Knee Meniscus Tear

Stiff knee, also referred to as arthrofibrosis, is a condition that is associated with moderate to severe pain with knee motion.

Pathology

The menisci are two C-shaped cartilage disks that sit between the thigh bone (femur) and the shin bone (tibia) and provide stability, support, and cushioning for the knee. Through wear-and-tear or a specific injury such as during sports, the menisci can tear. These tears can be horizontal, vertical, oblique, circumferential, or a combination of all of these tear patterns. If a meniscus tear creates a flap of meniscus, it can then flip into and out of the knee joint, causing pain, swelling, catching, and/or locking-type symptoms. Losing the cartilage lining on the lower end of the femur or the upper end of the tibia can predispose a person to a meniscus tear as the space between the two bones gets smaller. In younger patients, a knee ligament injury can occur at the same time as a meniscus tear. A meniscus tear can also occur in conjunction with a special type of tibia fracture. X-rays will show any fractures, dislocations, or any evidence of arthritis. An MRI may be necessary to better image the ligaments, tendons, cartilage surfaces, and menisci to determine the extent of any injury to these structures.

Treatment

Meniscus tears can be treated non-operatively or operatively. If the tear is small, does not extend all the way through the body of the meniscus, and the patient is not having any catching or locking-type symptoms, non-operative treatment is recommended as the first course of treatment. Non-operative treatment involves a cortisone injection and a course of physical therapy to strengthen the muscles around the knee.

If non-operative treatment does not provide relief, the tear is large, extends to the joint surface, or the patient is having pain, swelling, catching or locking-type symptoms, operative treatment is recommended. In most cases, the meniscus tear is trimmed back to a stable rim, leaving the healthy meniscus tissue to provide support, stability, and cushioning for the knee. The torn meniscus tissue that is not functioning and only causing the patient symptoms is trimmed out, leaving all of the healthy meniscus tissue to function properly. After the surgery, physical therapists work with the patient to start moving the knee, strengthening the muscles around the knee and leg, and getting the patient back to their desired activities.

In younger patients, or patients that have had a specific injury that caused the meniscus tear, the tear can sometimes be repaired with a separate incision and stitches. If the torn meniscus can be repaired, the patient will not be allowed to put any weight on the operative leg for a period of time after surgery while they work with physical therapists and then weight-bearing on the operative leg will slowly be advanced. Therapists will work with the patient to start moving the knee, strengthen the muscles around the knee and leg, and will ultimately get the patient back to their desired activities.