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Meniscus Tear

The meniscus is a C-shaped piece of tough cartilage located in the knee, that acts as a shock absorber between the shinbone and the thighbone. There are two menisci within each knee. The meniscus on the inside part of the knee is known as the medial meniscus and the meniscus located on the outside of the knee is referred to as the lateral meniscus. A meniscus tear may be the result of an acute injury to the knee, or degeneration as a result of many years of wear and tear. The tear most frequently occurs when the knee is bent and then twisted. Menisci have very poor ability to heal due to their limited blood supply.

Symptoms of a Meniscus Tear

Meniscus tears are usually defined by a distinctive popping or clicking sensation when the injury occurs. Most people will still be able to walk or play a sport using their injured knee, but the knee typically becomes swollen and stiff within a few days. The most common symptoms of meniscus tears include:

  • Persistent pain whenever the knee is moved or twisted
  • Stiffness
  • Swelling
  • Inability to fully straighten the knee

A torn meniscus may also be accompanied by joint that frequently locks in place and the inability to completely straighten the knee.

Diagnosis of a Meniscus Tear

A meniscus tear is typically diagnosed after a complete evaluation of the patient’s symptoms is conducted and a medical history obtained. The knee will be examined for tenderness along the joint line, which usually signifies the presence of a meniscus tear.

Several diagnostic tests will generally follow to confirm the tear. One commonly used evaluation tool is the McMurray test, in which the knee is bent, straightened and moved around in a circular fashion by the doctor. The circular motion places added tension on the meniscus and causes an audible clicking sound, enabling the doctor to diagnose the tear. Imaging tests, such as X-rays or an MRI or CT scan, may also be needed to obtain a view of the torn meniscus.

Treatment for a Meniscus Tear

If left untreated, a meniscus tear may result in a portion of the cartilage becoming loose and moving into the joint, causing the knee to slip out of place. Treatment usually depends on the severity of the tear and its exact location. Initial treatment methods for meniscus tears are generally conservative, such as placing ice on the knee, taking anti-inflammatory medications and elevating the knee to reduce swelling. Physical therapy is frequently utilized to help reduce swelling and pain, and improve strength, flexibility, and function.

If symptoms continue despite these conservative measures, surgery may be necessary. Minimally invasive knee arthroscopy is one of the most commonly performed procedures to treat the condition. During this procedure a camera known as an arthroscope is inserted into the knee through a small incision. Small surgical instruments will be used to perform either a meniscus repair, which focuses on suturing the torn edges of the meniscus together to promote healing, or a meniscectomy, during which damaged meniscal tissue is trimmed away. Very few meniscus tears are amenable to meniscal repair.

Physical therapy may also be effective at strengthening the muscles that support the knee joint. If these treatments are not effective and symptoms continue, meniscus surgery may be recommended. Meniscectomy is an arthroscopic surgery performed by orthopedic surgeons to remove the torn segment of the meniscus. A physical therapy program is also effective after surgery to strengthen muscles and help the patient regain full mobility.

If the meniscus is sutured back together, crutches will be utilized for a much longer period of time to protect the repaired meniscus. More extensive physical therapy will be utilized as well.

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Rotator Cuff Injuries

Four muscles in the shoulder that when injured or damaged can lead to sleepless nights, pain, and weakness.

The most common ways of injury to the rotator cuff are trauma, such as a fall on the outstretched hand, repetitive overload to the tendon by activity, or bone spurs cutting into the tendon.

Symptoms commonly begin with pain over the upper arm that is worse with reaching overhead, lying on your side, reaching behind your back, and weakness.

The rotator cuff has a very limited capacity to heal on its own and therefore treatment is often required to improve symptoms. This usually begins with a short period of rest, followed by a rehabilitation program focused on mobility, and strength to improve function. Steroid injection can be used if significant inflammation is present and interferes with the ability to engage in the exercise program. Two thirds of patients will improve with these modalities alone, and thus this is the first phase of treatment.

If symptoms persist, MRI is utilized to evaluate the rotator cuff for tears. Most commonly injured is the supraspinatus tendon. This is the muscle that allows you to put on a jacket, reach into the kitchen cabinet and get out the dishes, put a gallon of milk in the refrigerator, or pour a pot of coffee. Because the tendon is spring loaded, full tears commonly separate or retract. The more the retraction, the more serious the tear. If these tears are not addressed, atrophy will ensue and the tears will frequently get larger over time.

Surgical repair is performed arthroscopically and consists of stretching the tendon back out to it’s attachment point and repairing it back to the humerus greater tuberosity that it pulled off from. Traditionally, the shoulder was immobilized in a sling for up to 6 weeks before starting physical therapy to protect the repair. The downside of this approach was a high rate of postop stiffness, called frozen shoulder. We pioneered an accelerated rehab program for rotator cuff 25 years ago that reduced this immobilization down to just 5 days and actually lowered to postop stiffness rate.

Quality of the rotator cuff tissue has been a major determinant of success of the surgery, as well as the recurrent tear rate. The larger the tear and degree of separation, the higher the recurrent tear rate – that can approach 50 percent!

Innovation in rotator cuff surgery revolves around the use of biologics to reduce the risk of recurrent tears. CuffMend is an acellular, dermal allograft that is placed upon the repair to effectively double the thickness of an atrophic tendon and reduce the risk of recurrent tears. We have been effectively utilizing this technology over the past 2 years with great success to enhance patient outcomes for the most serious tears.

We remain committed to utilizing the best technology to remain innovators in rotator cuff surgery.