Treatment of meniscus tears begins with the accurate diagnosis of a meniscus tear. And then, there’s 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 what kind of meniscus tear and how completely the meniscus is torn.
In general, what one wants to do is to take away the inflammation, and stretch and strengthen the surrounding muscles to unload the knee to give it a chance to basically heal.
Often that begins with physical therapy, stretching the hamstring, stretching the hip flexor, strengthening the quadriceps, getting the biomechanics right to help take the pressure off of the knee to give the knee a chance to heal. You also look at the gait, you look at 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 with that, sometimes oral pain medications can be helpful in order to help control the pain and to a lesser extent the inflammation.
And then there are some passive modalities that can be done within physical therapy, such as TENS units, ultrasound, electrical stimulations, massage to the area, there are other also kinds of passive modalities that help both with the pain control and to an extent with helping to reduce the inflammation.
Sometimes, if the pain’s 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 either inject inject steroid into the knee. Steroid is a strong anti-inflammatory that helps to reduce the inflammation. It doesn’t fix the meniscus tear, it just takes away the inflammation and basically resets the inflammatory clock to zero. If a person is having trouble going through physical therapy because of the pain, or if the exercises and the other passive modalities aren’t doing it in terms of taking the inflammation away, then putting some steroid into the knee will offer a nice window of opportunity, during which the person can then do more with the physical therapy exercises and work on the biomechanics more to help unload the knee so that the pain’s not coming back in a few months or a year.
The other general kind of injection is something called hyaluronic acid injections, which is basically like introducing joint fluid into the joint. It helps to lubricate the joint, and that can help in terms of both reducing inflammation and helping to fill in some of the smaller 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 this window of opportunity, during which you can do more with the 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 again.
Often, over time, the meniscus may be able to be ground down, scarred down, and the inflammation can go away. So it’s not necessarily the case that one needs to go to surgery to fix a meniscus tear.
When meniscus tears aren’t responding to conservative care, and again depending on the kind of meniscus tear, some meniscus tears may be more amenable to conservative care as opposed to others. But when t’s not getting better, and if we’re sure that it’s the meniscus tear that’s causing the symptoms, it would definitely be appropriate at that point to at least have a conversation with an orthopedist about possibly going in arthroscopically and cleaning up the meniscus surgically.