Meniscus Tear

The meniscus is the tissue that cushions and stabilizes the femur (thigh bone) as it moves on the tibia (shin bone). It is made from thick cartilage (called fibrocartilage), which provides durability and is in a C-shape on the medial (inner) side of the knee and a more circular shape on the lateral (outer) side. It is most commonly injured with a twisting mechanism of the knee while playing sports.  

When the meniscus tears, it can be very painful. The true incidence of acute meniscal tears in children and adolescents is unknown. They are often associated with ACL injuries. There is concern that the number of meniscal tears in growing athletes is increasing with increased participation in sports and an increased awareness of this injury in kids.  

The function of the meniscus is well understood. It is important in load sharing, shock absorption, and stability.  Multiple biomechanical studies have shown the protective effects of a functional meniscus. A torn meniscus that has been treated with menisectomy (partial removal) has an increased risk for the development of early osteoarthritis.  

What Are the Signs and Symptoms of a Meniscus Tear?

• Knee swelling
• Popping sound with knee motion
• Tenderness around the joint line
• The knee “locks up” or gets stuck
• The knee might not completely straighten
• Knee pain with activity
• Difficulty with stairs and getting up from a seated position

After a meniscus tear, many patients are able to walk and put weight on their knees. Some athletes even try to play through the injury. However, with continued use, inflammation in the knee will occur. This can cause pain, tightness, and swelling in the knee. If the tear is large enough, it can flip over and get stuck, causing the knee to lock.  

How Is the Diagnosis of a Meniscal Tear Made?

Your physician will perform a thorough physical examination, focusing on the knee's range of motion and areas of tenderness. There are specific physical exam tests to perform to aid diagnosis. Imaging will also be utilized.

• Plain X-rays of the knee can help exclude other diagnoses.
• An MRI can confirm a meniscal tear.

What Is the Treatment for Meniscal Tears?

Treatment for meniscal tears focuses on controlling pain and inflammation.

How Is an Acute Traumatic Meniscal Tear Treated?

• Initial management of meniscus tears involves the common sports medicine approach of RICE (Rest, Ice, Compression, and Elevation) of the involved leg.
• If needed, pain medication can also be prescribed.
• Crutches can often help your athlete get around.  

Management of meniscal tears depends on the location and size of the tear, as well as how long the tear has been present. Small tears that are on the periphery with good blood supply may require nothing more than rest to heal. Other tears do not have the same potential to heal on their own and require surgery.  

If the decision is made to address the meniscal tear surgically, the primary goal of meniscus tears in the young athlete is to preserve as much of the meniscus as possible. Every attempt will be made to fix the meniscus. Some tears, however, are not repairable, and parts of the torn meniscus will be trimmed back to a stable base.  

How are Discoid Meniscus Tears Treated?

Many of the same principles apply to tears involving the discoid meniscus. When tears are symptomatic and causing pain, locking, or feelings of instability, surgery can be helpful. However, some surgical strategies differ from those for acute non-discoid meniscus tears, as the surgeon aims to reshape or “saucerize” the meniscus.

What Happens After Surgery?

We will have your athlete start in physical therapy with the goals of decreasing swelling and strengthening the quadriceps. If the meniscus is repaired, we recommend 4-6 weeks of toe-touch weight-bearing with crutches. Also, with some repairs, we may limit motion to 0-90 degrees for 3-4 weeks.

If the meniscus is trimmed (partial menisectomy) weight bearing is allowed immediately, and return to activity is dictated by recovery and strengthening of the quadriceps muscle.

Will My Child Be Able to Return to Sports?

The good news is that most growing athletes can recover and return to their previous activities after meniscus tears in a few months. It is important that your athlete rest and heal, and follow the guidelines and protocols established by your doctor, with your physical therapist's help.