A meniscal tear is a common injury of the knee. The meniscus is a crescent – shaped cartilaginous structure that provides a cushion to your knee. Each knee has two menisci – one at the outer edge(lateral) and one at the inner edge(medial) and function to keep the knee steady by balancing weight across the knee. Another function of the meniscus is to lubricate the knee joint. Both menisci are located between the femur bone and the tibia bone.
In sports, people sometimes use the word ‘torn cartilage’ which means they have a meniscal tear. It refers to an injury to any one of the menisci which may occur from twisting or turning while your feet are planted. As you get older, the meniscus can potentially weaken over time and is easily prone to tear.
The most common sports associated with knee injuries of this kind are football, volleyball, and skiing.
Causes of Meniscal Tears
Meniscal tears often happen during sports particularly in athletes. Players may squat and twist the knee forcing the ligament to tear. Sometimes there can be a direct blow on the knee joint which may cause the meniscus to tear. Football and soccer players often have to plant their feet to make various athletic moves on the field. Unfortunately, when these players get hit with their feet planted, this type of injury can occur.
As stated earlier, the elderly are also more prone to meniscal tears, but in this population, it is not because of sports, but due to degenerative wear and tear of the meniscus.
Meniscal Tear Symptoms
Meniscal tears can be categorized into three types. It can be minor, moderate, or severe. In minor cases, there is a little pain and swelling which goes away in few weeks on its own. A moderately torn meniscus can cause pain at the middle of knee or on the medial or lateral side. There is sharp pain and difficulty bending the knee. If movement is restricted, these symptoms can disappear in a few weeks, but may again reappear if you overuse the knee. If the tear is severe, pieces of torn meniscus can move into the joint space and can interfere with your knee joint range of motion. You may not be able to flex or extend your knee.
You should contact an orthopedic surgeon if you hear and audible pop followed by pain and swelling around the knee joint.
Meniscal Tear Diagnosis
Your doctor may ask you how the injury occurred and how long you have had pain. He may ask you to locate the area. He will examine the area, press on it to see if it hurts you, and he may ask you what movements aggravate the injury. He may also ask for an x-ray of the affected portion or order a MRI (magnetic resonance imaging). A MRI would be able to create better images of the soft tissues of knee joint.
One of the commonly done tests to diagnose a meniscal tear is the McMurray test. Your doctor will bend your knee, then straighten and rotate it. While he does this, it puts tension on the torn meniscus and if there is a tear, this movement will cause a clicking sound. If you have a tear in the meniscus, your knee will click each time your doctor performs the test on you.
Meniscal Tear Treatment
Treating A meniscal tear generally depends on its severity, your age and how active you are. To start with, home treatment may be given if the injury is not too serious. This includes plenty of rest, application of ice on the area, wrapping the knee with elastic bandage, and elevating the leg.
If this does not work, your physiotherapist may suggest some physiotherapy. If this too doesn’t work then surgery may be carried out either to repair the meniscus or remove it. Small tears generally heal with physiotherapy and home treatment. Larger tears may require a certain surgical procedure called a knee arthroscopy.
After surgery, your doctor may put your knee in a cast or brace to prevent it from moving and he may ask you to do some exercises at home. You may start with exercises to improve the bending and flexing of the knee.
Meniscal tears are an extremely common knee injury and with correct diagnosis and treatment, patients often return to their normal sports life.
Recovery depends upon the age of the patient, activity of the patient, severity of the tear, and the type of surgery performed to repair it.
On average, it takes about 4 – 6 weeks for the patient to recover completely from the meniscus surgery. In cases of minor surgery, he may be able to walk on his own and resume his work within a month’s time, but it may take longer than 2 months for the muscles to regain their full strength and therefore strenuous activities can only be resumed after 2 months of proper rest and care.
PRP Treatment for Meniscus Tears
Traditional surgical treatments for meniscal tear injury have certain limitations and little long-term benefits. There is definitely a short term plan for treating meniscus tears such as pain control, but in the long term, pain and instability may persist. This is because the meniscus, especially the inner meniscus, is poor in blood supply, therefore subject to poor healing. This has prompted researchers to investigate the method of providing blood supply to injured area and promoting regeneration of the injured tissue.
Growth factors play a role in the natural process of healing, therefore injecting concentrated growth factors to the site of injury can potentially cause new cell growth and promote healing.
Platelet rich plasma (PRP) is a unique in-office procedure of injecting concentrated platelets and growth factors into the site of injury to promote and accelerate healing of this specific injury.
It is a good alternative to surgery.
Procedure
This form of treatment can be performed in any medical setting, but it’s most commonly done in an outpatient surgery center or doctors clinic. This method of healing uses the patient’s own blood drawn by a nurse or perfusionist. Approximately 20cc-60cc of blood is drawn from the patient and placed in a special test tube/process disposable. The blood is then placed in a special machine called a centrifuge. When the machine begins, it will quickley spin the test tube/process disposable for about 15 minutes. When finished, the centrifuge has separated the concentrated platelets from the red blood cells. 3-10cc’s of PRP has been created. The test tube/process disposable is then taken out of the centrifuge and placed on a flat surface. A special syringe is used to extract the prp from the container and placed on a sterile field. The PRP is now ready to be injected into the injury site. Before injecting, the area of injury may need to be locally anesthesized to reduce pain associated with the injection.
To ensure the accuracy of the placement of the platelet rich plasma, a diagnostic ultrasound should be used. A needle is then attached to a syringe containing the PRP and is guided by ultrasound into the areas of injury. After the procedure, a simple Band-Aid is applied. Because there is no surgical incision created, you may have little to no pain immediately following the injection. You may have moderate discomfort days after surgery. The discomfort is due to the normal inflammatory process your body goes through when it’s healing.
Since the concentrated platelets are directly injected to the injury site, the increased presence of these platelets and growth factors has been shown to potentially regenerate the meniscus and thus aid in healing.
As you can see, PRP can be a potential form of treatment to avoid surgery. It is a nonsurgical, outpatient procedure with little to no risk of infection at the injection site and requires no general anesthesia. Its use has largely increased in recent years. The major advantage of this therapy is the use of patient’s own blood, hence there is no risk of any communicable infections and rarely any danger of having an allergic reactions.
An Injection of PRP treats the entire area, not only the torn meniscus, but also the surrounding weakened ligaments/tendons that most likely lead to the joint instability.
Post procedure
As stated earlier, you may notice some discomfort in the area of the injection that can last up to a few days, but it is temporary and is because of an inflammatory response which has just been stimulated.
When home, you can use ice over the injected area, elevate the leg, and limit physical activities, Your doctor may prescribe some analgesics to relieve pain, but not an anti-inflammatory medication because the treatment is designed to set up an inflammatory response, so you don’t want to stop that process with medications.
Many patients usually respond after their first treatment, but a follow up is generally scheduled four to six weeks after the injection to evaluate the patient’s progress. Some patients may need up to two to six treatments to completely heal the injury.
Cost
As compared to surgery, PRP treatment for Meniscal Tears can potentially be cost effective. The cost of PRP treatment is around $250-$500 per session. You will have to check with your insurance provider to see what they will cover for a PRP injection treatment.
During the time you are getting treated with PRP, you can still work and earn money, but if you opt for surgery, you may need to be off work and therefore are losing salary/pay.
Questions you may like to ask your doctor
- How soon after the first treatment can I start activity/sports when I have a meniscal tear?
- How many days/months will it take for complete recovery after injection?
- What kind of exercise should I limit?
- Do I need to be hospitalized for a meniscal tear?
- Is the procedure painful?
- What kind of medications should I avoid after the procedure and for how many days?
- Are there any side effects to this procedure?
- What advantages does this procedure have over surgery?
- What is the cost associated with PRP procedure?
- Is it covered by insurance?
Meniscal Tear Prevention
Use of proper technique while exercising or playing sports may help prevent a tear. However, many cases may not be preventable.
Meniscal Tear Complications
Having a Torn meniscus can severely hamper your quality of life. Surgery performed to repair the injury can lead to possible complications like stiffness of the knee after surgery or continued pain. There also can be infection, bleeding, and nerve damage at the surgery site.
Meniscal Tear FAQ
- What is a meniscus and how does it tear?
- How do I know that my meniscus has torn?
- Will there be a damage to my knee?
- How will I be treated and will I be perfectly fine after treatment?
- how can I care for my knee?
