Knee - Meniscus Tears
Description
The meniscus is cartilage that acts as a shock absorber between the femur (thigh bone) and tibia (shin bone). Each knee has two distinct menisci: the medial (inner aspect of the knee) and lateral (outer aspect of the knee). Medial meniscus tears are more common in general, and lateral meniscus tears are more common when the ACL is injured. Injuries to the meniscus may lead to eventual degenerative changes in the knee (aka – arthritis).
What are the causes?
The meniscus can be injured several ways. Acute meniscus tears result from a sudden twisting or pivoting maneuver. Acute meniscus tears are associated with ACL injuries. The meniscus can also undergo degeneration as patient age increases. The degenerative meniscus is susceptible to tearing with minimal trauma (i.e.-twisting the knee getting into the car).
What are the symptoms?
Meniscus tears, in the acute setting, cause immediate pain over the specific meniscus, potentially swelling and bruising and loss of motion and strength. The patient may feel clicking or catching with walking and increased pain with twisting on the affected foot. If the meniscus tears and gets stuck out of place, the knee may feel locked (aka - bucket handle meniscus).
How is it diagnosed?
Dr. Liu will perform a thorough history and physical exam with X-rays. On exam, swelling and loss of motion and strength is present. The knee is painful to touch over the affected meniscus. Your surgeon may perform provocative maneuvers to test each meniscus, resulting in pain and clicking if the meniscus is torn. X-rays are usually normal. MRI is helpful to confirm the diagnosis and characterize the tear for surgical planning. Other injuries can also be identified on the MRI.
Non-operative
Some meniscus tears are treated successfully without surgery. Your surgeon may prescribe anti-inflammatory medication, physical therapy, cryotherapy and activity modification to reduce pain and inflammation, as well as strengthen the muscles around the knee to decrease the force transmitted to the meniscus. Your surgeon may offer you an injection. Patients with continued symptoms (pain, clicking, etc.) may benefit from surgery. Bucket handle meniscus tears are not treated non-operatively and require surgery.
Platelet-rich plasma (PRP) injection is another non operative option for treating pain. Blood is taken from your arm and is spun down to get the healthiest healing factors - platelets and serum. The goal is to promote an anti-inflammatory effect, reduce pain, and stimulate healing. Although one injection may help, studies support a series of 2 injections, 1 x Week/2 weeks. Not covered by insurance.
Bone Marrow Concentrate "Stem Cell" Injections is another non operative option for treating pain. Bone marrow is aspirated from your pelvis and centrifuged in a special kit to concentrate stem cells, which are then re-injected into the joint. The goals are to change the living micro-environment of the joint to a positive one, and to decrease inflammation and cartilage cell death. Stem cells will promote healing of cartilage, will not re-grow cartilage, restore joint space, or remove bone spurs. Not covered by insurance.
Operative
Meniscus tears can be treated in most cases with a minimally-invasive arthroscopic surgery. Depending on the size and type of tear, as well as the quality of the torn tissue, Dr. Liu may choose to remove the torn meniscus or repair it with a series of sutures. Removing large portions of the meniscus will lead to expedited degeneration of the joint cartilage (aka- arthritis). Postoperative rehabilitation is at your surgeon’s discretion.
Can I shower after surgery?
If you have a bulky dry dressing you can remove it on postop day #3; you may then shower allowing water to run over steri-strips or sutures; towel pat dry and keep clean; NO soaking or submerging operative body part. If you have a waterproof dressing, please leave it on until you follow up in the office. You can shower over the dressing, no soaking or submerging the shoulder
How long do I need to wear the compression stockings?
Dr. Liu wants you to keep the compression stockings on for 3 weeks. Compression stockings are the best way to help the swelling to go down after surgery.
Should I use ice or heat?
Ice can provide analgesic effects and control swelling for the first 3-5 days; after that we recommend ice after exercises or PT.
How do I use an ice machine or CPM?
if either device is part of your recovery, treat this as an assistance to your recovery. Use either as directed, allowing only the machine to move or do the work. Remember, you should not be doing the work or moving the operative body part on your own.
How do I decrease my pain after surgery?
You may take your pain medication as prescribed; if pain continues, you may add ibuprofen or naproxen in between pain medication doses: (8am pain med, 10am ibuprofen 600-800mg or naproxen 500mg, 12p pain med).
Who schedules my first post operative appointment?
You are responsible for scheduling this appointment. This can be done prior to your surgery or within 1-3 days following. Please call the office, at 702-740-5327, provide your date of surgery, and you will be provided your appointment time and date.
When can I drive?
This depends on your surgery. Please wait until your first post op visit to discuss with your provider.
When can I go swimming?
Please wait at least 4 weeks until you submerge your incision into baths or pools. When your incision is submerged, it can open up and increase risk of infection. We ask that you wait 4 weeks when the incision is healed to soak in tubs or pools.
When do I start Physical Therapy?
Physical Therapy will be discussed at your first postoperative visit 10-14 days after surgery.
I have questions that have not been answered.
Please re-read your postoperative instructions handout. If questions remain, please contact the surgery line that has been provided to you on your post surgical handout.