Dr. Cunningham is a knee surgeon at Vail Summit Orthopaedics & Neurosurgery. He is an expert at diagnosing and treating meniscus tears for patients. The knee is the largest joint in the body. It is designed to bear the full weight of the body and absorb the impact of all weight bearing activities, from simple walking to cutting and pivoting in high impact sports.
Even more impressive, the knee is capable of absorbing the impact of up to five times the body’s weight. That represents nearly half a ton for the average US adult. As such, any injury to this vital joint requires expert care. Richard Cunningham, MD Vail, CO knee surgeon has the expertise to diagnose and treat meniscus tears.
What is a Meniscus Tear?
A meniscus tear is one of the most common knee injuries. The medial meniscus sits between the thigh bone and the shin bone on the inner side of the knee, while the lateral meniscus sits on the outside of the knee. The medial and lateral meniscus are made of a tough, rubbery cartilage that is designed to absorb impact and assist with fluid motion within the knee joint. With no menisci, the femur and tibia would rub together and then the coating cartilage layer on the ends of these bones would quickly wear away.
Top 3 Risk Factors for a Meniscus Tear
- Age: Wear and tear over time causes degeneration of the knee complex, increasing the risk of a meniscus tear. This is the most common cause of meniscus tears.
- Obesity: Carrying excess weight overly stresses the knee joint and menisci, creating vulnerability to knee injuries including a meniscus tear.
- Sports injury: A meniscus can tear due to a traumatic event particularly when ligaments such as the ACL also tear.
Sports injury to the meniscus occurs in several types of events. These include:
- Quick Force – This can happen unexpectedly in sports activity. An example is the common ski injury of colliding with an object, forcing the knee to flex out of range, resulting in a tear.
- Over Rotation – Planting the foot away from the path of motion, or an aggressive change of direction, ie, cutting, can result in a tear. Downhill skiing is an example.
- Unstable Footing – Uneven, slippery, loose surface material can set up a disproportionate force on the knees, causing tear injury. Mountain trail running is an example.
- Impact – A blow to the front or side of the knee – one of the most common events that can cause meniscal tear. Mountain biking falls, especially onto the side of the knee, is an example.
Symptoms of a Meniscus Tear
The symptoms of a torn meniscus can vary depending if the tear is an acute tear occurring in a sports injury or a degenerative tear occurring in an older person.
With an acute injury causing a meniscus tear in a younger patient typically involves:
- A sudden injury often with feeling a pop in the knee
- Immediate and severe pain
- Stiffness and a small amount of swelling in the knee
- Limited range of motion and weakness
- Feeling of locking or catching in the knee during knee movement
- Often other associated ligament tears (ie. ACL tears) causing knee instability and further pain
In contrast, with a degenerative meniscus tear in an older patient there is typically:
- Minimal trauma but often a pop or catch felt in the knee
- Moderate pain
- Minimal swelling
- Pain when squatting or stair climbing or changing directions when walking
- Bending or straightening of knee can be limited
- Catching or locking of knee joint
A meniscus tear is an injury requiring orthopedic attention. Richard Cunningham, MD, a knee surgeon in Vail, CO who can diagnose and treat patients with a meniscus tear.
Diagnosis of a Meniscus Tear
The diagnosis of a torn meniscus begins with a thorough patient history and physical examination by an orthopedic knee surgeon. The details of any injury– if known – will help inform the diagnosis. Tenderness over the meniscus at the joint line suggests a tear. A provocative test called a McMurray test can further indicate a torn meniscus.
An xray and MRI is usually required to confirm the diagnosis. An X-ray is used to rule out any arthritis or abnormalities to the bones of the knee joint. A magnetic resonance imaging (MRI) of the knee can provide information about the soft tissue of the knee joint. The knee joint coating cartilage, tendons, meniscus, and muscle can be evaluated for any fraying or partial or complete tears. An MRI can also help determine the presence of other abnormalities within the knee joint.
Non-Surgical Treatments for a Meniscus Injury
Not all patients with a meniscus tear require surgery. In older adults who have a degenerative meniscus tear, but who are minimally symptomatic, surgery is not recommended. Older adults with moderate to severe knee arthritis often have associated degenerative meniscus tears. In these patients, arthritis is typically the main source of pain, not the meniscus tear. Given this, surgery is not typically recommended but rather non-surgical treatments can help control the pain and swelling due to the arthritis.
Nonsurgical treatments for a degenerative meniscus tear not needing surgery are:
- Resting the knee and limiting activities for a period of time
- A knee compression sleeve
- Ice therapy
- Anti-inflammatory medications
- Physical therapy for restoring full range of motion, strength, and knee biomechanics.
- Possibly injection therapy
Surgical Treatments for a Meniscus Tear
Some older patients with degenerative tears, particularly those with large, displaced flaps of meniscus may come to an arthroscopic surgery as long as there is not severe arthritis in the knee. In surgery, the torn flaps of meniscus that are catching are trimmed away. These flaps will not heal if they were sewn together as there is no blood supply to them. These meniscus flaps are also no longer serving as a shock absorber cartilage in the knee and are simply causing pain. These patients can expect to be fully recovered in 4-6 weeks from surgery.
Sports patient injuries, especially younger patients with acute meniscus tears, are best treated surgically. Without surgery, the meniscus will not usually heal, and if a patient waits too long, the tear can progress, and the tissue then becomes more complexly torn until it is no longer amenable to repair and instead has to eventually be removed.
The outer third of the meniscus is called “the red zone.” This area has blood supply and the meniscus can heal if sutured together. The inner two thirds of the meniscus is called “the white zone.” This area has no blood supply and will not heal, even if sutured together. For tears in the red zone of the meniscus, Dr Cunningham always recommends meniscus repair, so that the entire meniscus can be preserved with no meniscus being removed. Removing a significant portion of the meniscus in a young person will predispose the patient to developing early arthritis in the knee.
Dr. Cunningham performs meniscus repairs arthroscopically. Several small incisions are made around the knee and an arthroscope is introduced. Specialized instruments are used to place sutures across the meniscus in order to hold the tissue together so the meniscus can heal. Following surgery, patients go home the same day. They are placed in a knee brace and for most repairs, they are allowed to fully weight bear on the knee as long as the knee is held straight in a brace. When there is no body weight being applied to the knee, the knee can be moved through a full range of motion. Patients are otherwise going to physical therapy. Full recovery following meniscus repair surgery can take 3 – 4 months.
Dr. Cunningham is a knee surgeon at Vail Summit Orthopaedics & Neurosurgery. He is an expert at diagnosing and treating meniscus tears for patients in Vail, Summit County, Aspen, and Denver, CO. Contact Dr. Cunningham’s team today.