What is a meniscus tear?
The menisci are two C-shaped pieces of rubbery cartilage that sit between the thigh bone and the shin bone. They absorb shock, spread load across the joint and help keep the knee stable. Tears can happen suddenly in a twisting injury, which is typical in younger people, or develop gradually as the tissue wears with age.
Where a tear is matters. The outer third of the meniscus has a good blood supply and can heal after repair. The inner part has little blood flow and rarely heals. Tears at the very back attachment, called root tears, are particularly important because they can let the meniscus shift out of place and speed up arthritis if not addressed.
What does a meniscus tear feel like?
Typical symptoms are pain along the joint line, swelling that builds over a day or two, catching, clicking, and stiffness. A torn flap can lock the knee so it will not fully straighten. Squatting, twisting and getting up from low seats tend to hurt.
Do I need surgery?
Often not. For degenerative tears in middle-aged and older knees, trying physical therapy first is a sound plan. In one trial, patients with a degenerative tear who had arthroscopic trimming did no better at one year than those who had a sham operation where the incisions were made but no tissue was removed.1
Surgery has a clearer role when the knee is locked, when a recent tear is in a younger person, when a tear is in a part of the meniscus that can heal, and for root tears in knees without advanced arthritis.
Repair or trim?
Preserving the meniscus is a priority whenever it is possible. Dr. Stepanyan repairs tears that are repairable, trims only the unstable, unrepairable tissue, and fixes root tears by reattaching them to the bone with sutures through a small tunnel.
What happens in surgery?
Meniscus surgery is done arthroscopically through a couple of small incisions, usually as an outpatient. Repairs use small sutures that pull the torn edges together, while trimming uses small instruments to remove the damaged piece. A root repair passes sutures through the torn root and anchors them in the shin bone. If a ligament tear, such as an ACL tear, is present, it is usually fixed in the same operation because it protects the repair.
Should I get a second opinion?
If you have been told you need meniscus surgery and your X-ray shows arthritis, or you had a meniscectomy and still have pain, a second opinion makes sense. Request a visit and bring your MRI.
Where can I see Dr. Stepanyan?
Dr. Stepanyan sees knee patients in Glendale, East LA and Santa Fe Springs.
What does recovery look like?
These are the typical stages in Dr. Stepanyan’s physical therapy protocol for a meniscus repair. After a simple trim, recovery is much faster. Your own plan may differ.
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Weeks 0–4
Protect the repair
You put about half your weight on the leg, progressing toward full weight by week 2, and wear a brace locked straight when walking and sleeping. Bending is limited to 90°. The focus is full straightening, control of swelling and quadriceps activation.
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Weeks 4–8
Walk and regain motion
Crutches and the brace come off when your quadriceps is strong and you walk without a limp. Motion progresses to 125°, but you avoid loading the knee deeper than 90° of bending.
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Weeks 8–16
Strengthen
Full motion returns. You build strength with leg press, squats and step-ups, and train balance. Running is not allowed yet.
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Weeks 16–20 and beyond
Return to running and sport
Running starts around 16 weeks if you can control an 8-inch step-down. Agility work and plyometrics come next, and sport begins after about 20 weeks with Dr. Stepanyan’s clearance.
Root repairs are more protected: toe-touch weight bearing for the first four weeks, full weight at about six weeks, and running at about 16 weeks. Follow the plan written for you; see the protocols Dr. Stepanyan’s therapists use.
Sources
- Sihvonen R, Paavola M, Malmivaara A, et al. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med. 2013;369(26):2515-2524. Journal article