Posts Tagged ‘torn meniscus’

Torn Meniscus and Torn Meniscus Surgery

Torn MeniscusWhen people talk about torn cartilage in the knee, they are usually referring to a torn meniscus. The meniscus is a rubbery, C-shaped disc that cushions your knee and acts as a shock absorber between your thighbone and shinbone. Each knee has two menisci, which help to keep your knee steady by balancing your weight across the knee.

Any person at any time can tear their meniscus, but athletes—particularly those who play contact sports—tend to be at a higher risk, the reason being that a meniscus tear is usually caused by twisting or turning quickly, often with the foot planted while the knee is bent. Players may squat and twist the knee, causing a tear.

As you get older, your meniscus gets worn which can make it tear more easily. Cartilage weakens and wears thin over time, increasing the likelihood of degenerative meniscal tears. One awkward twist when getting up from a chair may be enough to cause a tear, if the menisci have weakened with age.

Torn Meniscus Symptoms
Depending on the severity of the tear, symptoms will vary. Typically meniscal tears are categorized into three groups: minor, moderate and major tears. Generally, most people can still walk on their injured knee after a meniscal tear, but you may feel a “pop” when you tear a meniscus. Often athletes will keep playing with a tear, but over the course of two to three days the knee will likely become stiff and swollen.

Common symptoms of meniscal tears include the following:

  • Feeling a “pop” in the knee
  • Pain
  • Stiffness and swelling
  • Inability to move knee through full range of motion (such as not being able to straighten the knee)
  • Catching or locking of the knee
  • The sensation of the knee feeling “wobbly” or giving way without warning

In severe tears and those without proper treatment, a piece of meniscus may come loose and drift into the joint, causing your knee to slip, pop, or catch.

Torn Meniscus Diagnosis and Treatment
When diagnosing a meniscal tear, doctors will often perform what is known as a McMurray test. Your doctor will bend your knee, then straighten and rotate it. This puts tension on a torn meniscus. If you have a meniscal tear, this movement will cause a clicking sound. Your doctor may also order imaging tests such as an X-ray or MRI to confirm the meniscal tear.

How your doctor treats your meniscus tear depends on several things, such as the type of tear, where it is, and how serious it is. Your age and how active you are may also affect your treatment choices.

Common treatments include:

  • Rest
  • Ice
  • Physical therapy
  • Non-steroidal anti-inflammatory medicines (such as aspirin or ibuprofen)
  • Surgery

Surgical Treatment
Whenever possible, meniscus surgery is done using arthroscopy, rather than through a large cut in the knee. Knee arthroscopy is a commonly performed surgical procedure in which a miniature camera is inserted through a small incision to better view the knee. Your orthopaedic surgeon will then insert miniature surgical instruments through other small incisions to trim or repair the tear.

Depending on the tear, a variety of procedures can be done:

  • Meniscectomy. In this procedure, the damaged meniscal tissue is trimmed away (partial meniscectomy) or, in extreme cases, the entire meniscus will be removed (total meniscectomy). Total meniscectomy procedures are typically avoided because of the likelihood of causing osteoarthritis in the knee.
  • Meniscus repair. Some meniscal tears can be repaired by suturing (stitching) the torn pieces together.

It is preferable to preserve as much of the meniscus as possible. If the meniscus can be repaired successfully, saving the injured meniscus by doing a meniscal repair reduces the occurrence of knee joint degeneration compared with partial or total removal.

Recovery / Rehabilitation
How well the knee will heal depends on how bad the tear is. After surgery, your doctor may put your knee in a cast or brace to keep it from moving, and you may need to be on crutches for a period of time to keep weight off the knee. Your doctor will work with you on a rehabilitation program that helps you regain as much strength and flexibility as possible.

About Dr. Pombo

Mathew Pombo, MDMathew Pombo, MD, is a highly regarded orthopaedic surgeon, speaker, author and researcher who specializes in getting patients with injuries back to an active lifestyle. His professional interests include anatomic single and double bundle ACL reconstruction, rotator cuff tears, shoulder instability, meniscal/cartilage injury and repair, joint preservation in the aging athlete, and minimally invasive joint replacement surgery of the knee and shoulder. Dr. Pombo has conducted extensive scientific research, published multiple journal articles, written several book chapters, and has presented both at national and international meetings on topics related to sports medicine, concussions, and orthopaedic surgery. He is a member of several design teams for orthopaedic companies and enjoys participating in the engineering of the next generation of orthopaedic techniques and equipment. He has been instrumental in bringing awareness to Sports Related Concussions and the new Georgia “Return to Play” Act and is one of the top regarded experts in the area for the treatment of Concussions. He currently serves as the Director of the Emory Sports Concussion Program.

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When Doctors Operate on Doctors

A Chat with Dr. Sameh Labib and Dr. John W. Xerogeanes

Four years ago, Dr. X, a popular surgeon at Emory Sports Medicine, suffered a knee injury that required surgery. Who did he turn to? Dr. Sameh Labib of Emory Sports Medicine. The two doctors recently chatted about the surgery and recovery.

DR. X: I started to have back pain when I turned 40. Around that time, the football and basketball teams we treat at Georgia Tech were doing yoga classes with Diamond Dallas Page, the former wrestler. They all told me that it helped their flexibility and joint pains. I started taking the class once a week. As promised, I felt better and the back pain went away.

One year later, my wife was making fun of me for being the “Yogi Kudu.” (For those around my age, you might remember him as the yoga practitioner who made appearances in the 1980s on the TV show “That’s Incredible,” folding his six-foot frame inside small glass boxes.) In playful response to my wife’s comment, I showed her a new pigeon pose. Upon transitioning from one pose to another, I heard a pop in the knee and I had pain.

When the pain continued, I had an MRI, which showed a meniscal tear. To others who might have suffered this injury: When you tear your meniscus, you twist and feel sharp pain on the side of your knee—this is sometimes accompanied by a click.

DR. LABIB: Yoga is not a common cause of knee injuries. Football, basketball, soccer and tennis injuries are much more common. It’s best to have an experienced yoga instructor guiding you to avoid injury. Meniscus injuries usually happen due to twisting and pivoting. In yoga, it happens due to excessive knee bending or flexing with certain poses, such as the lotus pose.

When John injured himself, I remember thinking that doing knee surgery on the busiest knee surgeon at Emory was going to be a challenge! As you may know, sometimes doctors make the worst patients, and they can be noncompliant – as doctors, we tend to think that we’re bulletproof.

For that reason, I try to treat my “doctor” patients exactly as I treat everyone else and hope for them to follow instructions. Is this wishful thinking? Naive? Of course, there is also the “Doctor Curse,” where all the weird complications happen.

With the above in mind, I agreed to do John’s surgery. It went great and, to my surprise, he was very cooperative.

DR. X: My wife told me to listen to Sam, period! It still did not get me out of doing household chores …

Actually, it was no problem being operated on by someone else. The good thing about being a knee surgeon is that you KNOW who you think is the best guy to fix you. Thus, I had Sam take care of me.

If I hadn’t gotten surgery, I would have continued to experience pain. Doing athletic activities would have been painful, and the bending of my knee would be limited. Since I’m an athletic person, this wasn’t an option for me. I wanted to get better.

DR. LABIB: Once the surgery was complete, I told John to ice, elevate and avoid prolonged standing or walking for the first week or so. Also, he needed to start early motion.

I recommend making a gradual return to low-impact sports such as cycling and stepping. Swimming is allowed after the wounds have healed (approximately three weeks after). Knee swelling and stiffness are common in patients. Usually patients see that the incisions are small, and they feel good after the procedure so they end up “overdoing” it. We are often telling our patients to slow down and let the inside heal before they increase their activity. Three to four weeks are often needed before they can return to their sport.

I’m happy that John was a great patient. His knee has healed and he’s doing yoga again. I hope other doctors follow his example!

About Shaina Lane, MEd, ATC, LAT, OTC:

In 2006, Shaina applied and was accepted to the Emory Sports Medicine-Ossur Fellowship. She spent that year working alongside the physicians at Emory Sports Medicine, enhancing her clinical evaluation skills as well as learning how to assist in the operating room. After the fellowship, she spent several months working at a private practice in Tennessee before returning to Emory Healthcare as a clinical coordinator in the sports medicine department and program coordinator for the Emory Sports Medicine-Ossur Athletic Training Fellowship.