When people refer to torn knee cartilage, they are typically referring to torn meniscus. In fact, many people have damage to their meniscus but have no symptoms.
Meniscus tears are among the most common knee injuries. This is due to its location and function. Even though athletes in contact sports are most susceptible to this injury, anyone of any age can sustain a torn meniscus.
Because this injury is so common, your best option for recovery is physical therapy combined with regenerative medicine. The knee has a lot of moving parts. Imaging with MRI may detect a meniscus tear, but there is no guarantee that the tear is what is causing the pain.
So when the pain, locking, and popping become unbearable, what are your options? Let’s explore the meniscus with more detail and review your options when it comes to healing your knees.
Where is the meniscus located?
The meniscus is a wedge-shaped piece of cartilage positioned between your femur (thigh bone) and your tibia (shin bone) where the two come together. You have two menisci in each knee joint. One is on the lateral aspect (toward the outside) and one is on the medial aspect (toward the middle). The menisci are the cushions between these two bones, providing shock absorption. In addition, they provide proprioception, which is your body’s awareness of position and movement, and they supply lubrication and nutrition for the articular cartilage. The menisci also provide stability, especially when the anterior cruciate ligament (ACL) is not functioning optimally.
Menisci are tough and rubbery, designed to handle a lot of wear and tear. However, over a lifetime, tears can and do occur. Meniscus tears are named after the shape of the tear. The 4 most common are bucket-handle, radial, flap, and degenerative.
When an athlete suffers an acute (sudden, new) meniscal tear, often there is another injury to the knee, such as a ligament tear. That said, some tears may cause little or no symptoms as long as knee remains mechanically stable.
The big question then becomes “Do I need surgery?”
What is involved with meniscus surgery?
Surgery to the meniscus is most often a cutting away of the damaged piece (partial meniscectomy). Very few meniscus surgeries are meniscal repairs. In fact, 90% of the meniscus surgeries are meniscectomies (removing a piece or all of the meniscus) rather than repair. It is thought that a dangling piece of torn meniscus impedes movement of the joint and becomes the culprit of locking and popping.
The risks of meniscus surgery outweigh the benefits, especially in the long run. Partial meniscectomy can be complicated by removing too much of the meniscus (excessive resection), damage to surrounding uninjured articular cartilage, nerve injury, vascular injury, and infection. 1
Let’s not forget recovery time, pain, swelling, and rehabilitation post surgery.
Furthermore, the surgeon must attribute any of the symptoms to preoperative imaging, and exclude any alternatives causing the symptoms, including arthritis, infection, injuries to other structures, and referred pain from the hip, sacroiliac joints, and lumbar spine.
Remember, once this vital piece of tissue is removed, it’s gone and it’s no longer available to cushion your knee, especially when too much is removed. It cannot aid in balance or supply lubrication and nutrition to its surrounding tissues.
Most patients do not experience significant benefits from surgery. In recent studies, patients receiving surgery are no better off than those who chose non-operative conservative therapies. In fact, those who opted for therapeutic exercises gain valuable muscle strength, regained mobility, and showed better recovery long term, than those who opted for surgery.
The ability of meniscal tissue to heal is closely related to its blood supply. The outer edge of the meniscus contains the most blood supply and can repair itself easily. As you move toward the middle, the blood supply is less. This is the area where a tear may need an extra boost in order to heal.
What is needed to heal?
Furthermore, if given the right environment to heal, the tissues know what to do. They’re programmed by nature to recover. Because the surrounding tissues depend on the meniscus, it’s important to increase the blood supply, if possible, and provide an environment of healing, so that the knee ecosystem can be maintained.
In the absence of regenerative techniques, physical therapy alone, with therapeutic strengthening exercises may provide better results for you than opting for surgery. This is due to the increase in circulation, increase in muscle strength and a restoration of joint integrity.
Physical therapy combined with regenerative medicine, which enhances the cells ability to restore pe-injured tissue integrity, can equip you and your body with the best possible outcomes.
Let’s summarize your options:
- Surgical repair: Risks outweigh benefits, lengthy recovery time, up to a year or longer depending on complications, and may not cure the symptoms. You may want to give surgery more consideration when the tear is causing locking of your knee.
- Physical therapy alone: Benefits outweigh the risks. Healing is a commitment.
- Regenerative medicine: Benefits outweigh the risks. Provides an optimal environment for the cells to heal.
- Physical therapy and regenerative medicine: Provides the best possible outcomes, with improved balance, circulation, and supported by studies showing the best long-term results.
Complications In Brief: Arthroscopic Partial Meniscectomy: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3613538/
The BMJ: Patient reported outcomes in patients undergoing arthroscopic partial meniscectomy for traumatic or degenerative meniscal tears: comparative prospective cohort study – https://www.bmj.com/content/356/bmj.j356
NCBI: The knee meniscus: management of traumatic tears and degenerative lesions – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5489759/
New England Journal of Medicine: Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear – https://www.nejm.org/doi/full/10.1056/nejmoa1305189