What are meniscal tears?
Meniscus tears are among the most common knee injuries experienced by Americans annually. They are a frequent reason that patients come to see Dr. Chahla in his clinic. These injuries can cause short term symptomatic dysfunction such as pain, swelling, and locking/catching during movement. In the long term, meniscal injuries can lead to significant irreversible damage to the cartilage of the knee joint. The prognosis and treatment recommended for any patient with a meniscal lesion is based on several factors including the patient’s age, BMI, activity level, other health conditions, and ability to partake in postoperative rehabilitation as well as the patient’s meniscal tissue quality, tear type, and tear location.
What are the types of meniscal injuries?
There are two major subtypes of meniscal injuries: degenerative lesions and acute lesions. A degenerative lesion tends to be in a middle-aged patient or older and are frequently asymptomatic. These are typically more of a “fraying” type of injury. For patients with degenerative lesions, surgery is typically not recommended. This is because recent studies have shown that surgical removal of meniscal segments in patients with degenerative meniscal lesions did not improve symptoms relative to untreated patients.
Acute meniscus tears or traumatic tears, as their name suggests, occur from an acute traumatic event. Trauma can range from explosive movements in a basketball game to simply twisting and pivoting your knee after kneeling on the ground. These injuries tend to have a more immediate onset of symptoms, and patients will often report a popping sensation, swelling, pain (particularly while twisting the knee), a feeling of the knee giving away, and a catching/locking sensation. This catching/locking is from the torn tissue getting lodged between the bones and preventing the typical smooth synchronized gliding movement of a healthy knee.
What determines the healing potential for a meniscal injury?
In orthopaedic surgery, blood supply to an organ is the most critical variable for healing. Regions with high blood supply tend to heal well, while regions with poor blood supply tend to heal poorly. Unfortunately, the meniscus is an organ with relatively poor blood supply. The majority of the blood vessels within the meniscus are concentrated in its periphery. The meniscus can be divided into zones based on the level of blood supply . Peripheral zones (zone 1 and 2) have a higher blood supply and can heal well with surgery, while the more central zone (zone 3) has a low blood supply and tends to have a more limiting healing capacity.
When a patient comes to see Dr. Chahla for a meniscal injury, the patient’s specific health and demographics, the etiology of the injury, and a patient’s tear characteristics are all factored into decision making. Based on the most up to date research, we are able to create state of the art treatment plans that are unique to a patient’s specific injury and a patient’s specific goals.