Understanding Meniscal Tears & Treatment Options
In the world of sports and fitness, we usually see a lot of knee injuries. Also, knee issues could be related to age, degeneration of various structures in the knee, and wear of cartilage that takes place with frequent or prolonged loading. In such a scenario, meniscus tears are a very common complaint.
As an orthopedic and sports injury surgeon, I most often hear patients ask the same critical question upon learning that they suffer from a meniscal tear; that is, ‘Will my meniscal tear get better with time, or does it require intervention?’
Whether a meniscus tear will heal on its own or requires treatment is influenced by several factors: the type of tear, its dimensions, localization of the lesion, the person’s age, activity level, and related syndromes.
This article aims to elaborate on whether all kinds/modes of meniscal tears can heal on their own or require a nonoperative or operative management (arthroscopic surgery) modality.
What Exactly are Meniscal Tears?
The meniscus is the C-shaped cartilage structure that sits in between the femur and tibia in joint development. There are two meniscus cartilage in each knee joint: on the medial side, there’s the one sitting on the inside of the knee, while the lateral meniscus rests on the outside side of the knee. Therefore, the forms/functions included in the joint-specific purposes of menisci include load bearing, shock absorbing-waiting distributing in the joint, and stabilizing the joint. The menisci help deep surface concavities in the femur protect articular cartilage, prevent the wear of articular cartilage, and increase joint stability.
A meniscal tear is a disruption of the meniscal cartilage tissue that occurs when there is sudden torsion, pivoting, or a high-stress load on a flexed knee joint. Sports with such sudden high-stress movements, high forces, and weight support are particularly likely to cause meniscal tears—e.g., football, cricket, basketball, badminton, and athletics.
In the older population, meniscal tear can occur due to spontaneous degeneration of the menacterial cartilage which is often described as a horizontal tear. These degenerative horizontal tears may not be associated with any significant acute twisting or pivoting and usually occur due to degenerative changes in the meniscus.
Signs and symptoms of a meniscal tear include:
- Pain and tenderness on the inside or outside of the knee
- Swelling and stiffness
- A ‘pop’ sound at the time of injury
- A catching or locking sensation
- Decreased range of motion in the knee
- Post-traumatic effusion of the knee joint
Can Meniscal Tears Heal On Their Own?
Some meniscus tears can heal on their own, but most doctors say that most tears won’t heal on their own. The possibility of natural healing depends on several factors:
1. Tear Location
Red Zone: This area of the meniscus has a good blood supply. Tears in this area have a higher chance of healing on their own or in response to nonoperative treatment.
White Zone: This region has little to no blood flow. Tears in this area rarely heal on their own because the nutritional and oxygen requirements needed for healing do not reach the cells in the injured areas.
2. Size and Configuration of the Tear
Minor, stable meniscus tears may have the potential for healing over time in patients who receive good nonoperative care.
Significant, complex, or “flap” meniscus tears have a minimal chance of repairing themselves.
3. Age of the Patient(Individual)
In general, younger patients are considered more likely to have tears that may improve with conservative treatment. This is related to factors like increased vascularity and better cartilage metabolism. Older patients with degenerative meniscus tears are also less likely to notice healing of these tears.
4. Activity Level
In general, younger or athletic individuals are more likely to put prolonged pressure on the involved knee joint as a result of their activities and may continue these activities despite bracing or physical therapy.
Will an Untreated Meniscus Tear Heal?
Meniscus tears that are small, stable, and located in the peripheral “red” zone may heal spontaneously in an otherwise healthy individual. The chances of spontaneous healing or responsiveness to nonoperative measures increase in patients who are:
Meniscal Tear Nonoperative Treatment Options Include:
Activity Modification and Off-Loading Weight Bearing: patient education to avoid aggravating knee joint forces by twisting, squatting, climbing stairs, and running, etc.
Ice and Elevation: Rigid cords in the setting of significant stasis and effusion of tissue.
Knee Support: Either hinged knee braces or stretch-wrap elastic bandages for knee joint motion control could provide maximal static biomechanical stability during the acute phase.
Drug Therapy: Nonsteroidal anti-inflammatory drugs and analgesics.
Signs Your Meniscus Tear Won’t Heal on Its Own
Unfortunately, most meniscus tears do not heal on their own. This is due to limited blood supply, size of the tear, or characteristic features of the injury. Unattended, the tear may further enlarge over time and cause early onset of arthritis in the knee joint.
Signs of non-healing of the meniscus tear may include:
- Persistent knee pain not relieved by rest;
- Swelling that comes back again;
- The locking or catching sensation felt in the knee joint;
- Lost flexion or extension ability of the knee joint;
- Pain irritates sports or daily activities clearly.
Meniscal Tear: Options for Surgical Management
When failure of fetching treatment options is observed; for example, a bucket-handle tear or a tear going down to involve the popliteal cyst, then surgical intervention could be indicated. Dr. Akshay Shetty gives good arthroscopic surgical care, which is a minimally invasive procedure associated with quick recovery for patients.
Surgical treatment options include:
Meniscus Repair: This technique involves sewing the torn edges of the meniscus back together. Preservation of the remaining meniscus is vital and is commonly used for horizontal tears located in the red zone of the meniscus.
The Partial Meniscectomy: The goal here is to remove only the diseased portion of the meniscus while keeping all possible healthy areas of the meniscus intact.
Meniscus Transplantation is very rarely performed: This option is a last resort for patients with a significant degree of meniscal destruction, usually in younger ones without undesirable degenerative changes in the remainder of the cartilage, and not losing total knee function.
For that matter, the surgery is not definitely advised for aged persons with chronic meniscus tears, unless the patient has a very active life or shows persuasion for surgery. Patients with large tear sizes, like bucket handle tears, or complex tear classes are better candidates for surgical intervention.
Recovery and Rehabilitation
Whether conservative or operative treatments are decided upon, rehabilitation is a vital part of the recovery process.
Recovery without surgery and without post-surgical dysfunction: In general, takes about 4-8 weeks, requiring the constant active involvement of a physiotherapist, lifestyle changes to reduce the inflammation response, and avoidance of activities that provoke symptoms.
Recovery after surgery is from about 3-6 months, depending on the procedure; however, it is more about making actual progress through a structured physiotherapy program in those months so that good rehabilitation comes after the surgery.
Dr. Akshay Shetty emphasizes individualized rehab programs to help regain strength, flexible range of motion, and functional activity so the patient can return to their lifestyle in the safest and most efficient manner.
Insights shared by Dr. Akshay Shetty
As stated by Dr. Shetty, one of the common mistakes that a patient makes is waiting too long and trying to self-manage the injury, thinking it will heal with time and activity modification. While some meniscal tears may improve with time and modification, many do not and get worse with time and also could lead to arthritic changes in the joints and worsen outcomes regarding management of symptoms and joint preservation.
His treatment philosophy focuses on preserving the meniscus whenever possible, as it is vital for long-term knee health and prevention of arthritis.
Conclusion
Just as I said-there cannot be one right answer! Some minor tears of the outer meniscus may heal with rest and rehabilitation, but actual treatment from a highly trained professional is involved for many of them to get any long-term relief. Neglecting these kinds of symptoms may lead to some major chinks in the health of the knee and the development of chronic problems.
Suppose you have persistent knee pain with swelling or a problem locking the knee joint. In that case, it is advisable to consult Dr. Akshay Shetty, a joint replacement surgeon and sports medicine specialist in Bangalore. He provides diagnostic services and personalized treatment tailored to secure the best care for your knee health.
Leave a Reply