Meniscus tears are a common cause of knee pain that can often be treated without surgery.
What is a meniscus?
The meniscus is a fibrocartilage structure that sits on top of the tibia, or lower leg bone. Each knee has two menisci: a medial meniscus on the inside of the knee, and a lateral meniscus on the outside of the knee. Each one is shaped like a C, and acts like a shock absorber, lending the knee cushion and support.
How common are meniscus tears and what do they feel like?
Meniscus tears are quite common. In fact according to the British Journal of Sports Medicine, if you were to get MRI’s of people over the age of 35, most of them are likely to have a meniscus tear, many without any symptoms [1]. Your meniscus can tear due to a specific injury from things like sports, twisting, deep knee bending, rotating, or other high-intensity activities. It can also be degraded over time, with the natural wear-and-tear as you age.
A well known orthopedic surgery resource, Johns Hopkins Medical describes what meniscus tears feel like in this way: Symptoms of a meniscus tear are pain in the knee joint (usually on the inside, outside, or back), swelling, catching or locking of the knee joint, inability to fully extend or bend the knee, and limping [2].
Should you get surgery?
It is a common belief that if you can see a meniscus tear on an MRI, then it will require surgery, but surgery may not be the best option. About 96% of meniscus surgeries that occur are meniscectomies. These surgeries do not repair the meniscus, but rather remove the torn section. Despite most being called “meniscus repairs”, surgeries that actually repair the torn fibrocartilage are much rarer.
The majority of research indicates that most of these surgeries do not work. Not only will surgery often not work, it will also speed up the arthritic process leading to severe arthritis much quicker that what normally would have occurred. A 2013 study found that physical therapy had the same outcomes as surgery, while another study found the same results from patients who underwent meniscus surgery as those who underwent a fake procedure [3, 4]. And in the long term, surgery can actually be harmful to the knee. Evidence suggests that removing sections of the meniscus puts more stress and wear on the cartilage and leads to arthritis progressing much faster [5, 6]. Patients who underwent meniscal surgery were also 2.5 times more likely to require a knee replacement, than those who went without surgery [7, 8]. Surgery is often the go-to treatment for meniscus tears, but there are often better options.
Non-Surgical Treatment Options
Steroid Injection
Before recommending surgery many pain practices will recommend a steroid injection if physical therapy is not working. This injection can reduce inflammation, but it is actually not advised. Steroids are known to cause damage to joint cartilage, inhibit healing, and a number of other negative side effects.
Hyaluronic Acid Injection
This is another type of injection. Hyaluronic acid is part of some of the lubricating fluid in the knee. An injection of this will not help repair the area, but may have symptomatic benefits for a few months if there is no severe arthritis.
Regenexx non-surgical regenerative orthopedic treatment options
Regenexx is a world leader in the field of orthopedic regenerative medicine based on scientific publications and is arguably the world’s most advanced platform for in-office interventional orthopedics. Visit us to see if you are a candidate for:
PRP (Platelet Rich Plasma)
To actually have the meniscus heal on its own, Platelet Rich Plasma or PRP has good evidence to support its effectiveness in helping with meniscus injuries as well as mild and moderate arthritis. With ultrasound guidance, PRP is precisely injected into the torn parts of the meniscus, into other injured or loose ligaments, or into the knee joint itself. There are more than 25 high level studies showing PRP helps with knee pain [9].
Bone Marrow Concentrate
Injections of Bone Marrow Concentrate containing the patient’s own live stem cells can be used for more severe meniscus tears or if there is moderate or severe arthritis. Bone Marrow Concentrate that contains the patient’s own stem-cells has in randomized control trials, been found to be helpful for this type of injury [10-12].
Which treatment is right for you, can depend on what type of Meniscus tear you have. Often non-surgical treatments can be more effective, but sometimes surgery is necessary.
Types of Meniscus tears
In general there are 6 types of meniscus tears. Each can have different symptoms and treatment options.
- Horizontal Tear (Longitudinal)
This is a tear that runs up and down or left to right through the meniscus. Thes occur mostly in the “red zone” of the meniscus, where there is a good blood supply. Due to this it can potentially heal on its own, but if that does not occur surgical repair could be helpful.
2. Radial Tear (Transverse)
This type of tear is the most common and runs left to right through the meniscus. It often occurs in the “white zone” of the meniscus, the area that does not get much blood supply. This location makes it hard to heal naturally. Physically Therapy should be the first step for these types of tears, but they may benefit more from PRP or bone marrow concentrate. Surgery should rarely be done for this type of tear, as it can make the knee worse.
3. Intrasubstance Tear (Incomplete)
This is a type of degenerative tear in the midportion of the meniscus. These are very common after the age of 30, and often the knee pain will be caused by other knee issues like arthritis. Physical therapy should be the first line of treatment for mild or moderate arthritis, followed by PRP. Bone Marrow Concentrate can be used to treat more severe cases of arthritis.
4. Bucket-handle Tear
In this type of tear the meniscus is torn and flipped over like a bucket handle. It can cause some catching or altered motion of the knee and is one of the rare types of rear that requires surgery. Here a meniscectomy or removal of the meniscus is done as it may be beyond repair. If the knee does not have the symptom of catching or altered motion, then it is possible that physical therapy can help.
5. Flap Tear
A type of tear, where a small section of the meniscus has been torn and flipped over. If this type of tear occurs with catching of the knee as a symptom then surgery may be needed to remove the torn section. As long as there is no catching of the knee then Physical therapy can be attempted, with PRP and Bone Marrow Concentrate as alternatives.
6. Complex Tear
The final type of tear is a complex tear or one that is made up of a combination of several different types of tear. Here, surgeons commonly do meniscectomy as this type of tear is quite difficult to repair.
Conclusion
Meniscus tears are a common cause of knee pain. Often surgery to correct this can have many negative effects, like more stress and wear on the cartilage and the increased progression of arthritis [5, 6]. Alternative Regenexx Pittsburgh treatments like PRP and Bone Marrow Concentrate may be able to help.
Regenexx keeps a registry that tracks outcomes for multiple joint pain procedures. For a Meniscus injury with thousands of knee patients tracked, patients with meniscus injuries on average feel their joints are 36% better over only 1-month, and they continue to improve from there. [13].
See the Regenexx Patient Outcomes Registry Here.
Regenexx doctors have performed over 142,000 procedures for common injuries, arthritis and other joint conditions. These procedures offer the patient a viable alternative to invasive orthopedic surgery. increase function, decrease pain and quickly get patients back to the things they love.
If you have joint pain and think a procedure using PRP or your own bone marrow concentrate might help, find out if you’re a candidate today –Tap the “TALK TO AN EXPERT” BUTTON below.
References
[1] https://bjsm.bmj.com/content/48/9/741
[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3690119/
[4] https://pubmed.ncbi.nlm.nih.gov/24369076/
[5 ]https://pubmed.ncbi.nlm.nih.gov/20719317/
[6] https://pubmed.ncbi.nlm.nih.gov/23528623/
[7] https://pubmed.ncbi.nlm.nih.gov/29723872/
[8] https://pubmed.ncbi.nlm.nih.gov/31429198/
[9] https://centenoschultz.com/prp-for-meniscus-tears/
[10] Centeno C, Sheinkop M, Dodson E, Stemper I, Williams C, Hyzy M, Ichim T, Freeman M. A specific protocol of autologous bone marrow concentrate and platelet products versus exercise therapy for symptomatic knee osteoarthritis: a randomized controlled trial with 2 year follow-up. J Transl Med. 2018 Dec 13;16(1):355. doi: 10.1186/s12967-018-1736-8. PMID: 30545387; PMCID: PMC6293635.
[11] Hernigou P, Bouthors C, Bastard C, Flouzat Lachaniette CH, Rouard H, Dubory A. Subchondral bone or intra-articular injection of bone marrow concentrate mesenchymal stem cells in bilateral knee osteoarthritis: what better postpone knee arthroplasty at fifteen years? A randomized study. Int Orthop. 2020 Jul 2. doi: 10.1007/s00264-020-04687-7. Epub ahead of print. PMID: 32617651.
[12] Hernigou P, Delambre J, Quiennec S, Poignard A. Human bone marrow mesenchymal stem cell injection in subchondral lesions of knee osteoarthritis: a prospective randomized study versus contralateral arthroplasty at a mean fifteen year follow-up. Int Orthop. 2020 Apr 23. doi: 10.1007/s00264-020-04571-4. Epub ahead of print. PMID: 32322943.
