee. Pain or a clicking sensation during this movement may indicate a torn meniscus.
Apley’s Compression Test: The patient lies face down (prone) on an examination table. This test is also known as the Apley Grind Test. The doctor will then maneuver the knee to evaluate a potential meniscus injury in the knee.
Thessaly Test: While standing on the affected leg, you twist your knee inward and outward under the doctor’s supervision.
Discomfort, catching, or locking may signal a meniscus injury. These specific movements help the doctor locate the tear and assess its severity.
Common Physical Exam Tests for Meniscus Tears
Before the exam, the doctor asks about your medical history and when your symptoms began. They ask which activities—like walking or twisting—worsen the knee pain.
They look for swelling around the kneecap and check for tenderness in targeted areas.
Doctors often use imaging tests, such as an MRI, to visualize the meniscus and confirm the diagnosis. X-rays help rule out bone injuries but don’t show soft tissues like the meniscus. Doctors usually begin with an X-ray to check for joint space narrowing or signs of arthritis. Since X-rays can’t reveal the meniscus, the doctor typically follows up with an MRI.
An MRI provides high-resolution images of soft tissues and gives a detailed view of the meniscus and nearby structures. In some cases, the doctor uses arthroscopy, a minimally invasive surgical procedure to view the knee directly. This allows the doctor to identify and repair the meniscus tear using specialized tools.
Doctors combine physical exams and imaging tests to diagnose and classify meniscus tears accurately.
QUESTIONS AND ANSWERS
How did my child get a meniscus tear, and what are the common causes?
A meniscus tear in a child can result from a variety of causes, often related to sports or physical activities. Common causes include:
- Sports Injuries: Meniscus tears frequently occur during sports that involve sudden stops, twists, or changes in direction, such as soccer, basketball, or gymnastics.
- Trauma: Direct impact to the knee, such as a fall or collision, can lead to a meniscus tear.
- Degenerative Changes: In some cases, especially in older children or adolescents, wear and tear on the meniscus over time can contribute to tears.
How is a meniscus tear diagnosed, and what tests are needed?
Diagnosis of a meniscus tear typically involves a combination of a physical examination and imaging studies. The healthcare provider will assess the child’s symptoms, examine the knee for swelling, tenderness, and range of motion, and inquire about the circumstances of the injury.
Imaging tests, such as MRI (Magnetic Resonance Imaging), are commonly used to visualize the meniscus and confirm the diagnosis. While X-rays may be performed to rule out other potential injuries, they are not as effective at detecting soft tissue injuries like meniscus tears.
What is the treatment plan for my child's meniscus tear, and what is the expected recovery time?
The treatment approach for a meniscus tear in a child depends on factors such as the size and location of the tear, the child’s age, and activity level. Common treatment options include:
- Rest and Activity Modification: Initially, the child may need to avoid activities that could worsen the tear.
- Physical Therapy: Physical therapy exercises can help strengthen the muscles around the knee, improve flexibility, and enhance stability.
- Bracing and Supportive Measures: In some cases, a knee brace may be recommended to provide additional support.
- Surgical Intervention: For more significant tears or cases where conservative measures are not effective, arthroscopic surgery may be considered to repair or remove the torn portion of the meniscus.
Parents should maintain open communication with the healthcare team to address any concerns and monitor the child’s progress throughout the recovery process.
Schedule an appointment today to treat your child with a torn meniscus
Symptoms
The symptoms of a torn meniscus can vary depending on the severity and location of the tear. However, common symptoms of a torn meniscus may include:
- Pain in the knee joint, particularly when bearing weight or moving the knee
- Swelling or stiffness in the knee joint
- Difficulty straightening or bending the knee
- A popping or clicking sensation when moving the knee
- Feeling like the knee is giving way or locking up
- Limited range of motion in the knee joint
- Instability or weakness in the knee joint
- Difficulty walking or standing for extended periods of time
- Pain or discomfort when touching the knee joint
- Development of osteoarthritis in the affected knee joint over time.
- Persistent knee pain and discomfort if the meniscus tear does not heal properly.
- Increased risk of ongoing cartilage breakdown within the knee, which can further compromise joint health.
- Greater likelihood of future knee problems, such as stiffness, instability, or reduced range of motion.
It is important to note that not all meniscus tears produce symptoms. Some people may experience only mild or intermittent symptoms.
If you think you or your child may have a torn meniscus, a period of rest and caring for the knee at home may help symptoms improve, especially if they are mild. However, if symptoms persist or worsen after at-home care, it is important to consult a healthcare professional. Seek medical attention if there is difficulty bending or straightening the knee, if the knee feels unstable, or if you notice it giving way or locking up. These signs may indicate the need for a more thorough evaluation and targeted treatment.
If your child experiences any of the above symptoms, it is important to consult with a healthcare professional for proper diagnosis and treatment of the knee injury.
Torn Meniscus Treatment
Treatment for a torn meniscus can vary depending on the severity of the tear and the patient’s overall health. In some cases, the tear may heal on its own with rest, ice, and physical therapy.
Non-surgical treatments for a torn meniscus can include:
- Rest and ice: Resting the knee and applying ice can help reduce swelling and relieve pain.
- Physical therapy: Exercises can help improve strength, flexibility, and range of motion in the knee joint.
- Pain medication: Over-the-counter pain medications can help relieve pain and reduce inflammation. In addition to basic pain relievers, nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, or naproxen may be recommended to help manage pain and swelling and support a smoother recovery.
These conservative approaches are often effective, especially for less severe tears, and aim to help your child regain comfort and function without the need for surgery. In cases where the tear is more severe or does not heal on its own, surgery may be necessary.
Surgical treatment for a torn meniscus can include:
- Meniscus repair: In this procedure, the torn portion of the meniscus is reattached to the surrounding tissue using sutures or anchors. Instead of removing the injured part, the surgeon works to repair the tear, which can help preserve as much of the meniscus as possible. Recovery time for meniscus repair is typically longer than for other procedures, as the repaired tissue needs sufficient time to heal. This often involves the use of a brace and crutches for an extended period.
- Partial meniscectomy: This involves removing the torn portion of the meniscus while leaving the remaining tissue intact. A partial meniscectomy is often recommended when the tear is degenerative or located in an area with poor blood supply, making it less likely to heal on its own. The goal is to remove the damaged fragments and prevent further tearing or damage to the knee joint. Most people are able to bear weight and move the knee through its full range of motion soon after this minimally invasive, outpatient procedure.
- Total meniscectomy: In rare cases, the entire meniscus may need to be removed, although this can lead to long-term complications such as arthritis. Total meniscectomy is generally avoided unless absolutely necessary.
Points to note:
Surgery is generally recommended if pain and symptoms, such as knee locking, catching, or difficulty straightening the knee, do not improve with conservative treatments. These symptoms may indicate a displaced meniscus fragment, which can worsen if left untreated. Most meniscus surgeries are minimally invasive, performed through small incisions using a camera to view the joint and specialized instruments to repair or remove damaged tissue. The specific procedure chosen depends on the severity, location of the tear, and blood supply to the meniscus.
Partial meniscectomy is commonly used when the tear is degenerative or located in an area with poor blood supply. The goal is to remove only the torn fragments to prevent further damage and preserve as much healthy meniscus as possible. Most patients can return home the same day, often using crutches for balance, and are typically able to put weight on the knee and begin moving it soon after surgery.
What to Expect After Surgery
After that, your child ought to be able to resume his or her favorite activities in roughly nine months. For athletes, it may take up to a year before they may resume their sport.
The exact recovery timeline depends on the type of meniscus surgery performed and the severity of the tear. Surgical options are generally considered if pain persists after conservative treatments, or if your child experiences symptoms such as locking, catching, or difficulty straightening the knee, signs that a piece of the meniscus may have moved out of place.
Most meniscus surgeries today are minimally invasive, using small incisions and a tiny camera to guide specialized instruments inside the knee joint. There are two main surgical approaches:
- Partial meniscectomy: In this procedure, only the damaged part of the meniscus is removed. It’s typically used for tears in areas with poor blood supply or degenerative changes. Children who undergo a partial meniscectomy are often able to bear weight and move the knee through its full range of motion soon after surgery.
- Meniscus repair: In some cases, the surgeon will repair the torn meniscus rather than remove it. Because the repaired tissue needs time to heal, recovery is generally longer. Your child may need to use crutches and wear a knee brace for a while to protect the healing meniscus.
Regardless of which procedure is performed, following your doctor’s rehabilitation plan, including physical therapy—is essential for a safe and successful return to activity. Every child heals at their own pace, but with patience and proper care, most kids can look forward to getting back to the sports and activities they enjoy.
Prevention Measures
While some meniscus tears occur due to sudden injury or trauma, others can be prevented by taking certain precautions. Here are some prevention measures that can help reduce the risk of meniscus tears:
- Strengthen the muscles around the knee: Strong muscles can help support the knee joint and reduce the risk of injury. Focus on exercises that target the quadriceps, hamstrings, and calf muscles.
- Maintain a healthy weight: Excess body weight can put added stress on the knee joint, increasing the risk of injury. Maintaining a healthy weight can help reduce this risk.
- Wear proper footwear: Wearing shoes that provide good support and cushioning can help reduce the impact on the knee joint during physical activity.
- Warming up and stretching before physical activity: Warming up and stretching can help prepare the muscles and joints for physical activity, reducing the risk of injury.
- Use proper technique during physical activity: Using proper technique during physical activity, such as running and jumping, can help reduce the risk of injury to the knee joint.
- Avoid activities that put excessive stress on the knee joint: High-impact activities, such as running and jumping, can put excessive stress on the knee joint, increasing the risk of injury. Consider low-impact activities, such as swimming or cycling, as an alternative.
- Take breaks and rest when necessary: Resting and taking breaks during physical activity can help reduce the risk of overuse injuries, including meniscus tears.
Understanding Risk Factors
A torn meniscus can happen to anyone, but it’s important to recognize certain factors that may increase your risk. For example, playing sports that involve running, jumping, quick changes of direction, or physical contact—such as soccer, football, or basketball—can put significant strain on your knees and make you more susceptible to meniscus tears.
Additional risk factors include:
- Aging: As we get older, decades of use can wear down the meniscus, leaving it more vulnerable to tearing.
- Arthritis: Osteoarthritis, the most common type of arthritis, breaks down cartilage over time, increasing the chance of meniscus tears.
In summary, taking preventive measures such as strengthening muscles, maintaining a healthy weight, wearing proper footwear, warming up, using proper technique, avoiding high-impact activities, and taking breaks can help reduce the risk of meniscus tears. Additionally, being aware of your personal risk factors—like age, arthritis, or participation in certain sports, can help you make informed choices to protect your knee health.
Summary
In summary, a torn meniscus is a common injury to the knee that can cause pain, swelling, and difficulty with movement. There are several types of meniscus tears, and diagnosis is typically made through a physical exam and imaging tests. Treatment can include non-surgical options such as rest, ice, and physical therapy, as well as surgical options such as meniscus repair or partial meniscectomy. Prevention measures can help reduce the risk of a torn meniscus, and recovery time can vary depending on the type and severity of the tear and the treatment used.
As previously mentioned, our doctors at the Medical City Children’s Orthopedics and Spine Specialists, with offices in Dallas, Arlington, Flower Mound, Frisco, and McKinney, TX, will recommend physical therapy as the torn meniscus starts to heal. That will support the muscles and ligaments in becoming stronger.
____________________
Footnote:
Call 214-556-0590 to make an appointment.