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Ask a Doctor: Proper diagnosis necessary for meniscus injury

11:05 AM, Jul. 19, 2013  |  Comments
John McDonough
John McDonough
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Question: My son suffered a torn meniscus knee cartilage and fully recovered after surgery. Now my MRI shows that I have worn - and torn - knee cartilage. Do I need surgery, too?

Answer: The meniscus is a rubbery, C-shaped piece of cartilage located in the knee. Cartilage is found in certain joints and forms a buffer between the bones to protect the joint. The meniscus cartilage serves as a shock-absorption system, assists in lubricating the knee joint, and limits the ability to flex and extend the joint.

We frequently hear of young athletes suffering a torn meniscus, which as it sounds is a tear caused by twisting or turning quickly, often with the foot planted while the knee is bent. It's a common knee injury that can prevent your knee from functioning correctly.

As you get older, your meniscus gets worn, which can make it tear more easily. Osteoarthritis in middle age populations may hurt about the same and in the same location, which can cause confusion in diagnosing the source of your pain.

Initially, we treat both types of patients in similar fashion, with simple resting, icing and propping up the leg. If this fails to improve the symptoms, we'll usually try physical therapy, followed by arthroscopic surgery to either repair or remove part of the meniscus.

Most younger people wanting to continue with sports activities will usually benefit from removing the torn meniscus piece with an arthroscope, using only two or three tiny incisions. They often return home just hours after same-day surgery.

Repair of the tear is a good option for larger tears at the outer edge of the meniscus. Repair may not work as well with tears near the center of the meniscus. Repair may also be the right choice for young people because they have greater potential to heal a tear that has been repaired. Older people may not be able to heal the repair and may not benefit from repair.

A recent study published in the New England Journal of Medicine compared patients 45 years of age or older and found there was no significant differences between patients assigned to surgery and those assigned to standardized physical therapy, without surgery. In other words, the surgery in older people may not relieve the pain symptoms that are thought to come from a torn meniscus cartilage but are actually due to wear and tear from arthritis.

To answer your original question, it may not make sense for you to have the surgery that worked so well for your son. But don't guess. If you suspect you have damaged a meniscus cartilage, you should contact your physician and discuss a possible referral to an orthopedic surgeon for a more thorough analysis of your condition.

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