A torn meniscus is one of the most common knee injuries and one of the most misunderstood. Many patients arrive at consultation assuming a tear always needs an operation. Often it does not. Mr Kosuge sees this frequently, so it is worth setting out what a meniscal tear is, what it feels like and how the decision to operate is actually made.
What the meniscus is
Each knee has two menisci, which are wedges of tough cartilage that sit between the thigh bone and the shin bone. They act as shock absorbers and help the knee move smoothly and stay stable. A tear can happen suddenly, for example twisting on a planted foot during sport, or it can develop gradually as the cartilage wears with age. The two situations are quite different. That difference matters for treatment.
The symptoms to look out for
A meniscal tear typically causes pain along the joint line, swelling that comes and goes and a sense that the knee is not quite reliable. Some people notice clicking or catching. In more significant tears the knee can lock, which means it becomes stuck and will not fully straighten. Locking is one of the clearer signals that surgery may be needed.
Why many tears do not need an operation
Where a tear is degenerate, meaning it is part of gradual wear rather than a fresh sports injury, good evidence shows that surgery often adds little over a course of physiotherapy, activity adjustment and time. The body can settle a great many of these tears without an operation. Removing torn cartilage is not without consequence either, because the meniscus is there for a reason and taking it away can load the joint differently. For these reasons Mr Kosuge does not rush to operate on every tear that shows on a scan.
When surgery does make sense
Surgery, usually a keyhole (arthroscopic) procedure, becomes the sensible option when a tear is causing true mechanical symptoms such as a locked knee, when a specific type of tear in a younger patient is repairable, or when a reasonable period of non-surgical treatment has not settled the symptoms. The key is matching the treatment to the tear and to the person, rather than to the scan alone.
Getting the right assessment
If your knee is painful, swelling or catching, an accurate diagnosis is the first step. That usually means an examination and often an MRI scan. Mr Kosuge will explain exactly what has been found and set out the options honestly, including the option of not operating.
To book an appointment with Mr Kosuge at The Rivers Hospital:
Telephone: 01279 602675