Dr. Epstein: Hi, my name is Dr. David Epstein. I specialize in both sports medicine as well as foot and ankle surgery here at Tri-County Orthopedics.
The meniscus is a cushion of cartilage that exists between the femur bone and the tibia bone that provides a shock absorbing function within the knee joint. There's typically two menisci one on the inside part of the knee as well as one on the outside part of the knee.
One of the most common injuries to the meniscus is a meniscal tear where the shock absorbers or cushions of cartilage are torn. There are many different kinds of tears of meniscus depending on the mechanism of injury.
Typically, your physician will use both clinical exam as well as a patient history in order to make the initial diagnosis. This typically involves a range of motion assessment along with palpation along the knee joint line. Classically, meniscal tears present with tenderness along the medial or lateral joint line which overlies the meniscus.
Conservative treatment options for meniscal tears are similar to a lot of orthopedic injuries where we employ rest, ice, compression, and elevation of the extremity. Oftentimes, you still can weight bear on the affected extremity even with a significant meniscus tear.
We will often employ a period of rest and avoid high impact physical activity. We will have you ice the knee for a period of time along with provide you with a compressive bandage for the knee. In addition, a brief course of physical therapy may be very helpful in order to increase your range of motion, decrease pain and swelling. Additionally, an anti-inflammatory or non-steroidal anti-inflammatory or NSAID can be helpful in terms of decreasing inflammation and pain throughout your rehabilitation process.
Typically, when surgery is needed for meniscal injuries we do perform this via a minimally invasive or arthroscopic technique. This is done through two small surgical incisions where an arthroscope or camera is placed into the knee so we can visualize the tear. We then use the other portal as a working portal to use certain instruments that actually remove the torn meniscus tissue. In certain cases we are able to perform meniscal repair depending on both the size and the location of the tear.
After an arthroscopic procedure to treat the torn meniscus patients are typically able to weight bear on the affected extremity with crutches or a cane. In the immediate postoperative period I will have patients work on range of motion as well as apply compressive bandages to the knee to help with swelling after surgery. Lastly, we do employ an oral anti-inflammatory and pain medication after surgery.
Typically, at two days after surgery the surgical bandage is removed and patients are asked to keep their surgical incisions dry. At seven to ten days after surgery the patient does return to our office to have the sutures removed, and at that point typically is enrolled in a formal physical therapy program to work on range of motion, decrease swelling, and increase strength.