Meniscal tears are a common problem. The menisci of the knee are two pads of fibrocartilage whose purpose is to disperse friction in the kneejoint between the lower leg (tibia) and the thighbone (femoral condyles). There is a medial meniscus and a lateral meniscus. Symptoms of meniscal tear may include pain in the joint line, effusion, locking sensation and a sensation of giving way.
MRI is the imaging modality of choice with accuracy in diagnosis of approximately 90%.
The meniscus has very poor blood supply and that makes it difficult for it to heal on its own. Only 10 to 25 % of the periphery of the meniscus receives any blood supply. This is why it is difficult for them to heal.
Meniscus tears are common and also a common cause of knee pain. However not all tears will cause severe pain. In fact pain at times will go away completely if you give your knee a few weeks of rest. If in spite of rest and physical therapy your knee still hurts then you may need to consider other treatments with surgery never been the first alternative.
Frequently your orthopedist will recommend an arthroscopy of the knee when you are diagnosed with a meniscal tear. It is a well know fact that arthroscopy of the knee has been over utilized by orthopedist. In fact the British Medical Journal states the following: “Orthopedists are overusing arthroscopic knee procedures, performing them on patients for whom the benefits are questionable and the potential harms are serious, according to a new BMJ study. The benefits of knee repair procedures in older adults for painful arthritic knee or torn meniscus are short-lived and “inconsequential” compared with the potential harms, according to a study published online.” In fact the British Medical Journal guidelines strongly recommend against arthroscopy for nearly all patients with knee osteoarthritis or meniscal tears! Removing the meniscus leads to early arthritis with all its consequences and long term repercussions. The traditional option in the past for patients with torn meniscus was an arthroscopic procedure. This would require a major anesthetic such as a regional block or general anesthesia with all its risk in addition to the surgical risk. Today arthroscopy has been proven useless for nearly all patients!
So what are your choices if rest and physical therapy fails? There are much more benign and less risky procedures that can be used to treat torn meniscus. These are performed with local anesthesia in under an hour in your doctor’s office. You walk in and you walk out. I am referring to Proliferative therapy and therapy injections with plasma rich in platelets, which has become the first line of treatment for meniscal tears. Research has shown that damaged menisci lack the growth factors to heal because of their poor blood supply. In vitro studies have found that growth factors, including platelet derived growth factor (PDGF), transforming growth factor (TGF), and others, augment menisci cell proliferation and collagen growth many fold.This is why this injections work so well. The injections provide those growth factors that are lacking for the healing process to occur.