The meniscus is frequently injured in sports and also when lifting
in the gym. The most common mechanism of injury is a rapid twisting of the knee,
but it can occur many other ways such as a forceful flexion. This can happen
if a lifter hits the deep full squat position hard and bounces back up. In some
cases, you may not remember a specific injury, but the meniscus can tear due
to repetitive loads and chronic degeneration.
A torn meniscus is often painful because loose ends of the torn piece
can get trapped in the knee. In some cases the torn piece can lead to mechanical
catching or locking of the knee and you will have to maneuver the knee to "unlock"
it and allow motion. In other cases, a piece of the meniscus can break off and
become a "loose body" that can also lead to catching or locking. Magnetic
Resonance Imaging (MRI) is very helpful to confirm the diagnosis and can assist
in determining the best course of treatment for the meniscus tear.
After the onset of symptoms, a trial of physical therapy and anti-inflammatory
medications may be warranted. However, mechanical symptoms such as catching and
locking will only resolve if the offending fragment of meniscus tissue is removed.
This is done with arthroscopic surgery. This procedure is performed through two
small holes in the knee, each measuring less than a centimeter. A camera is inserted
into the knee through one hole and surgical instruments through the other. We
remove the torn pieces from the knee with the surgical instruments. To avoid
future problems with the knee, as little tissue as possible is removed. In some
cases, the meniscus can be repaired so no tissue is removed. We see our work
inside the knee live on a television screen in the operating room. The fiber
optics allow a better view of the inside of the knee than can be achieved with
open surgery.
Following the meniscus surgery, rehabilitation is undertaken with a physical
therapist. The initial steps in therapy are to reduce swelling and regain full
motion of the knee. You generally use crutches for a few days and most patients
are walking normally by one to two weeks following surgery. Strengthening is
an important part of the rehabilitation process and return to sports is generally
by three months. Professional athletes who are in top shape and can dedicate
each day to rehabilitation can return to play within a week or two in some cases,
depending on their sport.
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