A meniscus tear is one of the most common knee injuries seen in athletes, particularly those involved in contact sports. Often cause by a sudden bend or twist in the knee, it is the result of damage to the cartilage which cushions and stablises the knee joint. A meniscus injury can be characterised by stiffness, swelling, pain and a catching or locking sensation in the damaged knee which makes it difficult for your knee to perform its full range of motion.
When the shock absorbing cartilages of the knee (meniscus) have been torn in a particular direction and location, they may be suitable for meniscal suturing or repair. This can usually be performed through the keyhole technique without need for larger incisions, and often as a “walk in – walk out” day surgery procedure.
What is Meniscal Cartilage and What Does it Do?
Meniscal cartilage, also known as meniscus, are two shock absorbing c-shaped disks of cartilage which sit between the two main bones of the knee (femur, tibia). They are semi-mobile and are referred to as the medial meniscus on the inner aspect of the knee and lateral meniscus on the outer aspect of the knee. Shielding the underlying bone, the meniscal cartilage provides structural integrity and protection to the knee.
When functioning normally, they help protect the articular cartilage on the end of the femur and tibia from wear and tear, aid with stability of the knee and circulation of the knees protective lubricant, synovial fluid. Because of their shock absorbing role and their mobility they are susceptible to tearing with trauma. The pattern of meniscal tearing is often influenced by the type of trauma, the quality of the meniscal cartilage, the stability of the knee and the patient’s age.
Common Meniscal Tear Patterns
There are varying types of meniscal tears which describe the shape and structure of the injury. Identifying the type of tear is very important in helping the medical staff to achieve success through meniscal repair, plan the surgical procedure and recovery process and minimise the extent of damage to the surrounds of the meniscus.
The most common tear patterns include – radial, parrot beak, bucket handle and horizontal cleavage tears. Below is a summary of each tear type:
- Radial – A sharp split which usually occurs on the inner side of the meniscus and can often run part way or almost completely through the meniscus, which divides it into two.
- Parrot Beak – When a smaller radial tear grows and becomes a complete tear through the meniscus, it will often open up and appear as though a section is missing entirely. This is called a parrot beak tear and is often the result of a traumatic event or repetitive and forceful activities.
- Bucket Handle – This is a complete tear that occurs in the centre of the meniscus, running parallel to the contour and never touches the outer or inner rim of the meniscus.
- Horizontal Cleavage – This starts deep in the meniscus and divides the meniscus into a top and bottom section. This type of tear can easily become a complex issue if left untreated.
Good quality medical staff will take the time to explain your particular tear pattern, what causes that particular tear and the best process for surgery and healing. Whilst it is preferable in ideal situations to keep all the torn or damaged meniscus, there are many instances where this is not possible. The reason for this varies from case to case – some tears have inadequate tissue to allow for stitching back together (suturing), while others might have a tear pattern with excessive mechanical compromise or insufficient blood supply to allow for healing. In any case, your orthopaedic surgeon will explain the necessary course of action and what you can expect in terms of recovery and mobility of the knee in the future.
Factors Influencing Healing & Recovery Time
There are a number of factors which can influence the healing and recovery time from a meniscal tear. These factors include; the blood supply to the tear area (more blood flow means more likely to heal), the time from injury (sooner is favourable), age of the patient (younger is favourable), pattern of tear including direction (longitudinal in a front-back orientation or “bucket handle” is favourable) and stability of the knee (having a stable knee with intact or reconstructed ligaments is favourable). Good quality MRI scans will usually allow for accurate determination of the pattern and location of meniscal tearing, to help decide the likelihood of being suitable for meniscal repair.
How is Meniscal Repair Surgery Performed?
Meniscal repairs can almost always be achieved using “keyhole” techniques, without the need for any large incisions. The procedure begins by pumping fluid into the knee in order to improve visualisation and expand the joint space. The damaged surface on the meniscus and surrounding areas are then roughened around the edges to stimulate blood flow and the natural healing response. Depending on the size and location of the tear(s), between two and six sliding sutures (stitches) are inserted into the torn edges of the meniscus to pull the tear together, ready for the healing process to begin. The stability of the stitches is confirmed with medical tools before any excess debris in the knee is removed. The liquid is removed from the knee, enabling the meniscus to return to its position against the capsule.
Testing and Recovery
Once meniscal repair surgery has taken place, the meniscus are tested by pulling across the tear with a medical probe to assess its structural integrity. At this point, the most suitable rehabilitation program to ensure optimum recovery is decided by the surgeon and discussed with you. Physiotherapy after meniscal repair surgery is often a recommended course of action, which your surgeon can discuss with you and recommend a known physiotherapist.
The total recovery time can range from patient to patient, however the average recovery period is 4-6 weeks. During this time, you’ll be required to gradually increase the range of motion to your knee through daily exercises. It is likely that you’ll be wearing a hinged brace and using crutches during this recovery time to ensure the knee is fully protected.
Depending upon the individual meniscal tear and patient circumstances a further period of conditioning including strengthening and progressive load bearing from low to high impact is recommended before resuming more vigorous activities including competitive sports.
For more information about meniscal repair, expert advice, or to organise repair of your meniscal tear or injury make an appointment today.