A Meniscal Cartilage tear

The meniscus is often simply referred to as “a cartilage”. They are made of a tough and robust material called collagen but can be damaged through injury or as part of a degenerative process. The knee contains 2 meniscal cartilages, the inner (medial) and the outer (lateral) and they are best thought of as shock absorbers. They are situated between the femur (thigh bone) and tibia (shin bone) and are protectors of the joint surfaces in the weight bearing areas of the knee and also contribute to joint health and joint stability. They are frequently injured and a relatively common source of pain in the knee for all age groups. The frequency with which we find tears increases directly with age and certainly not all tears will need intervention. Although the medial inner cartilage is more frequently found to be torn, it is often the lateral outer cartilage tear that can be of more significance for longer term knee function as it plays a more important load transfer role.

With the ease of access to sensitive imaging techniques such as MRI, we readily identify meniscal cartilages with normal age related degenerative features and tearing but certainly not all need surgery. Meniscal tears can be both isolated or associated with other injuries (e.g. anterior cruciate ligament tear) or pathologies such as osteoarthritis. Those specifically related to trauma and sports in an otherwise young healthy knee are more likely to be a significant source of irritation and restriction and hence more frequently benefit from surgical treatments. Cartilage tears in the setting of a worn knee with features of osteoarthritis are much less likely to need surgery and be managed well non-operatively.

The diagnosis of a meniscal cartilage tear and the potential need for surgical treatment will be discussed during consultation and a treatment plan outlined. We have guidelines from expert groups and specialist associations on the non-operative versus operative treatment options and most degenerative tears should start with an initial 12 week period of symptom control with relative rest, activity modification, physiotherapy/strengthening and analgesia/anti-inflammatories. If this fails to settle symptoms adequately and the knee is not arthritic, then surgical options may be contemplated. A well preserved knee with clear mechanical symptoms and an unstable large or displaced tear seen on MRI may benefit from earlier surgery.

Please follow the following links to further details on surgical options for meniscal cartilage tears. These are generally days case operations and “key-hole” type surgery. This includes arthroscopic partial meniscectomy (a cartilage trim/removal) and meniscal repair. Other meniscal procedures are described, however, meniscal substitutes are not yet a well proven option and a meniscal transplantation is not readily available in Ireland with not too many individuals that are suitable. On occasion, I have arranged an assessment with links to specialist centres in Europe for consideration of this type of procedure.

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