Meniscal pathology

Technical Name: Meniscal tear / ‘Bucket handle’ meniscal tear

AKA Name: ‘Cartilage’ pad tear

Short Summary:

Within the knee joint there are two cartilage shock absorbers (menisci) that act to cushion the joint surface as well as stabilize the joint.  These are crescent shape structures that run around the inner (medial) and outer (lateral) aspects of the knee.    These can get damaged resulting in a ‘tear’ that can then irritate the knee when moving or if the tear is large can cause mechanical symptoms of locking, catching or giving way. 

What is a meniscal tear?

Meniscal tears can happen in younger patients (<40 years old) with a sudden impact or significant twisting injury to the knee (traumatic tear).  Alternatively beyond the age of 40 the meniscus begins to naturally weaken and with minimal force can become damaged or torn (degenerate tear).

What are the symptoms?

Meniscal tears can present with a ‘popping’ noise followed by pain and swelling.   The discomfort is commonly identifiable with one finger over either the inside aspect (medial) or outside aspect (lateral) joint line.  This is often associated with swelling and discomfort felt on twisting or moving the knee with a restriction in the range of movement.  Sometimes the meniscal tear can catch in the joint as it moves and this causes the sensation of the knee locking or jamming and on occasions even giving way.  

How is it diagnosed?

A clear detailed history focused on the mechanism of injury can give several clues as to the likely diagnosis.  This is supported with further imaging – commonly an MRI scan.  This will usually identify whether there is a tear in the meniscus.  X-rays are often used in conjunction to demonstrate any underlying degenerative changes within the knee, and should be taken before MRI scans in most patients over 40.

How is it treated?

Once a meniscal tear has been diagnosed it does not necessarily need operative treatment and symptoms can resolve with time.  

  • • Non-operative treatment – includes initial management of any swelling and pain.  As this resolves maintaining activity with strengthening exercises will help regain a full range of movement and return to normal activities over a few months.  If this fails to help improve things then an injection into the knee in the clinic (of cortisone steroid and local anaesthetic) can help settle the discomfort and stiffness. 
  • • Operative treatment – involves keyhole surgery (arthroscopy) of the knee through two small incisions over the front of the knee.  A telescopic camera is inserted through one of the incisions and through the other an instrument allowing surgery to be carried out.  Surgery is usually under general anaesthetic and is carried out as a day case (in and out of hospital on the same day).  The majority of meniscal tears are treated with ‘trimming’ of the torn piece therefore taking away the damaged tissue that is causing the irritation within the knee.   In younger patients the meniscal tear can sometimes be repaired (with internal stitches) when the tear has the potential to heal.  This then requires a period of restricted activity to allow tissue healing.

Keyhole surgery is only recommended when you have ongoing discomfort, mechanical symptoms (such as locking) or the symptoms are impacting on your everyday quality of life.  On many occasions patients manage with a meniscal tear without needing surgery and symptoms progressively settle.

Important: this information given above is only a guideline as is not complete.  For more information or to book an appointment please contact us.