Do I need a surgery for my meniscus tear? Take it nice and Knee-sy

It’s spring. Sunday morning. You’re up before the kids and are gearing up to go for a morning run just in time to catch the sun come up over the horizon. Your running gear is on, you head downstairs to put on your shoes and head out the door. As you take to the pavement, each stride is like a “thank-you” that you give to your body – your knees in particular – for supporting you all these years. As you carry on, the narrative shifts, and the “thank-you” turns to “oh wait…I remember” as you fondly recall the early days of your weekend-warrior career, and the nagging knee pain that has plagued you since as-long as you can recall. You’ve heard that knee pain is often helped with surgery. You know plenty of teens and adults who have had knee issues during sports, and even more-so during their regular day-to-day. Getting in and out of the car. Walking up and down the stairs. Kneeling down to play with the kids. You know that some people have knee pain for what seems to be no reason at all, and some people that have had surgery after surgery to try and fix a revolving door of injuries. What do you need to do to help with your pain so you can take up the mantle of ultimate weekend warrior once more? What is it that’s causing your pain? Is it my meniscus? Do I need surgery? We’ll explore those questions below.

Anatomy Of the Knee

“Meniscus” is a term not often employed in our daily vocabulary. To some, meniscus is a term used simply to describe a smooth curved surface. In the context of our human anatomy, the meniscus is a C-Shaped tissue between your femur (thigh bone) and your tibia (shin bone). It provides a shock-absorbing cushion within the knee joint that ensures optimal dispersion of force through the knee when you weight-bear, and ensures congruence of the surfaces of the joint as you move throughout your daily life. Each knee as had medial (inner side) meniscus, and a lateral (outer side) meniscus. The meniscus is composed of water, collagen, proteins, and other cellular elements.

Meniscus injuries

Because the meniscus provides a smooth surface on which the femur and tibia can move interact with one another, injuries to the meniscus often involve a disruption in the continuity of the cartilaginous surface, and will often present with symptoms consistent with irregularities within the joint. Symptoms associated with meniscus-related pathology will often include popping, clicking, giving-out, and sometimes locking. These symptoms can often be either painful or non-painful. Additionally, injury to the meniscus can be brought on through a defined moment of injury (such as a fall, a twist, or a sudden impact), or as a result of long-term wear-and-tear. Often, the degree of injury to the meniscus (whether through traumatic or atraumatic means) taken in consideration with the amount of dysfunction experienced by the individual dealing with the injury, will determine the type of treatment interventions that will be most suitable in management of the injury. Fortunately, tears in the outer 1/3 of the meniscus have healing potential because there is blood flow to these areas. Generally, tears in the inner 2/3 do not heal as well due to poor circulation.

Does My Meniscus Injury Need Surgery?

The answer to this question is simultaneously simple yet complex. While everyone’s injuries, needs, and goals are very different, there are some general rules-of-thumb that can be applied when considering whether or not to purse a surgery as a means of managing meniscal injuries. The fact of the matter is that all meniscus tears do not require surgery. Surgery may be indicated if some of the symptoms mentioned above (such as locking) are present. Otherwise, it is often recommended that conservative (non-operative) management should be tried first. This includes physical therapy, the use of anti-inflammatories, and, in some cases, injections. If a consistent and regimented bout of conservative treatment has been trialled, and symptoms continue, then you may be a candidate for surgery. The good news is that the research has shown promising evidence for the use of physical therapy management in the treatment of meniscus-related injuries. Ericsson et. Al (2009), found that “functional exercise training was well tolerated and improved functional performance…in middle?aged subjects with a previous degenerative meniscal injury and partial meniscectomy.”

Which Exercise Should I do?

In order to determine which exercise is best for you, a detailed assessment with your physical therapist will be needed. As there are many components of movement that can contribute to determining how our knee is used throughout the day, determining which of these components needs work is critical. Thankfully, our team at Leading Edge is highly skilled in performing these assessments, and we’re equipped with state-of-the-art tools and technology to carry out every part of your strengthening and treatment program. Generally, exercises that encourage knee mobility, motor control, and strength can help to reduce pain and improve function. In the initial phases of rehab, pain may be a limiting factor in completing as much exercise as one may feel they’re capable of doing. Technology such as our swim-ex pool, and our ALTER-G treadmills help to navigate these challenges by providing supportive environments in which one can strengthen and exercise more-so than typically able without their support. Additionally, our sport performance center boasts access to one-on-one personal training services delivered in collaboration with our physical therapy team to ensure that all rehabilitative needs are considered for the duration of the strengthening and re-training process. For those knees that have progressed to develop degenerative arthritis in the form of osteoarthritis, our GLA:d program can be extremely effective.

For more information on this very topic, feel free to check out Grant Fedoruk’s blog about his very own torn meniscus!

Guest contribution with thanks to our one and only:

Colin James, MScPT

https://onlinelibrary.wiley.com/doi/full/10.1111/j.1600-0838.2008.00794.x (Ericsson et. Al 2009)