Meniscus Tears Treatment Options

Physical Therapy

Physical therapy is often the initial step for meniscus tear management. This is particularly applicable to older individuals, those with minor stable tears, or those who cannot or choose not to undergo surgical intervention. The core of physical therapy involves a regimen of exercises designed to enhance the strength and flexibility of the knee and leg muscles, thereby providing stability and relieving pressure from the meniscus. Key areas of focus during therapy include targeted strength training, range of motion exercises, balance training, and proprioception exercises. It is paramount that patients minimize activities that provoke knee pain, such as deep squatting, heavy lifting, and extended periods of kneeling. Each of these activities can generate excessive stress on the meniscus. A key aspect of nonoperative management is weight management – maintaining a healthy weight is crucial as excessive weight can impart additional strain on the knee joint.

Bracing or Bandaging

Specific types of knee braces, such as unloader or offloader braces, can be beneficial in the management of meniscal tears. These are designed to shift the load away from the portion of the knee affected by the meniscus tear, thereby granting the tear an opportunity to heal. Knee sleeves, on the other hand, offer mild compression which can help reduce swelling, offer stability and provide proprioceptive feedback, helping the brain better manage joint positioning and movement.

Injections

Injections are utilized to provide temporary relief from inflammation and pain. Corticosteroid injections are potent anti-inflammatory medications that can rapidly decrease inflammation and pain. Hyaluronic acid injections are designed to replenish some of the knee’s natural joint fluid, thereby enhancing lubrication and reducing pain. A newer treatment modality, Platelet-Rich Plasma (PRP) injections, leverage the body’s healing mechanism to stimulate healing within the meniscus. However, the clinical effectiveness of PRP is still under scrutiny. Nonoperative treatments often enjoy good success in alleviating symptoms, although the degree of success can vary substantially from person to person.

Meniscus Repair

Preservation of the native meniscal tissue is the mainstay of meniscus repair. This is particularly pertinent in younger, active individuals and those presenting with specific types of tears that occur in the “red zone” of the meniscus where a rich blood supply can foster healing. These tears may include longitudinal, bucket handle, or flap tears. The procedure is usually performed arthroscopically, where small instruments are introduced into the knee joint via small incisions. After the surgery, the knee is often protected with a brace for 4-6 weeks to guard the repair and permit healing. Patients then undertake physical therapy to restore strength and mobility. The overall success rate for meniscus repair is high, with about 85-90% of patients experiencing relief from their preoperative symptoms.

Partial Meniscectomy

Partial meniscectomy involves the surgical removal of the unstable portion of the meniscus while preserving as much of the healthy tissue as possible. Indications for a meniscectomy commonly include older individuals, those with degenerative or complex tears in the poorly vascularized “white zone”, or those with persistent symptoms despite nonoperative treatment. This procedure can be performed arthroscopically. After surgery, patients often start weight-bearing and range of motion exercises almost immediately. The success of this procedure in terms of symptom relief is high, but it’s important to note that partial meniscectomy may increase the risk of developing osteoarthritis in the long term.

Meniscal Transplant

In a meniscal transplant, a meniscus from a donor (allograft) is inserted into the patient’s knee. This procedure is typically reserved for younger patients who have had a previous total meniscectomy and are experiencing ongoing symptoms but do not yet have severe arthritis. The transplant can be performed arthroscopically or via a small incision. Following a meniscal transplant, the knee is often protected with a brace and crutches for 4-6 weeks to allow the graft to heal.

Each treatment option for a meniscus tear carries its own unique set of advantages and challenges, with the most suitable option dependent on a variety of factors such as the type and location of the tear, patient age, activity level, and overall knee health.

Surgery is often recommended for patients who have persistent symptoms despite conservative treatment, or those with demanding physical requirements, like athletes. The timing of surgery depends on the individual’s circumstances and the nature of the tear. Acute tears, especially in younger patients or athletes, or those that are blocking motion, may require expedited surgery to maximize outcomes.