Meniscus Tear Treatment

A meniscus tear is a common knee injury that affects athletes, active individuals, and older adults alike due to forcefully twisting or rotating the knee, such as aggressive pivoting, sudden stops and turns, kneeling, deep squatting or lifting something heavy.  

Treatment for meniscus tears in Cuba is through non-surgical and surgical approaches, depending on the tear’s severity and location. For non-surgical treatment, physical therapy, including specialized exercises and hydrotherapy, is essential in strengthening the knee, enhancing flexibility, and achieving full recovery. Treating a meniscus tear offers numerous benefits including:  

• Pain and swelling reduction 

• Improved mobility 

• Enhanced stability 

• Preventing further damage 

• Return to daily activities 

• Improved quality of life  

Types of meniscus tear:  

Meniscus tears can vary in type and severity, affecting how they are treated.   

• Longitudinal Tear: A tear along the length of the meniscus, often along the inner edge. 

• Bucket Handle Tear: A type of longitudinal tear where a portion of the meniscus is displaced, resembling a bucket handle. This type of tear can cause the knee to lock or catch.  

• Radial Tear: This is a common type of meniscus teat that affects knee stability. It extends from the inner edge of the meniscus outward towards the periphery.   

• Horizontal Tear: This type of tear is caused by degeneration and splits the meniscus horizontally.  

• Flap Tear: A piece of the meniscus is displaced, forming a flap that can catch in the knee joint.  

• Complex Tear: This is a combination of different tear patterns within the meniscus, typically seen in degenerative meniscus tears. 

• Degenerative Tear: This type of tear is caused by the gradual wear and tear of the meniscus.  

Tear Zones  

Meniscus tears can be further classified based on their location within the meniscus, affecting healing potential due to varying blood supply: 

• Red-Red Zone 
  – The outer edge of the meniscus has a good blood supply. 
  – Tears here have a higher potential for healing. 

• Red-White Zone 
  – The middle portion with moderate blood supply. 
  – Tears here may heal but less reliably than those in the red-red zone. 

• White-White Zone 
  – The inner portion with poor blood supply. 
  – Tears here have a low potential for healing and often require surgical intervention.  

Severity of Tears 

Meniscus tear can also be typified as:  

• Partial Tear 
  – Only part of the meniscus is torn. 
  – May heal on its own or with conservative treatment. 

• Complete Tear 
  – The tear goes through the entire meniscus. 
  – Often requires surgical treatment for proper healing.  

Causes  

Meniscus tears can result from a variety of factors, primarily:  

• Sudden twisting or pivoting motions 

• Direct impact to the knee 

• Activities involving cutting, pivoting, or rapid changes in direction 

• Contact sports (e.g., football, soccer, rugby) 

• Age-related wear and tear 

• Osteoarthritis 

• Repetitive knee motions 

• Heavy lifting or squatting 

• Falls or missteps 

• Motor vehicle accidents 

• Weak thigh muscles 

• Lack of flexibility 

• Incorrect posture during physical activities 

• Obesity 

• History of knee injuries increasing susceptibility  

Symptoms:  

Symptoms of meniscus tears typically include:   

• Pain in the knee 

• Swelling and stiffness 

• Popping sensation at the time of injury 

• Difficulty moving the knee 

• Knee “locking” or “catching” 

• Decreased range of motion 

• Knee instability or giving way 

• Discomfort during twisting or squatting activities   

Diagnosis  

Diagnosing a meniscus tear typically involves medical history review and physical examination as well as the following:  

Imaging Tests 

• X-rays: Used to rule out other causes of knee pain, such as fractures or arthritis 

• Magnetic Resonance Imaging (MRI): Detailed images of the knee’s soft tissues, including the meniscus to identify the presence, type, and extent of a tear   

Diagnostic Arthroscopy 

• Arthroscopy: A minimally invasive surgical procedure where a small camera is inserted into the knee joint to visualize the meniscus and any tears. This procedure can be used for both diagnosis and treatment  

Treatment Options  

Treatment for a meniscus tear depends on several factors, including the type, location, size of the tear, as well as the patient’s age, activity level, and overall health.  

Nonsurgical Treatment  

Many meniscus tears will not need immediate surgery. Initially nonsurgical treatment may be recommended. Along with RICE protocol (Rest, Ice, Compression, and Elevation) the following may be recommended:  

• Steroid injection. Corticosteroid medication may be injected into the knee joint to help eliminate pain and swelling.  

• Therapy: Physical therapy can help you strengthen the muscles around your knee and in your legs to help stabilize and support the knee joint. This includes:
  – Strengthening Exercises 
  – Flexibility Exercises 
  – Functional Training 
  – Activity-Specific Training 
  – Endurance Training  

Surgical treatment 

For more severe cases, or for patients whose condition has not responded to non-surgical treatment, surgical intervention could be recommended. 

Surgery is almost always needed when: 

• A tear doesn’t heal with conservative treatment, such as rest or ice 

• Knee joint is out of alignment 

• Knee becomes locked  

There are few types of surgeries for the treatment of meniscus tear, including:  

• Meniscus Repair (Arthroscopic Surgery): This minimally invasive procedure in which a small camera and instruments is inserted into the knee joint to repair the torn meniscus depending on the tear’s nature. This procedure is favored for its precision, smaller incisions, reduced tissue damage, and quicker recovery times compared to traditional open surgery, enabling patients to resume normal activities more rapidly   

• Meniscectomy: When repair is not possible, partial or total removal of the torn meniscus may be performed. This procedure is often chosen when meniscus repair is not feasible, such as in cases where the tear is in an area with poor blood supply, or the tissue is too damaged to heal properly.   

The choice of whether a partial of full meniscectomy to be carried out is dependent on: 

– Patient’s age 
– Tear size 
– Tear location 
– Cause of the tear 
– Symptoms experienced 
– Patient’s activity level