Question: Last June I accidentally rolled over my left foot while standing on uneven ground. There was an audible pop from the knee and I felt something let go. To make a long story short, I have seen a local doctor and had X-rays taken. They showed a torn meniscus in the left knee. I was given a shot of cortisone in the knee joint and not much else. I have been taking NSAID on a daily basis and an occasional hydrocodone pill for the pain. The joint gets sore and stiff at night after being on it during the day. Rubbing it down at night and in the morning with Bengay does help. My question is: What is the short-term and long-term diagnoses of this condition in the terms of healing. Can this condition heal itself without surgery? If not, can this condition be corrected through an arthroscopic procedure? I am a 65-year-old male and have been told, my knee joints are pretty much worn out. I don't look forward to spending the rest of my life limping around. It has slowed me down, but has not stopped me from my normal daily activities.
Answer: As with any injury in the body, when the meniscus is damaged, irritation occurs. If the surface that allows the bones to glide over each other in the knee joint is no longer smooth, pain can occur with each flexion or extension. The meniscus can be damaged because of a single event or it can gradually wear out because of age and overuse.
A torn meniscus is damage to the cartilage that sits on top of the tibia and allows the femur to glide when the knee joint moves. Physical examination and magnetic resonance imaging (MRI) is the test of choice to confirm the diagnosis of torn meniscus.
Because there is different blood supply to each part of the meniscus, knowing where the tear is located may help decide how easily an injury might heal (with or without surgery). The better the blood supply, the better the potential for recovery. Blood supply to knee cartilage also decreases with age, and up to 20 percent of normal blood supply is lost by age 40.
The risk of developing a torn meniscus increases with age because cartilage begins to gradually wear, lose its blood supply and its resilience. Increasing body weight also puts more stress on the meniscus. Routine daily activities like walking and climbing stairs increase the potential for wear, degeneration, and tearing.
Some meniscus tears can be treated conservatively without an operation (less than 5 percent) using anti-inflammatory medications and rehabilitation to strengthen muscles around the knee to prevent joint instability. Orthotics may be useful to distribute the forces generated by walking and running.
If conservative therapy fails, surgery may be a consideration. Knee arthroscopy allows the orthopedic surgeon to assess the tear within the meniscus and repair it. Options include sewing the torn edges together or trimming the torn area and smoothing the injury site.
In older patients with degenerative joint disease (alo known as osteoarthritis), where the cartilage wears out, treatment options may be considered over a longer timetable. Exercise and muscle strengthening may be an option to protect the joint and maintain range of motion. As well, anti-inflammatory medications may be considered to decrease swelling and pain arising from the knee joint.
Cortisone medication injections into the knee joint may be used to decrease joint inflammation and to bring temporary symptom relief that can last weeks or months. A variety of hyaluronan preparations are approved for mild to moderate knee arthritis and include hylan G-F 20 (Synvisc) and hyaluronan (Orthovisc).
As a last resort, joint replacement may be an option with substantial degeneration of the knee if conservative measures fail and symptoms of pain and decreasing joint range of motion affect quality of life and prevent the patient from performing routine daily activities.
There is no cookie-cutter approach: The treatment of a meniscus tear depends on its severity, location, and underlying disease within the knee joint, as well as patient circumstances. Consult your doctor to determine what’s the best course of action for you.
Todd Lorenc, M.D.
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