by James Bicos, M.D., Orthopedic Surgeon & Sports Medicine Specialist; voted Top 10 Sports Medicine Surgeons by Sports Illustrated for cartilage issues
Four words that could spell doom for an athlete and their career. Feeling a pop or tear in the knee could be many things, but one of the most common diagnoses is a meniscal tear.
Detroit Lions fans were concerned to read that 2nd round draft pick Darius Slay has a torn meniscus. Oklahoma City fans learned that Russell Westbrook would be out the remainder of the NBA playoffs after surgery to repair the torn meniscus.
The meniscus is a piece of cartilage in the knee that sits between the femur bone and the shin bone. It looks like a “c-shape” and there is one on the inside and outside of each of our knees. Its main function is a shock absorber for the knee. It helps to dissipate forces of walking or running so that less stress goes to the cartilage on the ends of our bones. But much like shocks on a car, they can either wear out with age or tear from an injury.
When a meniscus tears, it has blood vessels and nerve endings, hence the pain and swelling most people exhibit. The meniscus also functions as a secondary stabilizer to the knee, but most of the disability people have when they tear the meniscus is from the pain and loose, torn fragments that are in the knee. The fragments can act as a “hang-nail” that can get pinched or further torn with knee movements. This can cause feelings of knee catching or locking.
Another way a meniscus can tear is in a bucket-handle type fashion. Much like a handle on a bucket, the meniscus can tear at its edges and then flip over on itself, becoming stuck in the center of the knee. Most people with this type of injury have a locked knee.
Most meniscus tears are degenerative in nature. The blood supply to the meniscus is tenuous at best and much of the meniscus “lives” in a zone where some of it gets nutrients from blood supply and the other gets nutrients from inside the knee. If the tear of the meniscus is in a zone that does not have a good blood supply then trying to repair the meniscus is fraught with problems.
Studies have shown that the more meniscus you lose, the higher a chance for progression of arthritis and cartilage damage. This is the main reason that for young athletes, every attempt is made to salvage the meniscus and try to repair it, but sometimes due to the way the meniscus tears, the zone of the tear, or the length of time from the injury to the surgery, the meniscus is not repairable and it must be partially trimmed.
The overall goal is to eliminate any catching and locking in the knee, preserve as much meniscal tissue as possible (either with a meniscal repair or meniscal trimming), and get the athlete back in competition as soon and safe as possible.
The type of surgery done has significant implications for length of rehabilitation. If a simple meniscal trimming is done, usual return to play is about 6 weeks. If a meniscal repair is done, return to play can take up to 5 – 6 months for many of the high impact sports.
As fellowship-trained sports medicine orthopedic physicians, we always weigh the needs of the athlete to return to sport quickly against the overall health of their knee for the rest of their lives. It is important for us to educate the athlete on the big picture. Although they are focused on the next 6 months of their season or career, their knees will be with them for the rest of their lives. Simple decisions now can have long-lasting consequences later.