Hi i was tripped in hockey about 6 months ago and now have been diagnosed with two meniscus tears, one in both knee's. I didnt get it checked right away hoping i was ok. We'll the doctor told me that they were small tears and may be fixed with only physio and if not, then she will send me for an MRI. We'll the question i am asking if i will make a full recovery? I can straighten both legs tight and feel strong, just a pinching feeling on the inner part of my leg...I would really like to get back to being active again..

ALso, do you think i should have surgery? My physio says no, but i just started my rehab today. I just dont want to go through physio, spend all the money and then end up having surgery anyways and then going back for more physio....

Can someone please give me some advice on this?
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replied April 26th, 2013
Especially eHealthy
mp10,

It is very difficult to accuratley diagnose nondisplaced meniscal tears from just an exam. There are just too many "joint line" structures that can be "tweaked" in an injury, to definitively say that the discomfort is coming from the meniscus.

In some patients, if they have a chronic tear of a meniscus, they will develop chronic joint line tenderness and chronic effusions (swelling inside the joint). But, the exam is still pretty nonspecific: some joint line tenderness.

Now, in cases of a displaced bucket handle tear of the meniscus, where the patient has true "locking" of the joint (inability to completely extend the joint), it is pretty easy to tell it is a torn meniscus.


But, usually, it takes an MRI to actually diagnosis a tear in a meniscus.


The meniscal cartilages are avascular (no blood supply), so they have NO capacity to heal. If they are torn in the white-white zone (where there is no blood supply), the tear will never heal. If a meniscus is torn away from the caspule (the soft tissue that covers the joint), then it usually heal. There is a small blood supply along the outer edge of the meniscus (where it attaches to the capsule), again these types of tears will usually heal (in what is known as the red-red zone). It is in the red-white zone, within the mensicus, but at its outer edge, where its outcome is uncertain. Some of these will heal, some will not.

If a meniscus is torn in the red-red zone, it is usually recommended that surgery be done to actually "repair" the meniscus (since these have the capacity to heal). But, some patients want to wait and see if the meniscus will heal on its own, and that is fine also.

If the meniscus is torn in the white-white zone, it will not heal. But, not all tears in this zone are symptomatic. So, if the patient wants to wait and see if the symptoms get better with some physical therapy, that's fine. If the patient does develop chronic joint line tenderness with effusions, and there is a tear in the white-white zone, then usually surgery is recommended to just take out the torn part (called a debridement). As long as the outer rim of the meniscus is retained, that is all that is needed. The meniscus is not actually a cushion for the knee joint, as used to be thought. Its main purpose is to stabilize the knee joint, to prevent abnormal movement of the joint. This abnormal movement is what can lead to accelerated degeneration of the joint. So, now that almost all meniscal debridements are done with the aid of the arthroscope, the outer rim can be retained. So, there is no longer the accelerated degenerative changes that were seen with the total menisectomy that used to be done openly.


So, again, it is very difficult to say with any certainity that it is actually a meniscal tear, without an MRI. There are actually a lot of things that can cause "joint line tenderness" after a "tweaking" of the joint.

If the meniscus tear is displaced and causing locking, or it becomes a chronic tear, then it is a little easier to make the diagnosis.


If you want to try to see if physical therapy makes your knee feel better, that is a very good option. Doing physical therapy to strengthen the muscles and maintain joint range of motion is never a waste of time. In fact, a lot of surgeons require that their patients do physical therapy BEFORE surgery. The main predictor of how a patient does after surgery, is how well they do before surgery. It is always best to have a full range of motion and be as strong as possible before surgery, so that it is easier to get over the procedure. (About the only time that full range of motion cannot be obtained before surgery, would be in the case of a displaced bucket handle tear of the menicus. And, in that case, it is recommended that surgery be done immediately to "unlock" the knee.)


So, again, the time spent in physical therapy is never a waste of time. You do not necessarily have to spend a lot of money in therapy. Many patients never actually need the formal setting of a physical therapy clinic. They can do the exercises on their own. There is nothing magical about physical therapy, it just a lot of hard work. However, some patient do need the formal setting. They need someone to tell them what to do and to provide the external support/encouragement. It is basically up to the patient. Again, some do well on their own (they feel it is a waste of their money/time to go to the clinic to do exercises); while others actually need the formal setting (they need someone to tell them what to do).


Thus, it is up to you, what you want to do. But, whatever you decide to do, you will still need to keep your muscles strong and joint supple, if you want to continue to participate in athletic competition (whether or not you every have surgery).


Good luck.
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replied April 26th, 2013
Gaelic,

Thanks for the reply and i very much appreciate the time u have taken in replying to my post. I have been thinking of what u have said and think i'll do the physical therapy part-time, once a week for now and see how i progress. This way i'll still maintain contact with a professional and my progression will be documented.

About my results from the ultra-sound and x-ray it did appear my family doctor wasn't entirely sure if i did have two torn meniscus...Perhaps they just assume i do,,

The only thing i can say right now is that i do have full range of motion in both knee's, no locking at all and never had since my injury. I do have right now clicking noise and stiffness in both knee's, but i think i just need more time to heal..(i am hoping this) It's been since October 10 since my injury so its only been 7 months and perhaps give it another 6 months with no strenious running/skating and perhaps i can get back with no surgery..

Again, thanks for the post, very helpful.
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replied April 27th, 2013
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mp10,

No problem.

It is not uncommon for nonorthopedic surgeons to attribute all joint line tenderness to a tear in the meniscus. But, again, there are a lot of structures along the area of the joint line that can be injured, besides the meniscus.

Since the meniscus is made up of cartilage, it does not show up on x-rays. On an x-ray of the knee, there appears to "space" between the femur and tibia (the bones which make up the knee, along with the patella (kneecap)). This is where the menisci "live". If that "space" is narrowed, it is assumed that the meniscus has worn away some (degenerated), or the articular cartilage has worn away. The articular cartilage is the glistening white covering on the ends of the bones which make up the joint. Both of these cartilages can be worn down as the patient ages, and the joint "space" will narrow.


Hopefully, your knee will get back to its usual state in the next few months. Continue to work on strengthening of the muscles and maintain your range of motion.

Hang in there. Good luck.




Diagnostic ultrasound of the joints is not used too often in the US, but is widely used in other parts of the world. Unfortunately, it is very operator dependent. Also, the results have to be read by someone who is very well versed in musculoskeletal ultrasound techniques. So, the results of ultrasound studies when looking at the meniscus are not as good as that of an MRI or an arthrogram, but they are better than that of an exam alone.



Continuing with the physical therapy is a fine idea, as long as you are getting something out of it. You will, of course, need to do the therapy more often than just once a week. It is great to see the therapist once a week, as you stated, to keep in touch with a professional, for evaluation of how you are doing and to document it in your medical records.
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replied September 2nd, 2015
Hi

Can anyone comment on the following statements?

a)A torn meniscus can lead to Arthritis if the tear is not removed or treated
b)if meniscus tear is removed then there is less meniscus left so you will surely get Arthritis.
c)torn meniscus is best treated with Physio therapy.

which one of this is actually accurate.
(I have seen 2 OP surgeons and I get a feeling that they are just out there to make money, nobody spends more than 5 minutes with you and gives you the info you need to make a decision for getting a surgery done.)
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