Video presented by Grant Cooper, MD
This video accompanies: Knee Meniscus Tear Video
Treatment of a meniscus tear begins with accurate diagnosis. Then, there are a couple of different ways of going about treating the meniscus, and it depends on how severe the pain is from a meniscus tear, and to an extent it will depend on the kind of meniscus tear and how completely the meniscus is torn. In general, what you want to do is take away the inflammation, and stretch and strengthen the surrounding muscles to unload the knee to give it a chance to heal.
Physical Therapy and Exercise for Knee Meniscus Tear
Often it begins with physical therapy: stretching the hamstring, stretching the hip flexor, strengthening the quadriceps, getting the biomechanics right to help take the pressure off the knee to give the knee a chance to heal. You also look at the gait and the feet to make sure there is no hyperpronation, and if there is then an orthotic may be helpful – either a custom one or over-the-counter. Basically trying to get all the biomechanics right. Along the way, sometimes oral pain medications can be helpful in order to control the pain and to a lesser extent the inflammation.
There are some passive modalities that can be done within physical therapy such as TENS units, ultrasound, electrical stimulations, and massage among others that help both with pain control and to an extent the inflammation.
Injections for Knee Meniscus Tear
Sometimes if the pain is not getting better with physical therapy and a little bit of time, injecting into the knee with one of two different substances can be helpful both to control the inflammation and to lubricate the joint depending on the injection that you’re doing. You can inject steroid into the knee; steroid is a strong anti-inflammatory that helps to reduce the inflammation. It does not fix the meniscus tear, it just takes away the inflammation and resets the inflammatory clock back to zero.
If a person is having trouble going through physical therapy because of the pain, or if the exercises and other passive modalities are not taking the inflammation away, then putting some steroid into the knee will offer a nice window of opportunity during which the person can do more with the physical therapy exercises and work on the biomechanics to help unload the knee so that the pain is not coming back in a few months or a year.
The other general kind of injection is called hyaluronic acid injection, which is basically introducing joint fluid into the joint to help lubricate the joint. That can help in terms of both reducing inflammation and filling in some of the potholes within the joint while the knee is being rehabbed. Again, just like with a steroid injection, it’s not going to fix the meniscus tear; it’s going to open up a window of opportunity during which you can do more with physical therapy, you can tweak the biomechanics so that hopefully you’re not sitting there again in six months needing to do any kinds of injections.
Surgery for Knee Meniscus Tear
Often, over time, the meniscus may be able to be ground down or scarred down and the inflammation will go away. It’s not necessarily the case that one needs to go to surgery to fix a meniscus tear. When a meniscus tear is not responding to non-surgical care, (some meniscus tears may be need more minimal to non-surgical care than others) and if we’re sure that it’s the meniscus tear that is causing the symptoms, it would be appropriate at that point to at least have a conversation with an orthopedist about possibly going in arthroscopically and cleaning the meniscus surgically.