A nice long walk here, a quick jog there -- many of us take our mobility for granted, until it becomes an issue. Our knees bear the weight of our body (pressure about four times the weight of our body, to be exact) and injuries to the knee may be more common than you think. When pain comes creeping along, it could be a tear in the meniscus. Meniscus tears are relatively common in older adults and can result in the inability to walk comfortably, locking of the knee and even debilitating pain.
This week, Dr. Gregory Martin joins us with meniscus basics and a look at which options are key to prolonging flexibility and mobility. Dr. Martin is a board-certified, Harvard-fellowship trained orthopedic surgeon. He’s also author of the book “Education for Knees: Everything You Need to Know for Happy, Healthy and Pain-Free Knees.”
The meniscus is a rubber disc-like piece of cartilage (not to be confused with joint cartilage). It serves as a shock-absorber to protect the joint cartilage. When we start out as children and mature into teenagers and then young adults, the meniscus is filled with water. Martin says it’s very resilient at this time.
Unfortunately, with age, the meniscus becomes more brittle and loses the water content it once had. That makes it much easier to tear.
“Sometimes just bending over to pick up the newspaper or a little twist on the tennis court – or something like that – and you can get a pretty significant tear in the meniscus,” Martin says.
The problem is pretty common, according to Martin. The catch is that while some people don’t experience pain at all; others can have problems with mobility and flexibility, accompanied by very significant pain.
Pain is the most common symptom of a meniscus tear, usually associated with bending and twisting the knee. Attention should be paid, though, if there are any mechanical problems with the knee – locking, catching or buckling.
What’s to blame?
“As we age, we get into our 40s and 50s, our knees are already starting to degenerate,” Martin says. “So, if you take 100 people off the street that have no knee pain, and put them in an MRI, a lot of them you can diagnose with meniscal tears – even though they didn’t have any pain or know that they had anything wrong with their knee.”
In short, a meniscus tear is part of the degenerative process. This fact has changed treatment of the problem. Addressing the tear (in an operation, for example) might fix the pain, but won’t address the real problem according to Martin – the degeneration of the knee.
Diagnosis and treatment
A meniscal tear can only be seen on an MRI, but “if you see significant changes on the X-ray, meaning that there’s significant arthritis, then you can almost guarantee that the patient’s going to have underlying meniscal tears as well,” says Martin.
The bad news is that the menisci will almost never heal (Martin says they usually don’t have a very good blood supply). But, when a meniscus tears, if the initial pain and inflammation can be managed and controlled, then followed by rehabilitation, the knee will often become pain-free. It’s not healed, per say, but the patient can live the rest of their life comfortably with the tear. Additional treatments can include physical therapy, some medications, weight-loss to relieve pressure and sometimes surgery if severe buckling or locking is occurring.
“We don’t know how to prevent our knees from degenerating or wearing out at this time, but I always think that the core things that we can do – which is true for a lot of our health – is really take care of ourselves,” Martin says.
