The meniscus is one of the many cartilage-fueled shock absorption cushions that your body has to keep your bones and joints protected. Acting as the main protective measure in one of the major joints of the body, the two menisci of the knee are located between the top of the shinbone and the bottom of the thigh-bone, termed the lateral meniscus and the medial meniscus. Tears in the meniscus happen to be one of the most common causes of knee pain, with symptoms of a tear manifesting as:
- Popping sounds
- Stiffness and swelling
- Locking, catching, or giving away of knee
- Lack of usual range-of-motion in knee
Meniscus tears happen every day to everyone, with causes ranging from heavy use and high levels of activity to joint disorders and arthritis to the simple wear-down of cartilage that allows everyday tasks to put you at risk. So how are they avoided, then? And how are they treated?
Well, like all injuries that affect particular demographics more – in this case, athletes and the elderly – there are certain exercises and preventative measures to aid in strengthening the muscles around the meniscus. To learn more about preventative measures, call 502-212-2663 and get a consultation on your knee pain, or check out Dr. Grossfield’s videos on knee injuries in the Videos section.
As for treatment, not all meniscus tears are the same – there are actually six common types that are treated, and each tear relies on a number of different factors to determine which avenue of treatment should be taken, including age, the body’s response to non-surgical treatment, and any damage that extends beyond the meniscal tear.
The most important takeaway is that not all tears require surgery, and our job at Orthopaedic Specialists PLLC is to diminish your need for invasive surgery – most often arthroscopic knee surgery – or to help you recuperate from it.
So what are the six most common meniscus tears?
Before we delve into the list, it’s important to mention that meniscal tear diagnoses are usually very detailed, and can have an effect on the type of treatment received. Your particular tear may be described in terms of:
Every tear is categorized as either an acute tear or an degenerative tear.
- Acute tears occur in weight-bearing situations, which is why this is usually the category athletes and injuries due to unnatural positions fall into.
- Degenerative tears, on the other hand, is a category that usually holds more statistics for the elderly and are usually less severe than acute tears. These types of tears develop from a weakened meniscus, which happens naturally as the body ages, much like degenerative disc disease in the back.
The location of the tear is critical in the ability to treat the injury non-surgically, and, alternatively, if surgical repair is even a viable option for treatment. There are four primary locations used to describe tears: anterior horn, posterior horn, central, and peripheral.
- Anterior horn tears are located in the front of the meniscus and are usually caused due to sudden twists or trauma, with pain occurring during knee extension.
- Posterior horn tears are located in the back of the meniscus and are one of the most common locations for tears, with pain occurring along the joint line and back of your knee – such as when you squat down.
- Central tears are located on the inner side of the meniscus. This part of the meniscus does not have a blood supply and is therefore not responsive to repair. Most pain from central tears happen when twisting or rotating your knee.
- Peripheral tears are located on the outside of the meniscus. If a meniscus can be surgically repaired, peripheral tears are the most likely to respond to surgical treatment.
Depending on the extent of the injury, meniscus tears have a sub-classification of either complete or incomplete.
- A complete tear travels all the way through the meniscus, meaning that a piece of the tissue is entirely separated from the rest of the meniscus.
- An incomplete tear stops before total separation, meaning that the tissue is still partly attached to the body of the meniscus.
Additionally, a second sub-classification that tears are sorted into are stable and unstable tears, which can also be a crucial factor in concluding if surgery is necessary.
- A stable tear is a best-case scenario meniscus tear because it does not move and may potentially heal on its own, depending on the location in terms of vascular or avascular zones.
- An unstable tear is the opposite – it is the worst-case scenario meniscus tear, since it does allow the meniscus to move abnormally, which will likely develop to be a problem if not surgically corrected.
The six types of meniscus tears are actually in reference to the type of tear pattern, so now, we’ll get deeper into the types of tears that you may be diagnosed with.
Coming in as the most common kind of tear, this centrally-located injury lies within an avascular zone of the meniscus – and where there is no blood flow, there can be no natural repair, and this type of tear must be resolved with surgery that trims the damaged portion of the meniscus so that no further tearing occurs.
Intrasubstance or incomplete tears – known by both names – are stable tears and usually mild injuries that don’t require surgery. They are, however, usually signs of early degeneration in the meniscus, which should be monitored and treated with preventative PT to prevent more serious meniscus injuries later in life.
As a surgically-responsive form of meniscal tears, horizontal tears “go with the grain,” so to say, meaning that the tear follows the curved fibers of the meniscus. So, rather than removal, there is an opportunity for repair via stitching the tear together, although the success of this is highly dependent on the location of the tear. As with all central and avascular-located injuries, if the tear does not have access to blood flow, the body will not be able to heal.
In the case of the unusual tear pattern flap tears in the meniscus present, this type of tear has the potential to cause a ‘catching’ sensation in the knee, as a part of the tissue has been torn and peeled back from the rest of the meniscus, causing it to get stuck in the joint. This type of tear is usually mended surgically, where the flap is trimmed away so that it no longer catches. In most cases, this tear will not need much tissue trimmed away to fix the problem.
Complex tears are exactly what they say they are – complex in nature pertaining to both the tear pattern and surgical reparations. Since complex tears are identified by a combination of tear patterns, both radial and horizontal tear patterns often occur and make any potential surgical option complicated. If surgery is at all considered, often times, the surgeon will treat each portion of the tear differently – removing some parts while attempting to completely repair others, which is why this tear is very dependent on location.
Bucket-handle tears usually require surgery due to the nature of blockage that occurs. Similar to a horizontal tear, these tears occur along the grain of the meniscus, but are deeper and involve a larger part of the meniscus. Because of this, the torn part can separate from the rest of the tissue and cause the knee to become stuck and immovable, which is why surgery becomes more urgent in order to restore movement.
For more insight into what your meniscus tear looks like, visit VeryWellHealth for images.
If you or someone you love has suffered a knee injury in the Louisville, Kentucky-area, board certified sports medicine physician Dr. Stacie Grossfeld at Orthopaedic Specialists PLLC can help. Orthopaedic Specialists PLLC is accepting new patients, and same day appointments are available. For additional information or to schedule an appointment, please contact Orthopaedic Specialists PLLC today at 502-212-2663.