The menisci are the shock-absorbers of the knee and may get torn during an accident (with a knee rotation or hyperflexion), sometimes associated to ligaments tear. This kind of traumatic meniscal tear mainly happens in <50 years old and active patients. A bucket-handle tear is a severe traumatic tear where half of the meniscus dislocates and locks the joint in flexion.
When the meniscus gets torn, the pain is sharp and lasts the next days or weeks, the knee gets swollen. If part of the torn meniscus gets unstable it creates a flap which can produce clics or lockings in the joint. In case of a bucket-handle tear, the knee is locked in flexion.
A knee specialist should be consulted in case of joint lockings (feeling that a fragment moves and locks the joint, as a stone in a shoe), when the functional impact is important (limping), or if the pain lasts for more than 3 months.
Some kinds of meniscal tear may be treated conservatively by adapting the sport and professional activities. Forbidden movements are rotations of the knee (lotus position, pivoting activities as ski, tennis, soccer, etc) and hyperflexion of the knee (kneeling down). Physiotherapy will help preserving the muscle tone and show the patients how to stay active without damaging more the torn meniscus. In case of persisting pain (more than 3 months from the accident), a surgical treatment should be considered.
The surgical treatment of a traumatic meniscal tear consists of a knee arthroscopy to visualise the tear and appreciate the quality of the meniscus (information difficult to get on the MRI). The idea of such surgery is to “save the meniscus”, to preserve the maximum of meniscus in order to avoid arthritis. So according to the type of tear and the quality of meniscus, the meniscus will be repaired (sutured) or partially removed (a minima resection).
Meniscal suture: all repairable tears are sutured, arthroscopic suture devices are very efficient nowadays, so that open repair (open knee surgery) is rarely necessary. Meniscal sutures are often painful the first few days and the patients are usually hospitalised one night after surgery.
Meniscectomy: in case of meniscal flap or when the meniscus is not repairable, the surgeon proceed to a partial meniscal resection, called a minima meniscectomy, by arthroscopy. This surgical procedure is minimally invasive and the patient can be ambulatory (go back home the same evening).
The rehabilitation protocol will depend on the surgical procedure:
After a meniscal suture: the goal is to let the repaired meniscus heal, and as the vascularisation of the meniscus is minimal, the healing is a slow process: most of the time, crutches are necessary 4 to 6 weeks for partial weight bearing, and the knee flexion is limited to 90°. Except for meniscal root repair or radial tear repair where no weight is allowed at all for 6 weeks, to let the meniscus heal. Walking is allowed progressively without crutches after 6 weeks and impact sports after 4 to 6 months according to the type of repair.
After a minima meniscectomy: walking is possible from the same day of surgery, crutches may help in case of pain for the first week, the patient get back to usual daily activities after 10 days and to impact sports after 4 to 6 weeks.
After a meniscal suture: haemarthrosis (hematoma inside the joint) may develop after surgery, requiring a puncture or an arthroscopic lavage; rarely the skin sensitivity may be altered by the arthroscopic scars (infra patellar branch of the saphenous nerve).
After a minima meniscectomy : the cartilage wear (risk of arthritis) will be proportional to the quantity of removed meniscus.