What is it?
The meniscus is a cartilage in the knee that acts as a shock absorber for the knee joint. There are two menisci in the knee, one on the inner aspect of the knee (medial) and one on the outer aspect of the knee (lateral). Meniscus tears can happen with an acute twisting knee injury, especially in younger athletes. Athletes may also have degenerative tears, which can happen over time. Degenerative tears can start to occur as early as in the mid-thirties and might occur without any known injury.  Meniscus tears can happen by themselves or with other acute injuries of the knee such as ligament tears.

Symptoms
Symptoms of meniscus tears may include:

• Pain
• Swelling                                            
• Locking or catching of the knee with movement
• Difficulty with squatting
• Knee stiffness

Sports Medicine Evaluation and Treatment
A sports medicine physician will review symptoms, and push along the inside and outside of the knee for areas of tenderness. He/she will also move the knee around in several ways that may cause pain. He/she may also order x-rays to look for any acute or wear-and-tear damage to the knee. Depending on the results of the above evaluation, the physician may order a magnetic resonance imaging (MRI) scan of the knee to look at the knee structures more clearly.

Treatment of the meniscus tear will depend on many factors, including the age of the athlete, timing of the injury, and whether there are any locking or catching symptoms.

Treatment options include:

• Applying ice to the knee for 20-30 minutes, 3-4 times a day
• Anti-inflammatory medications such as ibuprofen or naproxen
• Use of an elastic bandage or other knee brace
• Injection (especially for degenerative tears)
• Physical therapy
• Arthroscopic surgery to shave out damaged meniscus (shorter recovery time) or repair of the damaged meniscus (longer recovery time)

Injury Prevention
Unfortunately, many meniscus tears happen acutely during sports or accidents and are not preventable. Some ways to avoid getting meniscus tears include keeping the core (abdomen and back) muscles and lower extremities flexible and strong.

Return to Play
If treated without surgery or just by shaving out the damaged part of the meniscus, return to activity is usually possible in about four weeks, after progressing through a rehabilitation program. If surgery is needed to repair the meniscus by stitching the tear together, return to full sporting activity is usually longer.

AMSSM Member Author: Jeffrey Bytomski, DO

References

Giuliani JR, Burns TC, Svoboda SJ, Cameron KL, Owens BD. Treatment of meniscal injuries in young athletes. J Knee Surg. 2011 Jun;24(2):93-100.

Sihvonen R, Paavola M, Malmivaara A, Itälä A, Joukainen A, Nurmi H, et al. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med. Dec 26 2013;369(26):2515-24