PT Perspective

with Jason Lau, Doctor of Physical Therapy

Question: 

I have a meniscus tear. Do I need to have a surgery?

Answer:

 It is often assumed that all meniscus tears require a surgical solution. In reality, it depends on the degree of the tear. The meniscus forms the bottom pad of the knee joint and the articular cartilage is the top pad. Meniscus injuries can come in many shapes and sizes and at varying degrees. 

The key deciding factor of whether to choose surgery or not should be function. Can you engage in your chosen activities with minimal disability? If so, there is a possibility that the severity of your tear is low, and you can recover with inflammation control and strengthening. However, if the severity of the tear is high, then likely the inflammation is causing frequent pain and weakness. Another common symptom of a significant tear is locking in the knee. People with knee locking describe their knee as being stuck in a bent position and not being able to have full range of motion until they unlock their knee with a random movement. In short if you have frequent pain and swelling that doesn’t calm down with anti-inflammatory remedies and if your knee locks often, consult your doctor regarding a surgery.

Since a meniscus tear is a structural injury, why not just have the surgery to get to the root of the issue? This brings us back to the severity factor; if your meniscus tear is only 1mm long, it would not be worth the trauma it takes to puncture your knee and go into the knee to repair a small tear like that. In other words, the trauma of the surgery could cause more issues than the actual injury itself. 

Sometimes people decide on having the surgery because they don’t want to go through the process of strengthening their knee. However, the road to recovery from a low severity meniscus tear and post-surgical arthroscopic knee surgery (to repair the meniscus) is the same.   The road to preventative care to avoid future meniscus problems is also the same. It all boils down to strengthening. 

The more strength and muscle you have surrounding your knee joint, the less likely the knee will misalign during activities that demand loading the knee at different angles like basketball. The better the knee stays in line, the less likely your meniscus will injure. Strengthening the knee joint muscles is only one aspect of many for prevention. The other equally important areas to strengthen are the hips, ankles and feet. Consult your physical therapist regarding the full scope of exercises to prevent meniscus injuries.

Your meniscus is like the eraser on a yellow number 2 pencil. Once you have used it up, it is gone. At that point, your only option is total knee replacement. Do your best to take care of your knees and they will take care of you.   

Submit your questions for future PT Perspective columns to Jason Lau, Doctor of Physical Therapy at jasonlaudpt@gmail.com