Tuesday, May 21, 2024

How To Treat Knee Meniscus Tear With Arthritis

How The Recommendation Was Created

Knee Osteoarthritis and Degenerative Meniscus Tears – Brian Feeley, MD

A randomised controlled trial published in The BMJ in June 2016 found that, among patients with a degenerative medial meniscus tear, knee arthroscopy was no better than exercise therapy. This study adds to the body of evidence suggesting that the benefits of arthroscopy may not outweigh the burden and risks. The RapidRecs executive felt that the study, when considered in context of the full body of evidence, might change practice.

Our international panel including orthopaedic surgeons, a rheumatologist, physiotherapists, a general practitioner, general internists, epidemiologists, methodologists, and people with lived experience of degenerative knee disease met to discuss the evidence. No person had financial conflicts of interest intellectual and professional conflicts were minimised and managed .

The panel followed the BMJ Rapid Recommendations procedures for creating a trustworthy recommendation and used the GRADE approach to critically appraise the evidence and create recommendations . The panel considered the balance of benefits, harms, and burdens of the procedure, the quality of evidence for each outcome, typical and expected variations in patient values and preferences, and acceptability. Recommendations can be strong or weak, for or against a course of action.

Is It Worth Having Meniscus Surgery

What are benefits? Tears in the knee can be repaired, which usually relieves symptoms by 85% of the time. According to the data, 100 people who have this surgery have pain relief and can use their knees normally, while 85 others cannot. Tears can be repaired to minimize the risk of long-term joint problems.

Most Patients Able To Return To Regular Activities Within 4-5 Months After Meniscus Surgery

It is not possible to predict when the knee will fully heal following knee surgery. A majority of patients, however, can return to their normal lives within four months. It is critical that you strictly follow your doctors instructions after surgery, as any deviation from them can lead to re-injury. You should be patient and allow your body time to heal after surgery, as you would any other procedure.

Meniscal Tears And Osteoarthritis: Whats The Risk

May 31, 2017

In an earlier blog post, we discussed meniscal tears, which are actually a very common knee injury. You often hear about athletes suffering from these, due to their twisting and turning quickly, with one or both knees bent while playing a sport or lifting a weight. However, the truth is that any individual at any age can tear a meniscus.

The meniscus is the cartilage between the three bones that come together to form your knee joint: the femur , tibia , and patella . These bones form three knee compartments, with each compartment named after the two bones that join that compartment of the knee:

Medial femoro-tibial compartment

Lateral femoro-tibial compartment

Patellofemoral compartment

Several studies have shown that a meniscal tear can lead to knee osteoarthritis , which can affect one or all of these compartments. It typically starts in one compartment and can, over time, spread to others. When all three compartments are affected, its called tricompartmental osteoarthritis. This form of arthritis tends to be more common in older adults, as it represents an advanced progression of the disease.

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Meniscal Tears The Treatment Conundrum

Although there is a paucity of evidence examining the efficacy of treatments available for meniscal tears, there are some commonalities emerging from both RCTs and observational studies.

Overwhelming evidence has demonstrated the poor long-term outcomes from total menisectomy, and this procedure should be considered a procedure of yesteryear . All APM, meniscal repair and physical therapy have been shown to be associated with symptom improvement, although there are conflicting data regarding the comparative superiority of the surgical versus the conservative approach. While one RCT demonstrated that APM was superior to conservative measures, the between-group comparison was limited by a small number of subjects who were young . The other four larger RCTs have examined older subjects and have failed to demonstrate superiority of APM over conservative measures . This discrepancy between studies may be attributable to the different ages of the cohort.

Finally, studies have predominantly defined outcome on the basis of symptoms. There is no clear evidence as to whether the risk of developing knee OA, or showing increased progression of knee OA, is affected by surgical intervention comprising either APM or meniscal repair. Determining whether these procedures influence structural progression will be important in helping to understand whether such procedures impart deleterious structural changes.

Treatments For A Meniscal Tear Without Surgery

Knee Ice Pack Wrap  Cold Therapy with Adjustable Compression Support ...
  • If you go to most pain practices if you fail physical therapy and surgery is not recommended, they may recommend a steroid injection, which can help temporarily reduce inflammation in and around the knee and meniscus, but this is not advised as steroids as we know can cause damage to the joint cartilage, inhibit healing, and has a host of other negative side effects.
  • An injection of something called hyaluronic acid, which is a naturally occuring substance that makes up part of the lubricating fluid of the knee joint, could be used for temporary pain relief. It does not help repair the area but may provide a few months of symptomatic benefit if there is not severe arthritis in the knee.
  • If you actually want to try and get the body to heal that meniscus on its own when rest and physical therapy has not do the job, PRP has excellent evidence that it helps with meniscal injuries as well as mild to moderate arthritis that can be associated with these issues. PRP, when used in the right hands, should be injected precisely with ultrasound guidance into the torn parts of the meniscus, into any ligaments or tendons that may be injured or loose, and into the knee joint itself for optimal results. Many practitioners just inject into the knee, which still can help quite a bit but not as much as if a more thorough approach is taken. There are more than 25 high level studies showing PRP helps with knee pain ).
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    What Questions Should I Ask My Doctor

    You may want to ask your healthcare provider:

    • How severe is the tear in my meniscus?
    • Is the tear likely to heal on its own?
    • Will I need physical therapy?
    • Do I need surgery to repair or remove the torn meniscus?
    • When will I be able to get back to full activity?
    • What are signs the injury is getting worse instead of healing?

    A note from Cleveland Clinic

    A torn meniscus is a very common knee injury. It usually results from twisting your knee suddenly. It can happen playing sports, exercising or just doing daily activities. Small tears often heal on their own, while others may require arthroscopic surgery. Most people fully recover from a torn meniscus and can get back to doing their favorite activities without knee pain.

    Last reviewed by a Cleveland Clinic medical professional on 04/17/2021.

    References

    Do I Need To See A Doctor

  • Yes, you should see an orthopedic physician. A physician can check out your knee and tell you how bad the tear is. Depending on how bad the injury is, your doctor might recommend at-home treatments, or suggest getting surgery to fix the tear.XResearch source
  • During your appointment, your doctor might see how much you can move your knee, and see if your knee feels sore or tender. They might also do an MRI or X-ray to get a better idea of where the tear is.
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    The Role Of Rehabilitation

    Approximately 750,000 of knee meniscus surgeries are performed each year in the United States. Rehabilitation is a critical part of recovery. Physical rehabilitation programs following surgery typically include physical therapy exercises, which work to strengthen leg muscles for better support for your knee joint. For patients who undergo a partial meniscectomy, the recovery period is typically longer due to the time it takes for the cartilage tear to completely heal. Rehabilitation exercises have to be on hold until the cartilage has healed. It usually takes about three months to complete rehabilitation for a partial meniscectomy, whereas for a total meniscectomy, recovery is typically shorter.

    Meniscus Tears And Arthritis

    Watch a Knee Surgeon Treat a Meniscal Tear

    Many meniscus tears do not cause pain or other symptoms and are only diagnosed during evaluation for another knee problem. About 30% of people over the age of 40 who think they have a normal knee find out they have an abnormal meniscus when they have an X-ray, says Dr. Benner.

    If X-rays show knee osteoarthritis, its difficult to determine whether symptoms are from this or a meniscus tear. Arthroscopic surgery wont relieve knee osteoarthritis. Its become clear over the last few decades that arthroscopic surgery for arthritis does not work and should not be done, even if the patient has a meniscus tear, says Dr. Benner.

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    Torn Meniscus: How To Avoid Further Injury And When To Resume Activities

    In the case of a torn kneecap, avoid further swelling and allow the pain to go away as soon as possible. Most activities should be able to resume within 2 to 3 months, but it will take some time. If you have a torn meniscus, it will usually take between six and eight weeks for you to return to most activities.

    How Do I Know If I Have A Torn Meniscus

  • 1You cant move your knee as much. After a meniscus tear, you might not be able to straighten or rotate your knee like you normally would. You might also feel like your knee is locked, or that it cant support your weight.XTrustworthy SourceMayo ClinicEducational website from one of the world’s leading hospitalsGo to source
  • 2Your knee is really sore. Pay attention to your regular, daily movements, like climbing out of bed or walking down the street. With a meniscus tear, your knee might feel painful, swollen, and/or extra stiff. You might also feel like your knee is popping.XTrustworthy SourceMayo ClinicEducational website from one of the world’s leading hospitalsGo to source
  • The pain may be especially obvious when you rotate or twist your knee.
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    When To See A Doctor

    See your doctor if you experience any of the following symptoms after a suspected meniscal tear:

    • locking of the joint, which can indicate a portion of damaged tissue is lodged in the knee joint
    • extreme swelling of the knee joint that makes the knee hard to move
    • extreme pain with moving the knee joint
    • knee buckling or difficulty putting weight on the knee

    You should also see your doctor if any of your symptoms worsen over time.

    In some cases, a doctor may not be able to repair the meniscus. Instead, they may recommend removing damaged areas of tissue. This can reduce discomfort and movement restrictions.

    Introduction To The Knee

    PowerLix Compression Knee Sleeve

    The knee is the largest joint in the body. The knee allows the leg to bend where the femur attaches to the tibia . The knee flexes and extends, allowing the body to perform many activities, from walking and running to climbing and squatting. There are a variety of structures that surround the knee and allow it to bend and that protect the knee joint from injury.

    The quadriceps and hamstring muscles are responsible for moving the knee joint. When the quadriceps muscles contract, the knee extends or straightens. The hamstring muscles, located on the back of the thigh, are responsible for flexing or bending the knee. These muscles are also important in protecting the knee from being injured by acting to stabilize the knee and preventing it from being pushed in directions that it isnât meant to go.

    There are four ligaments that also stabilize the knee joint at rest and during movement: the medical and lateral collateral ligaments and the anterior and posterior cruciate ligaments .

    Cartilage within the joint provides the cushioning to protect the bones from the routine stresses of walking, running, and climbing. The medial and lateral meniscus are two thicker wedge-shaped pads of cartilage attached to top of the tibia , called the tibial plateau. Each meniscus is curved in a C-shape, with the front part of the cartilage called the anterior horn and the back part called the posterior horn.

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    Questions To Help Figure Out Your Knee Pain Cause

    The following questions can help you get a better handle on the source of the pain in your knee to determine if youâre suffering from arthritis or a torn meniscus. This will not lead you to a diagnosis, however. When experiencing any kind of unusual pain, always visit a Beacon specialist to get an official diagnosis and establish a plan of care.

    #1 When did your knee pain begin?The biggest difference between having a torn meniscus and arthritis is if the pain started over a period of time, suddenly or after an injury. Arthritis-related pain typically continues to increase over time and canât be narrowed down to a specific injury. On the flipside, sudden knee pain is usually a sign of a torn meniscus.

    #2 Whatâs your pain type?Dull and/or constant pain typically accompanies arthritis, and meniscus tears often cause sharp pain right after sustaining a traumatic injury. In the latter, rest can help. It might go away and then return after turning the wrong way. The sides of your knee are likely to become tender, too.

    #3 How old are you?Age is a big factor in the likelihood of your knee pain cause. Arthritis is more likely to happen in older adults. A torn meniscus can happen at any age, although itâs more likely to happen to younger, more active people.

    BONUS! Have you tried the Thessaly Test?The Thessaly Test is a method used to diagnose a torn meniscus, which you can do at home.

    Nonsurgical Treatment For A Meniscus Tear

    Treatment depends on the size, type, and location of the tear, but nonsurgical treatments are often used to treat the injury initially. They include the following:

    Rest

    Some meniscus tears improve over time with rest, activity restriction, and keeping the knee and leg elevated when possible. It is particularly important to avoid activities that involve twisting, rotating, or pivoting the knee in any way. Walking aids such as crutches may be recommended to take pressure off of the knee and to promote healing.

    Using a cold compress or ice pack can help to reduce swelling and pain in the knee. Elevate the knee and leg, wrap the ice pack in a towel , and place the wrapped ice pack on top of the injured area of the knee for 15 minutes at a time. Do this four times per day.

    If the ice pack is too cold to the point of causing pain, remove it right away. It should feel numbing and soothing, but not painful in any way.

    Medication

    Over-the-counter pain-relief medications may help to relieve the knee pain and to reduce inflammation while the cartilage heals. However, taking too much can cause liver damage, so talk to your orthopedist about which medicine would be best while your knee heals.

    PRP Therapy

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    How Can I Prevent A Meniscus Tear

    Meniscus tears are tough to prevent since they’re usually the result of an accident. But some precautions might lower the risks of a knee injury. You should:

    • Keep your thigh muscles strong with regular exercises.
    • Warm up with light activities before taking part
    • Give your body time to rest between workouts. Fatigued muscles can increase your risk of injury.
    • Make sure your shoes have enough support and fit correctly.
    • Maintain flexibility.
    • Never abruptly increase the intensity of your workout. Make changes slowly.

    Show Sources

    Comprehensive Meniscus Tear Diagnosis

    Meniscus Tears – Everything you need to know

    To diagnose a meniscus tear, we will first ask you about your symptoms. We may also order diagnostic tests including:

    • Movement tests: We will move your knee and leg in different directions and ask you to squat and walk. These activities help us pinpoint the location of the meniscus tear.
    • Imaging tests: We may use X-rays to rule out other conditions that are causing the knee pain. A magnetic resonance image scan can provide detailed pictures of soft tissue, like your meniscus, to confirm a diagnosis.
    • Arthroscopic procedure: We may perform this minimally invasive procedure to help diagnose a meniscus tear. Well make a tiny incision in your knee and insert an arthroscope, a thin instrument with a camera. The arthroscope gives us an enlarged, detailed picture of your knee anatomy.

    At Aurora, youll get a prompt, precise diagnosis from a team of experts, so you can get the treatment you need. Learn more about our orthopedic diagnosis process.

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    What Causes A Meniscus To Tear

    A forceful twist or sudden stop can cause the end of the femur to grind into the top of the tibia, pinching and potentially tearing the cartilage of the meniscus. This knee injury can also occur with deep squatting or kneeling, especially when lifting a heavyweight. Meniscus tear injuries often occur during athletic activities, especially in contact sports like football and hockey. Motions that require pivoting and sudden stops, in sports like tennis, basketball, and golf, can also cause meniscus damage. The sports injury does not have to occur during a game but can also occur in practice, where the same motions lead to meniscus damage.

    The risk of developing a torn meniscus increases with age because cartilage begins to gradually wear out, losing its blood supply and its resilience. Increasing body weight also puts more stress on the meniscus. Routine daily activities like walking and climbing stairs increase the potential for wear, degeneration, and tearing. It is estimated that six out of 10 patients older than 65 years have a degenerative meniscus tear. Many of these tears may never cause problems.

    Because some of the fibers of the cartilage are interconnected with those of the ligaments that surround the knee, meniscus injuries may be associated with tears of the collateral and cruciate ligaments, depending upon the mechanism of injury.

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