CNY Orthopedic Sports Medicine, PC: TreatmentPrint: Meniscal Tear
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Injuries and Conditions: Meniscal Tear : Meniscal Tear : Treatment Options
 

Overview
A damaged meniscus may not require surgery for a full recovery. There are some cases where patients with tears that do not cause locking of the knee, can improve over time. Differences in the severity and type of injury will affect the treatment, as well as the degree of activity that the patient wishes to pursue after treatment.

Meniscus injuries range from minor tears to complete tears of the structure. Some patients, even those with quite severe injuries, may choose to not undergo surgery. A partially torn meniscus can rebuild itself. However, a more severe tear will require surgery to repair and prevent further damage to the joint.

Treatment options:

Meniscal Repair Surgery Overview
In order to preserve the entire meniscal cartilage, the torn meniscus is surgically repaired. This repair allows the meniscus to continue functioning as a natural shock absorber and offers a stabilizing receptacle for the end of the femur.

Evaluation of Patient for Surgery

  • A complete physical examination which provides an assessment of the patient's overall health.
  • An examination of both the injured and uninjured knee.

    Post Operative Recovery

  • Immediately after surgery, as anesthesia wears off, patients will usually feel tired and slightly disoriented, although the effects of anesthesia can vary greatly from patient to patient.
  • The knee will remain tender and painful after surgery. The most intense discomfort is felt in the first 24-48 hours, after which the pain generally steadily decreases.

    POST-OPERATIVE INSTRUCTIONS:

  • Wear the brace at all times, except when bathing or showering.
  • Bear weight as tolerated in the brace with the knee locked in full extension.
  • Use crutches as needed until stability returns.
  • Ice the knee three times a day for 20 minutes.
  • Keep the wound dry. The dressing can be removed for showering (with the knee wrapped in plastic kitchen film) after four days.
  • Three times a day, for 30 minutes each time, sit with a large towel roll under the heel with the brace locked in full extension.
  • It is normal to have some discomfort and swelling, as well as some blood-tinged drainage, following meniscal surgery. If this becomes severe or the patient develops a fever, calf pain, shortness of breath, or chest pain, contact a doctor immediately.

    Long Term Expectations for Recovery

  • A surgically treated meniscus which is rehabilitated properly will allow the patient to eventually regain complete strength, stability and motion of the knee.
  • Patients that are in good physical condition are likely to recover within four to six weeks and will then usually be able to perform at previous levels of intensity.
  • Patients that are in poorer overall condition will be able to return to previous activity levels, although rehabilitation and physical therapy will tend to be more lengthy and involved.
  • In all cases, physical therapy is required to restore the muscle strength, flexibility and joint stability due to the injury.

    Possible Complications and Risks

  • Re-injury to the meniscus is possible if physical therapy or other activities during rehabilitation are overly strenuous.
  • Risks during and after surgery include problems that may develop in relation to bleeding, the possibility of infection and reactions to anesthesia.
  • The repaired meniscus is often as healthy as before the injury and will tend to remain healthy if not subjected to abuse.

    Conservative Treatment of Meniscal Tears Overview
    Initial care will focus on rest and the avoidance of activities that aggravate the condition. Actions that involve any pounding force against the knee, such as running or jumping should be avoided. Physical therapy will focus on increasing the strength and stamina of the quadriceps and hamstrings. Strengthening these muscles will help support the knee.

    Click on the Non-Surgical Details button to review additional information.

    Rehabilitation Program

  • Ice packs around the knee may be used to reduce pain and swelling, usually for 20-30 minutes every hour until the pain subsides.
  • After the activity or behavior that has injured the meniscus is identified (running, soccer, etc.) the modification or elimination of the injurious activity is required while the tears are healing.
  • Bandaging the knee helps reduce and prevent swelling.
  • Anti-inflammatory medications (NSAID's) may be prescribed.
  • A knee immobilizier or other type of brace may be recommended.
  • Medication and Medical Products
    Knee: Support A knee support is a sleeve-like support that fits firmly around the knee. The support is used to reinforce the joint during motion and provide compression to aid healing and reduce pain and swelling. Patients suffering from knee strains or inflammation will usually be directed to use a support during daily activities.

    The thin and flexible construction of the support allows for normal movement of the knee and also allows the support to be worn under loose fitting clothing. To prevent harmful pressure to certain structures, the support applies differing compression around the knee. The sides of the joint receive intermittent pressure to help stimulate blood flow while the rear of the support fits relatively loose to prevent constriction of circulation. The kneecap is aided in positioning, but remains free of compression to allow its natural movement.

    Knee supports can be used to treat:

  • Strains
  • Sprains
  • Inflammation
  • Chondromalacia patella

  • NSAIDs NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) are a group of drugs used to control pain. This category of medications includes both prescription and common over-the-counter painkillers such as ibuprofen. NSAIDs are effective for many types of pain that can occur because of inflammation of muscles, joints and bones. The drugs work quickly and people often notice some benefit within a few hours of taking the tablet. However, the complete effectiveness of the drug may not be realized for up to four weeks. For each individual, some varieties of NSAIDs are more effective than others. Often, patients will find that one or two varieties are helpful whereas others may not be as effective in controlling symptoms. It is usually necessary to try several brands and continue with the one that is most suitable. NSAIDs can be used to treat:
  • Pain resulting from inflammation or swelling.
  • Pain after injury.
  • Joint pain and arthritis.


  • Long-Term Expectations for Recovery

  • Patients can expect a full recovery after treatment.
  • With moderate exercise to recondition the surrounding muscles and reduce stiffness after injury, a patient may participate in athletic activities at their pre-injury level.
  • If the meniscal tear is a result of a specific athletic activity, the patient will need to discontinue or modify that activity to prevent re-injury.
  • Possible Complications and Risks

  • The meniscal injury may recur if the patient returns to the injury producing activity.
  • More severe injuries that are treated non-surgically may not heal completely, demanding the knee be used at a less intensive level during athletic activity.
  • Injury to other structures of the knee may occur if the meniscus is not providing correct support, lubrication or insulation from impacts while running or walking. Damage to the bones of the knee or cartilage can be severe if activity is continued on an injured meniscus.
  • Surgical Hardware Considerations

    Although some meniscal tears require surgery, the procedure does not require implanting surgical hardware.


    Factors in Transplant Source
    The meniscal surgical procedures discussed here do not require the transplanting of any tissue.