What is the treatment for a torn meniscus?
The treatment of a meniscus tear depends on its severity, location, and underlying disease within the knee joint. Patient circumstances also may affect the treatment options. Often it is possible to treat meniscus tears conservatively without an operation using anti-inflammatory medications and physical therapy rehabilitation to strengthen muscles around the knee to prevent joint instability. Frequently, that is all a patient needs. Patients involved in sport or whose work is physically demanding may require immediate surgery to continue their activity. Most patients fall in between the two extremes, and the decision to use conservative treatments or proceed with an operation needs to be individualized.
Torn meniscus due to injury
The first steps in treatment after the acute injury usually include rest, ice, compression, and elevation (RICE). This may be helpful in easing the inflammation that occurs with a torn meniscus. Anti-inflammatory medications, such as ibuprofen (Advil, Motrin) or naproxen (Aleve), may help relieve pain and inflammation. It is important to remember that over-the-counter medications can have side effects and interactions with prescription medications. It is reasonable to ask a health care professional or pharmacist for directions as to which over-the-counter medication might be best for someone's particular situation. Rest and elevation may also require the use of crutches to limit weight-bearing.
A brace is often not used initially because most hold the knee in full extension (completely straight) and this can worsen the pain by decreasing the space within the knee joint capable of accommodating any fluid or swelling. Many patients choose initial conservative or nonsurgical treatment for a meniscus tear. Once the injury symptoms have calmed, the health care professional may recommend specifically guided exercise programs; physical therapists are especially helpful, to strengthen the muscles surrounding the knee and add to the stability of the joint. Maintaining an ideal body weight will also help lessen the forces that can stress the knee joint. Shoe orthotics may be useful to distribute the forces generated by walking and running. Braces tend not to be effective because the meniscus injury does not cause the knee joint to become structurally unstable.
If conservative therapy fails, surgery may be a consideration. Knee arthroscopy allows the orthopedic surgeon to assess the cartilage tear and potentially repair it. During an operation, the goal is to preserve as much cartilage as possible. Procedures include meniscal repair (sewing the torn edges together), partial meniscectomy (trimming away the torn area, and smoothing the injury site), or total meniscectomy, removing the whole meniscus if that is deemed appropriate.
Microfracture surgery is another surgical option to stimulate new cartilage growth. Small holes are drilled into the surface of the bone and this can stimulate articular but not meniscus cartilage development. The articular cartilage that grows as a result of surgery is not as thick or as strong as the original meniscus cartilage.
Degenerative joint disease
In older patients with degenerative joint disease (also 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 degenerative arthritis and include hylan G-F 20 (Synvisc), sodium hyaluronate injection (Euflexxa, Hyalgan), and hyaluronan (Orthovisc).
Other injection options are being investigated to help regrow or repair meniscus injuries. Platelet rich plasma and stem cell injections are potential alternative treatment options to knee arthroscopy surgery, however, consensus does not yet exist that the treatments are effective. There are ongoing studies to assess whether or not they can be effective in treating knee meniscus injury instead of, or in conjunction with, arthroscopic surgery.
The use of dietary supplements, including chondroitin and glucosamine, have yet to have their effectiveness proven, but many people find relief with their use.
As a last resort, joint replacement may be an option for patients who have substantial degeneration of the knee with worn out cartilage. These individuals typically have recurrent or constant pain and limited range of motion of the knee, preventing them from performing routine daily activities.