Do I Have Knee Arthritis or a Meniscus Tear?
The meniscus is the cartilage between the bones of the knee and it’s very common to tear those.
When people tear it, they usually have swelling or pain in the knee. The pain is typically worse with squatting or twisting the leg.
The big thing to differentiate meniscus tears from arthritis is that arthritis pain is typically in the front of the knee whereas a meniscus tear is typically on the side of the knee.
The meniscus tear could be on the inside or the outside. There’s two different meniscus tears that you can get:
- Medial meniscus on the inside or,
- Lateral meniscus on the outside.
Patients typically have a twisting injury, but in almost half of the cases that I treat, people don’t know how they injured their knee and how the meniscus came to be torn; it happened just from daily activities.
And when it bothers them, a lot of times, it affects their ability to get up to a standing position and they can’t squat up and down. That’s typically how a meniscus tear presents itself.
How Meniscus Tears Happen in Young People vs Older Patients
This can happen in teenagers. For example, a girl I just saw in the office doesn’t remember exactly hurting her knee, but she had a very big lateral meniscus tear that we were able to see on the MRI and now she’s going to have surgery for it.
Older patients may just wear through part of the meniscus rather than a twisting injury, which is more common in the younger people.
And older people even with the meniscus tear don’t necessarily need surgery. But more common than not, younger people do need surgery for a tear.
Meniscus Tears From Everyday Activities, Not Warming Up, and Sports
People can tear their meniscus by twisting the knee or doing more activity than they are used to usually doing.
But sometimes it just happens spontaneously just from a part of the meniscus being weak and tearing through.
Or, maybe you haven’t been exercising and pushed yourself too hard.
If someone does too much too soon and they haven’t really warmed up and stretched out, they are more likely to tear it. So if people are going back to activities, it’s always important to start slowly and build yourself back up.
In athletes I see a lot in football players and soccer players. But it’s common in just about any sport where you have to do pivoting activity. So I also see it in lacrosse players or even in track runners.
In short, a lot of activities that put force on the knee can cause a meniscus tear.
Meniscus Tear Prevention
There are no braces that really can prevent a meniscus tear but, having strong quadriceps and hamstrings definitely protect the knee.
You are more likely to tear it when you’re fatigued or at the end of the game or at the end of skiing rather than when it’s early on.
So when the muscles get tired, it’s more likely to not protect the knee and you’re more likely to tear the meniscus.
Symptoms of a Torn Meniscus
If you have a little bit of pain in the knee that goes on for a day or two and goes away, it’s nothing to worry about.
If it goes on more than a couple of days or the knee is really swollen and really painful, you go see an orthopedic sports specialist as soon as you can.
If the pain is interfering with your life and your activities and it’s going more than a couple of days, come in and get it checked.
Swelling From Torn Meniscus
The swelling can be mild or it could be a tremendous amount of swelling.
The most common place to get the swelling, even if the tear is on the sides of the knee, is above the kneecap, that’s where the biggest portion of the knee capsule is opened. So that’s where the swelling usually goes.
You may also notice the inability to fully bend your knee because it feels tight and if you look at your legs and compare both knees, you’ll see a difference if there’s a lot of swelling.
Exam, Diagnosis, Arthroscopy, Surgery
When you come in to my office, I can tell pretty confidently based on my exam if you have a meniscus tear.
We almost always get an MRI just to confirm the diagnosis before we consider surgery. If the MRI does show a tear and you’ve had the symptoms going on for a while, then we do an arthroscopy.
I do a couple of hundred knee arthroscopies a year and the procedure takes me ten to 15 minutes. I do it under a local with IV sedation.
Typically you are not under general intubation. You don’t have a tube in your throat and you don’t have any pain or feel anything during the surgery.
When you wake up, typically the knee continues to not be painful for up to 6 to 8 hours afterwards.
Right after the surgery, I’ll let you walk on it and use it. You can use crutches if you need them, but most people don’t need crutches or a cane.
Physical Therapy and Returning to Sports, Activities
You’ll see me approximately one week after the surgery and at that point, we’ll send you to start physical therapy.
The therapy goes on for a couple of weeks until you can do the exercises on your own or until the therapist feels that you’re good enough to go on your own.
In terms of returning to sports, most people are back to sports at six to eight weeks, but it depends on how bad the tearing is and your age and level of fitness before the surgery.
So if you’re 80 years old and you’re in bad shape, it’s going to take you a lot longer to recover, of course, than a 21-year-old.
Recovery and Pain
Pain during recovery is between zero and ten for the range of pain. Patients typically are between two and six. So it depends how you tolerate the pain. Some people have absolutely no pain, but most people have a mild amount.
We’ll prescribe pain medications to take only as needed.
Repair the Meniscus vs Taking Out Torn Tissue
In younger patients, typically younger than 40, we do try and repair the meniscus rather than take out the torn part. It’s not that often that it’s repairable, but if we can repair it, we do.
Meniscus repair helps keep the normal tissue in the knee rather than having to remove it.
But in many cases, the tissue is too damaged to be fixed.
When the Tissue is Too Damaged
In the cases where the tissue is too damaged we just take out the torn portion, which is usually ten to 20 percent of the meniscus.
So even though it’s a partial removal, it’s only a small piece that is removed. And the problem is if that piece is not removed, it continues to pull on the rest of the meniscus. It can make the tear bigger and it could damage other parts of the knee if it’s rubbing in there and make a person more likely to get arthritis.
Surgery Is Not a Good Option for Knee Arthritis
Meniscus surgery it’s not a good surgery for people with significant arthritis.
I have people coming in who do have a lot of arthritis in the knee and said, “Can we do an arthroscopy?” And there are some doctors out there who will do an arthroscopy, but it’s not a successful surgery for arthritis.
But it is a very good surgery for meniscus tear.
So if the problem is primarily arthritis, I do not operate on those patients and they shouldn’t choose to have surgery. So if your doctor recommends that you have surgery and you have a lot of arthritis, you should go for a second opinion.