Meniscus disorder

Disease Description (Causes and Symptoms)

• Definition and pathophysiology
  • The menisci (medial and lateral menisci) are crescent-shaped fibrocartilage structures involved in shock absorption and maintaining stability in the knee joint. When a meniscus tears, it may become trapped between the joint surfaces, or joint deformity may occur due to wear. The likelihood of healing and the prognosis vary according to the location and pattern of the tear and the blood supply (the peripheral area has a richer blood supply). Common tear patterns include vertical (longitudinal), bucket-handle, radial, flap, and horizontal tears.
• Causes
  • Young people: Occurs due to traumatic injury from rotational forces or sudden changes in direction (sports, falls).
  • Middle-aged and older people: Tears can occur even with relatively minor stress due to degenerative changes (degenerative tears).
  • Contributing factors: Repetitive overuse and knee instability (for example, the frequency of tears increases when an anterior cruciate ligament injury is also present).
• Main symptoms
  • Pain (particularly along the joint line), joint swelling (acute bleeding or chronic effusion), limited movement (restricted flexion and extension), joint locking or a catching sensation, a feeling of instability, and intra-articular noise (clicking or snapping sounds).

Treatment Methods (Standard Treatment · Medication · Procedures/Surgery · Lifestyle Management), Precautions, and Complications

• Initial (conservative) treatment
  • RICE (protection, rest, ice, and compression), adjustment of weight-bearing, and pain control with nonsteroidal anti-inflammatory drugs (NSAIDs).
  • Physical therapy: Restoring the range of motion, strengthening the quadriceps and hamstrings, and balance and neuromuscular retraining.
  • Use of a brace (knee support) or walking assistance if necessary.
  • Intra-articular steroid injections: These are not standard treatment for the meniscal tear itself and should be used cautiously to relieve symptoms of accompanying arthritis. Intra-articular lubricants (hyaluronic acid) may provide some symptom relief but do not treat the tear.
• Surgical treatment
  • Arthroscopic surgery is the standard approach: diagnosis and treatment can be performed at the same time, including partial meniscectomy (partial lateral or medial meniscectomy), repair, and, rarely, transplantation (surgical reconstruction).
  • Criteria for selecting surgery: Severity of symptoms (severe pain, locking, or functional impairment), tear type (vertical/longitudinal tears with peripheral blood supply have a higher likelihood of being repairable), the patient's age and activity level, and accompanying injuries (the success rate of repair increases when an ACL injury is also present).
  • Protection (non-weight-bearing or partial weight-bearing) and gradual rehabilitation are necessary after repair surgery. Partial meniscectomy allows faster recovery but may increase the long-term risk of developing arthritis.
• Rehabilitation and lifestyle management
  • Strengthening muscles (particularly the quadriceps) and restoring the range of motion are important for preventing recurrence and improving the prognosis.
  • When returning to sports, gradual rehabilitation and technique correction are needed (avoiding twisting movements and performing proprioception training).
• Precautions
  • Early orthopedic evaluation is recommended when acute swelling, severe pain, or locking persists.
  • Infection, thrombosis, joint stiffness, and failure to heal (particularly after repair) may occur with surgery.
  • After partial meniscectomy, the long-term risk of developing osteoarthritis may increase.
• Complications
  • Persistent pain, recurrent tears, joint stiffness, surgical complications (infection, bleeding, and thrombosis), and long-term progression of degenerative arthritis.

Checklist Before an Outpatient Visit (Preparation and Examples of Records)

• Items to prepare (recommended to bring)
  • A list of currently used medications (including prescription drugs, OTC medicines, and supplements)
  • A history of previous related surgeries and injuries, and medical reports (if available)
  • Original copies or reports of previous test results (MRI, X-ray, etc.)
  • Pain diary: When the pain started, frequency, triggering movements (e.g., twisting), pain intensity (0–10), and whether locking or instability occurs
  • Activity level and occupation (whether heavy manual labor or sports activities are involved)
• Main items the doctor will check during the visit (useful for the patient to prepare in advance)
  • Mechanism of injury (whether it was traumatic or whether the pain developed gradually)
  • When swelling occurs and how long it lasts (whether acute bleeding is present)
  • Effects on daily life and exercise (walking, using stairs, squatting, running, etc.)

Examples of General Questions to Ask the Doctor

• What exactly is causing these symptoms? Do I need an MRI?
• What are the advantages and disadvantages of the treatment options (conservative versus surgical)? Why do you recommend this option?
• What is the recovery period and rehabilitation plan for the treatment you recommend?
• What are the side effects of medications (e.g., NSAIDs) or injections?
• How likely are complications such as arthritis in the future? How can they be prevented?

Examples of Condition-Specific Questions

• Is my meniscal tear a type that can be repaired, or would partial meniscectomy be more appropriate? What are the criteria for making that decision?
• As an athlete (or someone with an active occupation), when can I return to training or competition? What rehabilitation program is needed to reduce the risk of recurrence when I return?

General recommendation: If you have symptoms (particularly persistent locking, limitations in daily life, or severe pain), early orthopedic evaluation and review of imaging (MRI) are recommended.