Meniscal Tears.

Anatomy

There are two menisci in each knee — the medial (inner) and lateral (outer). Each is a wedge-shaped piece of cartilage, thicker on the outside and tapering to a thin inner edge. They distribute load, stabilise the joint, and protect the articular cartilage lining the bone surfaces.

Seven tear types

• Vertical / longitudinal
• Horizontal / flap
• Radial
• Oblique
• Buckethandle — large unstable tear; can lock the knee
• Complex — multiple patterns combined
• Root — meniscal attachment to bone disrupted

Symptoms

• Pain on the affected side of the knee
• Swelling, typically within days of injury
• Catching or locking
• Inability to fully straighten the knee (especially with buckethandle tears)
• A sense of instability or giving way

Non-surgical treatment

• Rest and activity modification
• Ice
• Anti-inflammatories
• Physiotherapy
• Low-impact exercise — cycling, swimming, hydrotherapy

Surgical treatment

Three principal surgical options, chosen by tear pattern, location, and patient factors:

Meniscectomy

Removal of the damaged portion. Reserved for tears that cannot be repaired.

Meniscal repair

Suturing the meniscus back together. Preferred whenever the tear pattern and tissue quality allow — preserves shock-absorbing function.

Meniscal root repair

Reattachment of the meniscal root to bone. Restores the meniscus's ability to distribute load.

Degenerative tears

Degenerative tears in arthritic knees often respond as well to injections, anti-inflammatories, and physiotherapy as they do to arthroscopic surgery — and in some cases, the underlying problem is the arthritis rather than the tear. Where end-stage arthritis is present, knee replacement is the more durable solution.