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Meniscus Tear

What is it?

The knee joint is made up of three bones: the femur (upper leg), the tibia (lower leg), and the patella (kneecap). The joint is cushioned by two pads of specialized cartilage, located between the femur and tibia bones, which act as a shock absorber within the knee. These pads, known as menisci, are designed to help distribute weight and reduce friction during movement. Meniscus tears are very common and can be found in both the medial meniscus, located on the inside of the knee, and the lateral meniscus, located on the outside of the knee. A tear in the meniscus can be either vertical or horizontal. Vertical tears are most commonly associated with traumatic injury and horizontal tears are typically degenerative, wearing away over time.

What causes it?

Sudden meniscus tears often occur in a traumatic injury, when the knee is twisted or when direct contact is involved. As these are common in sports-related activities, athletes are especially at risk for meniscus injury.

Degenerative meniscus tears are often seen in older patients as the cartilage wears thin over time. As this worn tissue is weakened, more minor twisting motions can be enough to cause a tear.

What are the symptoms?

A “pop” may be felt at the time of injury, but most people are still able to walk. Other symptoms include pain, stiffness, swelling, and limited range of motion. There may be a sensation that the knee is going to “give way” and that you are unable to fully straighten your leg at the knee joint. Catching or locking of the knee is also common.
 

How is it diagnosed?

Your doctor will discuss symptoms and any history of injuries. Physical examination will include checking for tenderness along the joint where the meniscus is located and performing the McMurray test. This test positions the knee to put tension on the meniscus. If there is a tear, this movement will cause a clicking sound. X-rays are often helpful to check for other causes of knee pain, such as osteoarthritis. Magnetic resonance imaging (MRI) allows for better visualization of the soft tissues and can provide a clear diagnosis of meniscus tear.

What are the treatment options?

Treatment of a meniscus tear depends on the type, size, and location of the tear, along with the activity level and age of the patient. Nonsurgical treatment may be acceptable in patients who still have stability in their knee and find that their symptoms are not significantly limiting their daily activities. Rest from activity, compression, and elevation may be helpful, along with the use of anti-inflammatory medication. If symptoms persist, surgery may be considered.

What is involved in surgery?

If surgery is necessary, minimally invasive arthroscopic techniques can be utilized to either repair the meniscus (meniscal repair) or trim out the damaged portion of the meniscus (partial meniscectomy).

Meniscus repairs are less common as fewer than 10% of these fit the tear pattern optimal for this type of surgery. Successful healing of the tear is dependent on the tear location. Meniscus repairs are best suited for tears along the outer edge of the meniscus where there is a better blood supply, and are more commonly performed in younger patients fitting this specific tear pattern. If the tear is not located in this vascular zone, or is more complex in nature, a partial meniscectomy is typically performed.

Partial meniscectomy involves trimming out the torn portion of the meniscus. Although originally performed as an open procedure, the development of minimally invasive arthroscopic techniques has allowed a partial meniscectomy to become one of the most successful and frequently performed orthopedic procedures.

Partial meniscectomy is an outpatient procedure and most patients are able to return to activities of daily living within two to three days following surgery. Regaining knee motion and quadriceps strength are key components to a full functional recovery. Although not required, physical therapy may be helpful for patients who find that they are not able to regain range of motion and strength with home exercise. Return to sports is typically considered within 4-6 weeks following surgery.

If you believe you are suffering from a meniscus tear or would like more information on minimally invasive arthroscopic techniques, the physicians at Orthopedic Specialists of Seattle provide excellent treatment options available for you. Please feel free to contact OSS at (206) 633-8100 to schedule an appointment.

 

Anterior Cruciate Ligament (ACL) Tear

What is it?

The knee joint is made up of three bones: the femur (upper leg), the tibia (lower leg), and the patella (kneecap). The patella sits in front of the joint to provide some protection for the underlying ligaments. As the knee is a mobile joint, tissues called ligaments connect the bones to provide stability. Of the four primary ligaments in the knee, there are two that control sideways motion and rotation (collateral ligaments) and two that control the back and forth motion (cruciate ligaments). The collateral ligaments are located on the sides of the knee, with the medial collateral ligament (MCL) on the inside and the lateral collateral ligament (LCL) on the outside. The cruciate ligaments are located inside the knee joint, crossing each other to form an “X”. The anterior cruciate ligament (ACL) crosses in front of the posterior cruciate ligament (PCL).

The ACL is an important ligament as it prevents the tibia from sliding out in front of the femur, provides rotational stability to the knee, and minimizes stress across the knee joint.

About half of all injuries to the ACL occur along with damage to other structures in the knee, such as articular cartilage, meniscus, or other ligaments.

Injured ligaments are considered sprains and are graded on a severity scale.

Grade 1 Sprain

The ligament is mildly damaged and may be slightly stretched, but stability of the knee is intact.

Grade 2 Sprain

The ligament is stretched to the point where it becomes loose, often referred to as a partial tear.

Grade 3 Sprain

This is most commonly referred to as a complete tear as the ligament has been split into two pieces and the knee joint has become unstable.

What causes it?

Injuries to the anterior cruciate ligament (ACL) are one of the most common knee injuries. These sprains or tears are typically caused by twisting, cutting or pivoting movements, which is why athletes participating in sports like soccer, football, basketball or skiing are more likely to injure their ACL. Anterior cruciate ligament injuries can occur when changing direction quickly, stopping suddenly, slowing down while running, landing from a jump incorrectly, or during direct contact or collision.

What are the symptoms?

Many people describe feeling a “pop” or tearing sensation at the time of injury, along with instability as the knee “gives out”. Other common symptoms include: pain, swelling, loss of range of motion, discomfort while walking and an inability to bear full weight.

How is it diagnosed?

Ligament injuries are diagnosed with a thorough physical examination of the knee and the use of magnetic resonance imaging (MRI) to fully visualize the soft tissue. X-rays may be used to show whether the injury is associated with a broken bone.

What are the treatment options?

Nonsurgical treatment of a torn ACL may be acceptable for elderly patients, those with a fairly low activity level, or for patients whose stability remains fairly intact. A physical therapy program helps restore function by strengthening the leg muscles that support the knee. Bracing may also be recommended to provide stability and support.

Most complete ACL tears require surgery in active patients.

What is involved in surgery?

ACL surgery involves completely removing the torn ligament and reconstructing the torn ACL using a minimally invasive arthroscopic technique. A tissue graft is used to replace the torn ligament, acting as a framework for the new ligament to grow on. Grafts can be obtained from several sources, most commonly from the patellar tendon, the hamstring tendon, or cadaver tissue (allograft). Each type of graft offers both advantages and disadvantages. These differences will be explained thoroughly so that the best decision can be made to optimize your outcome.

Rehabilitation plays a vital role in your return to daily activities. A physical therapy program will help you regain both range of motion and strength. The initial focus will be on regaining motion in your knee joint and the surrounding muscles, followed by a strengthening program which gradually increases the stress across the ligament while still providing protection. As the regrowth of this ligament takes time, it may be six months or longer before an athlete can return to sports after surgery.

If you believe you are suffering from an anterior cruciate ligament (ACL) tear or would like more information on minimally invasive arthroscopic techniques, the physicians at Orthopedic Specialists of Seattle provide excellent treatment options available for you. Please feel free to contact OSS at (206) 633-8100 to schedule an appointment.

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