Knee pain: When is it a meniscus tear and how to treat it

Early intervention can prevent permanent damage and delay the onset of osteoarthritis, says orthopaedic surgery specialist Dr Tan Sok Chuen

If you have a painful feeling on either side of the knee, especially upon touch, you could have a meniscus tear. PHOTO: GETTY IMAGES

Knee pain is a common condition that is often not taken seriously enough. However, that nagging ache you are feeling in your knees might not subside by itself with time.

In fact, what starts off as tenderness or a “locking” feeling in your knee joint area can quickly escalate into swelling, debilitating pain and loss of range of motion.

Knee pain can be caused by conditions such as cartilage tears, osteoarthritis, ligament injuries or inflammatory conditions such as gout or rheumatoid arthritis. In rare cases, it could be due to occult fractures or tumours.

If you have a painful feeling on either side of the knee, especially upon touch, you could have a meniscus tear. On top of that, if you feel a popping sensation, it likely indicates that a torn piece of meniscus might have come loose.

“Each knee has two meniscii, and they act as shock absorbers for the knee, similar to the cushions in your running shoes,” explains Dr Tan Sok Chuen, an orthopaedic surgeon at Hip & Knee Orthopaedics.

“Acute twisting injuries to the knee or age-related degeneration can lead to tears in the meniscus,” she adds.

If knee pain and swelling persist for more than a week, and is coupled with limited knee movements, it is best to seek medical assessment. PHOTO: GETTY IMAGES

How does a meniscus tear occur?

A meniscus tear usually happens when there is a sudden strain on the knee. This could be from contact sports or sports that involve a lot of pivoting and rapid change in direction such as football or boxing.

Activities that require kneeling, squatting or lifting, or a sudden increase in physical training after a long period of rest and weight gain, could also contribute to a meniscus injury.

Dr Tan usually sees meniscus tears in younger patients who lead active lifestyles. In comparison, elderly patients are more likely to have advanced cartilage disease as their predominant condition.

Those with an existing injury to their anterior cruciate ligament (ACL) are also more susceptible to a meniscus tear. And wear and tear from age or being overweight may also contribute to it.

Apart from a popping sensation in the knee, and pain on either side, symptoms of a meniscus tear include tenderness at the joint line area, a swollen knee or difficulty moving your knee. Other signs to look out for: A locking or catching feeling in your knee; the sensation that your knee is giving way or unable to support your weight due to discomfort; and waking up in the middle of the night with a stiff and painful knee. 

If you have any of these symptoms, it is best to seek medical advice to get an accurate diagnosis.

“To confirm a meniscus tear, a doctor will conduct a clinical examination followed by magnetic resonance imaging (MRI) scans,” explains Dr Adrian Lau, an orthopaedic surgeon from Hip & Knee Orthopaedics.

If you have a large tear, the meniscus will be unable to function as a shock absorber for your knee, says Dr Lau. This places your knee under immense stress and, over time, the cartilage will eventually get worn out, and you will develop osteoarthritis. 

Unfortunately, not many people are aware that they may have a meniscus tear and often ignore it until it’s too late.

Says Dr Tan: “It is sometimes difficult to differentiate between soreness after an intense workout and a serious structural injury like a meniscus tear.”

If knee pain and swelling persist for more than a week, and is coupled with limited knee movements, it is best to seek medical assessment, advises Dr Tan.

 How to reduce the risk of a meniscus tear

The good news is that a meniscus tear can be prevented, says Dr Tan.

Those active in sports should warm up before exercising, wear the right shoes when working out and give their bodies adequate time to rest between workouts.

For those who are older, it helps to reduce the intensity of fast-moving sports, especially after a long hiatus. Plus, they should also add some strength and conditioning exercises in between the high-intensity workouts. 

If you are involved in work where you cannot avoid squatting or lifting, try to modify your work environment to make it more ergonomic. For instance, sit on a small stool instead of doing full squats, and reduce lifting loads.

Significant tears in the meniscus should be treated early, says orthopaedic surgery specialist Dr Tan Sok Chuen (second from right). PHOTO: HIP & KNEE ORTHOPAEDICS

Treating a meniscus tear

The size of the meniscus tear determines how it should be treated. For very mild conditions, the RICE (Rest, Ice, Compression and Elevate) method, coupled with a short course of oral anti-inflammatory medications, plus physiotherapy, is sufficient enough to allow the injury to heal.

However, in general, for tears beyond 1 cm, surgical repairs are recommended. The doctor will also find out more about the patient, such as whether they lead an active lifestyle, before recommending surgery.

This process is known as arthroscopy, and it is a minimally invasive surgery that can be done in a day. It usually costs a total of $20,000 for an isolated meniscus repair surgery, says Dr Tan.

The patient is usually put under general anaesthesia and two small 1cm cuts are made on either side of the knee. Through one, a keyhole camera known as the arthroscope will be inserted, and through the other, small meniscus implants made of either non-absorbable sutures and/or bioinert polymers are used to repair the tear.

Surgery is especially suitable for young, active individuals who are eager to get back to sports. However, it is not recommended for the elderly who might already have advanced cartilage disease.

“Significant tears in the meniscus should be treated as studies1 have shown that early treatment of meniscus tears help to preserve meniscus tissue, thereby preserving knee cartilage and delaying the onset of osteoarthritis,” advises Dr Tan. 

The downtime after surgery depends on the severity of the meniscus tear, but typically a patient would require crutches for four to six weeks, adds Dr Tan. 

Patients can usually return to sporting activities from four to seven months after surgery, adds Dr Tan. If they want to remain active post-surgery, Dr Tan recommends low-impact exercises such as cycling, swimming and Pilates.

1 Weber at al. The role of meniscal repair for prevention of early
onset of osteoarthritis. J Exp Orthop 2018 Apr 2;5(1):10.

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