Snap, Crackle, Pop

One of the most common knee injuries facing active people are traumas to the meniscus, which is often collectively called “torn cartilage”. The meniscus is a piece of cartilage that helps to support and absorb impact to the bones of the patella-femoral joint and it serves to help provide a near friction-less surface that allows uninhibited  motion to occur at the knee.

The location of the injury and the type of tear to the meniscus plays the largest role in the return to activity, both with surgical and non surgical cases.  Most tears that occur on the outer edge of the meniscus have a relatively sufficient blood supply and may heal on their own. However the further the tear is from the outside blood vessels, the less probably that it will heal on its own.  Depending on the type of tear (visual examples of the types of tears can be found here) people can have  varying degrees of pain. The pain may be present with all activity or only with certain movements. The general rule is that if it is affecting your quality of life and has not resolved on its own in a reasonable amount of time, surgery may be your best option.

Typically with surgery, small holes are made on the outside of the knee to allow small scopes and instruments to pass into the joint from the outside. The doctor will visualize the meniscus and make their judgment from there. Sometimes the best plan is to debride (remove) the part that is torn. Sometimes sutures (stitches) are placed in the meniscus, sewing it back together.  And in the most significant cases, holes are drilled through the meniscus and into the bone, bringing new blood to the area to help it heal itself. While most meniscus surgeries are rather painless and allow you to return to full activity in just a few weeks, procedures requiring drilling can take longer to heal and cause more pain after the surgery.

The initial rehab goals after surgery are to decrease pain and inflammation and to increase range of motion. This is a balance, because increasing your range of motion too soon will cause an increase in pain and inflammation. Your certified athletic trainer or physical therapist will use evidence based practice when rehabilitating you post injury and will progress you through several benchmarks before allowing you to return to full activity. Once cleared by your surgeon, you will be allowed to return to all activities that you enjoyed prior to surgery with no restrictions as long as you’re are functionally able. Most people do great with this surgery and will have many more years of activity ahead of them!

Websites of interest:

http://orthoinfo.aaos.org/topic.cfm?topic=a00358

http://meniscustears.net/

http://www.medicinenet.com/torn_meniscus/article.htm

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