Meniscus tear

Disease Description (Causes and Symptoms)

• Definition: The meniscal cartilage (medial and lateral menisci) is crescent-shaped cartilage within the knee joint that helps absorb shock, distribute load, and maintain joint stability.
• Causes and pathophysiology:
  • Younger individuals: Traumatic tears caused by sudden rotational forces (twisting), landing injuries, and similar trauma are common.
  • Middle-aged and older individuals: Tears may occur even with minor stress due to degenerative changes (degenerative tears).
  • Healing capacity differs according to the blood supply (red zone/white zone), so the treatment approach varies depending on the lateral/medial location, tear location, and tear type. Some reports indicate that these injuries are relatively more common in women.
• Main symptoms: Joint pain (pain along the knee joint line), joint swelling (effusion), restricted movement, locking or catching, a feeling of instability (the knee giving way), joint sounds (clicking), and others.

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

• Conservative treatment (early stage/mild cases):
  • Short-term rest, ice, compression, elevation (RICE), analgesics and anti-inflammatory drugs (e.g., NSAIDs), protected walking (crutches if necessary), joint exercises, and gradual strengthening (physical therapy).
  • After resting for 1–2 weeks during the acute phase, range-of-motion exercises and strengthening exercises are recommended.
• Injection treatment: Intra-articular steroids or viscosupplementation injections may be considered to relieve symptoms, but they are not intended to heal the tear itself (the decision depends on the symptoms and condition).
• Surgical treatment (indications): Persistent pain that interferes with daily activities, recurrent locking or restricted joint movement (especially inability to fully extend the knee), or persistent instability, among others.
  • Arthroscopic treatment:
    • Partial excision (partial meniscectomy): Removal of the torn portion in cases of irreversible damage or tears that cannot be repaired. Recovery is quick (several days to several weeks).
    • Repair: If the tear can be repaired (such as a tear in an area with blood flow, in a young patient, or an acute tear), repair is considered first. Although the recovery period and restrictions are longer, it is advantageous for preserving the joint.
    • Reconstruction (transplantation) is rarely considered for extensive defects, revision surgery, and similar cases.
  • When there is concomitant ACL injury, performing repair at the same time as reconstruction may improve the success rate.
• Rehabilitation: This varies depending on the surgical method (partial meniscectomy: early joint movement and walking; repair: restricted weight-bearing and protection of ROM, use of a brace for 4–6 weeks or longer, and staged rehabilitation).
• Complications and precautions: Surgical complications include infection, thrombosis, and joint stiffness. In the long term, the risk of degenerative arthritis increases as more of the meniscus is removed. Recurrent locking or severe pain requires prompt evaluation by a specialist.

Checklist Before an Outpatient Visit (Items to Prepare · Useful Information for Consultation with Medical Staff)

• Items/materials to prepare or bring:
  • A list of medications currently being taken (especially anticoagulants, antiplatelet drugs, and analgesics) and allergy information
  • Copies or image files of previous test results (knee X-rays, MRI, ultrasound, and past surgery or medical records)
  • A record of when the symptoms began and the mechanism of injury (when and in what situation it occurred)
  • Symptom pattern: Whether locking occurs and how often, when swelling occurs (immediately/after several hours/chronic), and whether weight-bearing is possible
  • Occupation, exercise (sports) activities, and activity level; the impact of pain on daily activities (stairs, walking, driving, etc.)
  • Pain intensity (VAS), movements that trigger pain, and the response after taking medication
• Things that are useful to show the doctor during the outpatient visit: A recently taken MRI or X-ray, a short video of walking (if possible), and a photo marking the location of the pain.

Examples of General Questions to Ask the Doctor

• Is an MRI absolutely necessary for this condition? (If one has already been taken: What do the MRI findings mean?)
• How likely is improvement with conservative treatment? Can surgery be delayed or avoided?
• What are the advantages and disadvantages of the recommended treatment (medication, physical therapy, or surgery), and what is the expected recovery time?
• If surgery is necessary, what are the risks of complications and what is the rehabilitation plan (activity restrictions and timing of return to activity)?
• What can be done to reduce the long-term risk of arthritis (degenerative changes)?

Examples of Condition-Specific Questions

• Based on the location of my tear (e.g., lateral/medial, posterior horn) and the MRI findings, is repair possible, or do you recommend excision (partial meniscectomy)?
• My current symptoms are causing ‘locking’ or functional limitation. During arthroscopic surgery, which would you recommend—partial meniscectomy or repair—and what would the expected rehabilitation period be?

---

Reference (Summary of Diagnostic Methods and Treatment Principles): The clinical history and physical examination (e.g., McMurray and Apley tests) help with the initial diagnosis, while MRI shows high accuracy (approximately 90% or higher) in confirming tears and evaluating concomitant injuries. Arthroscopy is a standard method that allows treatment at the same time as diagnosis.