MENISCUS INJURY
What is the Meniscus?
The meniscus is a C shaped rubbery cartilage structure which acts as a cushion in your knee joint. There is an inner knee (medial) and outer knee (lateral) meniscus in both knees. The meniscus is made up of a network of collagen, proteoglycan, glycoproteins, and cellular elements which give it a dense but springy consistency.
Why does the Meniscus Tear?
The meniscus is largely made of collagen, the same substance that gives elasticity to your skin. Just like your skin hangs a little more loosely every year, your meniscus also loses elasticity and makes it more likely to tear. In addition, the meniscus is dependent on excellent blood flow either thru direct artery feeding or through diffusion. The standard American diet leads to impaired microvascular perfusion (blood flow) which can accelerate meniscal degeneration.
Can Meniscal injuries heal?
It depends on multiple factors including, extent and location of the tear, your general health and the health of your joint cartilage in the knee. Meniscal tears that are flipped, causing locking of your knee or prolonged swelling and severe pain are unlikely to heal on their own.
Do all Meniscus Tears require surgery?
No. Most meniscal tears do not require surgery. Extensive studies show that “non obstructive” meniscal tears do just as well on average with therapy as they do with surgery. We commonly combine excellent PT with PRP or stem cell injections to enhance healing and improve knee stability. We have on average a > 80% success rate.
References:
Effect of Early Surgery vs Physical Therapy on Knee Function Among Patients With Nonobstructive Meniscal Tears JAMA 2018
Arthroscopic partial meniscectomy versus physical therapy for traumatic meniscal tears in a young study population: a randomised controlled trial BJSM 2022
What are the risks of Meniscal Surgery?
Although meniscal surgeries are relatively low risk, the risks include bleeding, infection, nerve injury and limb loss. It is also concerning that meniscal surgeries accelerate osteoarthritis by up to 600%. The majority of “meniscal repairs” are not repairs, just removal of the torn portion of the meniscus and shaving down some of the cartilage on the end of the bone. This leads to bleeding and inflammation and loss of meniscal cushioning. In turn this leads to joint degeneration and progressive osteoarthritis. Many patients, especially those over the age of 40 end up with short term pain relief after surgery but quickly find themselves in a state of chronic, progressive osteoarthritis pain. For this reason we advocate against meniscal surgery unless absolutely necessary.
What do we recommend for Meniscal tears?
It is essential that the “cause” of your pain be determined 100%. Many people have meniscal tears on MRI and no pain, so seeing a meniscal tear on an MRI does not mean you need surgery. You want to be sure that the meniscus is your real problem. If a careful history and exam find the meniscus is your primary problem then we usually start with excellent knee stability PT in conjunction with a nutritional intervention to reduce inflammation and improve blood flow to the meniscus. If pain persists we advance to Prolotherapy, PRP and Stem Cell injections combined with a PT protocol and possible short term bracing.
If you want to learn more and find out if you are a candidate for Biologic injections for your meniscal tear then click HERE to schedule a Teleconsult with Dr Esser.