Meniscal Tear Treatment without Surgery

Is it Possible ?

Meniscal tear is a common out-patient diagnosis in all age groups ranging from young athletes to elderly patients. The most common reason for meniscal injuries is a twisting movement which leads to the entrapment of the cushion like structure between the two bones and further causes tractional tear in the substance.

Meniscal Tear illustration

The athletes facing this situation clearly point out a typical history consisting of a forceful twisting over a bent knee where as elderly population have a more subtle presentation. This usually consists of a mild nagging pain and heaviness in the knee which is primarily due to Osteo-arthritis. This suddenly aggrevates to a worse pricking and throbbing pain typically while bearing weight mainly because of reduced space in th joint due to ack of muscle tone.

The patients in both kinds of menical tears complaint of a locking/catching sensation while the try to bend the knee at a specific angle. These patients also complain of a sweling just over and above the knee joint in the front which subsides gradually.

Degenerative meniscal tears are very common. Do need surgery only if mechanical symptoms exist.

Diagnosing a patient of a meniscal tear is very important to figure out the exact cause and nature of pain. This history is supplemented with clinical examination and radiology confirms the diagnosis. These tears on the basis of morpology , size, grades etc. have been classified into various types, of which the one assosiated with worse prognosis remains in group 3 or 4.

MRI grading of meniscal tears

Most patients start reading out the scan reports only to find a mild element of meniscal tear . Only in cases where there is a presence of mechanical symptoms, instability and or restricted range of motion, we need to do something other than conserve the meniscal tear.
Grade 3 and 4 tears causing mechanical problems warranting an immedite definative treatment in all age groups. Where most others are intrasubstance or grade 1 and 2 meniscal tears. These patients do well with only conservative approach in long term.

Illustration of meniscal anatomy and tear

Any pain generating source in the body is a source of swelling, heaviness and muscle soreness. This is the reason why most people should consult your orthopedic before reaching out for a diagnosis. As the pain settles down with conservative treatment, things become more clear and respose to therapy will guide us to the modality of treatment.

So, Grade 1 and 2 tears, especially in the elderly age groups should be treated conservatively and selected cases of grade 3 tears can also be treated without surgery depending on presence or absence of mechanical symptoms. Any young patient who has mechanical symptoms (catching/locking) should definately opt for early surgery for best outcomes. Usually these patient also have a ligament tear (Instability) associated with meniscal tears.

Pre and Post operative view of a partial meniscal tear.

Conservative treatment mainly of medications to reduce pain and swelling in menical tears along with ice packs and lifestyle modifications. Whereas surgical treatment may consist of a Meniscal Repair or partial meniscal removal.

Illustrtion of a new technique of All-inside Meniscal repair system available at Jyoti Hospital

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