Meniscus Tear

Meniscal tears are among the most common knee injuries. They occur not only in young athletes, but also in older individuals with a reduced range of motion. The medial (inner) meniscus is much more prone to tearing than the lateral (outer) meniscus.

Causes / Symptoms

A variety of different circumstances can lead to tearing of the meniscus. Forceful twisting of the knee is a common mechanism of injury.
However, tearing sometimes occurs when a person is simply standing up from a squatting position.

The main symptom is a sharp shooting pain in the knee, which may be accompanied by "locking" of the knee. Extensive swelling of the knee is common. The pain generally occurs during knee activity, e.g. when climbing stairs or bending the knees. However, the pain symptoms sometimes start at night when a person is resting (e.g. lying in bed) and can be very annoying.
Meniscus tears can also develop gradually due to degenerative changes in the knee without a sudden event or accident occurring. This often begins after the onset of arthritis in the knee.

The main symptom in these cases is diffuse pain that generally begins during weight bearing.

However, sudden sharp pain is possible, as is locking of the affected knee, albeit less frequent.

Treatment

If you suspect that you have a torn meniscus, consult your primary care physician first.

Your doctor will be able to decide whether it is sufficient for you to rest the knee for a while and take medications to reduce the pain or whether your knee should be evaluated by an orthopaedic specialist.
If necessary, your doctor will give you a referral to the OZM orthopaedic clinic.
An orthopaedic specialist at OZM will ask you to describe how the pain started and will then perform a thorough examination of the knee. In many cases, an X-ray will be obtained.

If the specialist suspects that you have a torn meniscus, magnetic resonance imaging (MRI) of the knee will be performed in order to establish the definitive diagnosis. Based on the MRI scans, the specialist can determine precisely which anatomic structures are damaged and the exact type and nature of the injury or injuries.
If the suspicion of a meniscus tear is confirmed, we generally recommend arthroscopic surgery for removal of the injured portion of the meniscus.

Surgical Planning / Preparation

First, you will be given an appointment for arthroscopic surgery. You should arrive at the clinic in Münsingen in the morning of the appointed day.

The arthroscopy procedure will be performed during the course of that day.

Once the anaesthesia has worn off, you will be permitted to walk on crutches. If this causes no problems, you will be discharged home on the same day. If not, you will be required to stay in the hospital overnight.

Anaesthesia

Knee arthroscopy is generally performed under spinal anaesthesia. The advantage of spinal anaesthesia is that it allows the patient to follow the events happening in the operating room. If you like, you can also watch the orthopaedic surgeon perform the arthroscopic surgery. If you would prefer to sleep during surgery, the anaesthesiologist can give you a mild sleep medication in addition to the spinal anaesthesia.
Your anaesthesiologist will meet with you before the surgery to discuss all of this in advance. You can naturally let the anaesthesiologist know your preferences at that time.

Arthroscopic Surgery for Meniscus Repair

In arthroscopic surgery for meniscus repair, an arthroscopic camera and instruments are inserted into the joint space through two small incisions in the knee. This allows a full inspection of the interior joint space.

Once the torn part of the meniscus is located, it is examined using a surgical hook. The loose and torn parts of the meniscus are then removed using an instrument that is a cross between scissors and a tissue punch. The serrated edges are then smoothed using a rotating burr to smooth the cartilage surface and remove the particles through suction.

If the meniscus tear is located near the joint capsule, then another procedure called meniscus repair may be performed. In that case, the torn cartilage is not removed, but repaired by suturing the torn edges of the meniscus back together. The disadvantage of meniscus repair is that a longer recovery period is required before weight bearing is permitted (see below).

Postoperative Care

For the first 5 days after arthroscopic surgery, you should use crutches to reduce pressure and weight bearing on the knee. After that, you can walk normally. You may still feel some pain during weight bearing (walking) during the postoperative period. This is completely normal, and the pain should go away within a few days or weeks.
However, if the surgeon had to perform a meniscus repair with sutures, you must stay on crutches for 6 weeks after surgery. Full weight bearing is not permitted until the okay is given by the specialist when you return to OZM for the postoperative check-up.

Physiotherapy is a central element of postoperative care after knee arthroscopy. During physiotherapy, you will perform special exercises to strengthen the muscles that support and move the knee. The better you train the muscles, the fewer problems you will have during knee function.