Summary. Inside-out meniscus repair is a versatile, cost-effective technique that remains the gold standard for management of most meniscus tear patterns. Through a thoughtful approach, efficient suture retrieval and repair can be performed while protecting critical neurovascular structures.
Magnetic resonance imaging is the gold standard, first choice for investigation of suspected meniscal tears.
A McMurray test is usually one of the first steps your provider will use to diagnose a torn meniscus in your knee.
The Apley grind test, also known as the Apley compression test or the Apley test, is a maneuver performed to evaluate meniscus injury. Clinicians usually perform it in conjunction with the Apley distraction test, which assesses for ligamentous injury.
Stem-Cell Therapy
Researchers have been developing stem-cell therapies that may help heal the injured tissue. During treatment, stem cells from your own body or some other source are injected into the injured knee area, where they grow, differentiate and assist with the healing of the meniscus.
Physical Therapy
Strengthening the thigh and leg muscles and stretching the knee, thigh, and leg can help to restore the full range of motion to the knee. Low-impact exercises such as stationary biking may reduce your level of pain, improve mobility, and restore function to the area around the meniscus tear.
Meniscus tears are the most frequently treated knee injuries. Recovery will take about 6 to 8 weeks if your meniscus tear is treated conservatively, without surgery. If your symptoms persist after 3 months or your symptoms become significant, your doctor may recommend surgery to repair the tear.
The injury won't heal on its own, which means it may continue getting worse without proper care. For example, a partial tear may continue to worsen until it's a complete tear. Continuing to walk on the affected leg can aggravate your symptoms, making pain and stiffness worse in as little as a few days.
You will have a physical examination to find out if you have a torn meniscus and to rule out other knee injuries. Your doctor will check both knees for tenderness, range of motion, and knee stability. X-rays are usually done. Based on your symptoms and the physical examination, your doctor may diagnose a meniscus tear.
The pain may come and go over a period of years if the tear isn't treated. Larger tears usually cause more pain and immediate swelling and stiffness. Pieces of the torn meniscus can float into the joint space. This can make the knee catch, pop, or lock.
Meniscus tears, indicated by MRI, are classified in three grades. Grades 1 and 2 are not considered serious. They may not even be apparent with an arthroscopic examination. Grade 3 is a true meniscus tear and an arthroscope is close to 100 percent accurate in diagnosing this tear.
MRI scans allow for deeper viewing of the soft tissues in the knee joint, which can be integral in determining the location and severity of the tear. It will also indicate how much excess fluid is in the knee and whether or not any torn piece of the meniscus has lodged within the joint itself.
Knee arthroscopy is considered the gold standard for detecting meniscal tears.
During a Thessaly test, you'll stand on one leg with and turn side-to-side while your provider supports your arms. If you need a McMurray test, you'll lie on your back while your provider bends and moves your knee. In both tests, your provider is feeling and listening for symptoms of a torn meniscus in your knee.
There are three basic MR characteristics/criteria of meniscal tears 5: high intrameniscal signal extending to at least one articular surface, which should be seen in at least two slices: two slice touch rule (do not have to be contiguous, e.g. sagittal and coronal slices)
Although knee braces do not heal or treat your meniscus tear directly, they can provide extra support and stability for your knee while your meniscus injury heals. A good brace will protect your knee and take the pressure off your meniscus, allowing it to rest.
Management and Treatment
RICE stands for rest, ice, compression and elevation. Rest: Keep your weight off the injured knee as much as possible. Ice: Place an ice pack on your knee for about 20 minutes, several times a day. Compression: Wrap your knee with a compression bandage to help reduce swelling.
Ordinarily, your doctor or physical therapist will ask you to reduce your sports activities while your meniscus tear heals. Healing could take between four and eight weeks. However, the time depends on the severity and position of the tear.
The patient should avoid pivoting and squatting and should work on keeping the quadriceps muscles strong. If the swelling and pain have not resolved in 6 weeks, they usually won't without surgical intervention.
Most meniscus injuries get better with conservative treatment (such as physiotherapy) and in very few instances has surgery been found to provide superior outcomes both in the short and long term.
Avoid activities that aggravate your knee pain, especially any activity that causes you to twist, rotate or pivot your knee. If your pain is severe, using crutches can take pressure off your knee and promote healing.
A meniscus tear interferes with the normal movement of the knee, and without treatment, you can wind up with serious, lifelong problems.
“You can live with a meniscus tear,” Dr. Parker says. “And it may heal on its own, or just not cause you problems.” However, you'll know pretty quickly when it is a problem.