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Surgical vs. Non-Surgical Treatments for Meniscus Tears

Dr Andrew Dutton - Meniscus Tear Symptoms and Treatments
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Meniscal tears are quite prevalent in Singapore, with data from the AFP journal indicating that 60 to 70 out of every 100,000 residents experience this injury each year. Specific demographics see even higher incidence rates, soaring to six per 1,000 individuals. Men, in particular, are at a heightened risk, up to four times more likely than women to suffer from this type of injury.

The meniscus, a vital crescent-shaped cartilage between the shinbone and thigh bone on both sides of the knee, is crucial in ensuring knee joint stability. It aids in minimising friction, distributing weight across the knee, and maintaining overall joint health.

The presentation and cause of meniscal tears can differ significantly based on the patient’s age. For younger individuals, these injuries often result from a forceful twist applied to a weight-bearing, flexed knee, leading to what’s commonly referred to as a “bucket-handle” tear. In contrast, as people age, degenerative factors become the primary culprits. The tears that older patients experience are usually horizontal, mirroring the natural wear and tear that accumulates over the years.

Recognising the differences between these types of tears is fundamental for effective prevention and treatment. Tailoring care and rehabilitation strategies according to the root cause can significantly enhance recovery outcomes.

Should you be worried about meniscus tears?

Knee pain is a common complaint in people of all ages. While occasional aches and twinges may not always cause alarm, it’s essential to understand when to seek professional attention. Several factors can guide your decision on when to be concerned about knee pain.

If you experience sudden and acute pain following an injury or trauma, such as a fall or direct blow to the knee, it’s prudent to consult a healthcare professional immediately. It is especially true if a popping sound or immediate swelling accompanies the pain or you find it challenging to bear weight on the affected leg.

Chronic pain, or persisting for over a few weeks, also warrants medical evaluation. This type of pain, especially if it limits your daily activities or disrupts sleep, could indicate underlying conditions requiring treatment.

Other red flags include persistent swelling, redness, warmth around the knee, or noticeable deformities. These could signify infections, inflammatory conditions, or structural abnormalities requiring prompt intervention.

Knee pain that’s accompanied by other symptoms, such as fever, unexplained weight loss, or feelings of instability when walking, should not be overlooked. These could be indications of systemic issues or severe problems.

READ: 10 Common Knee Injuries (Especially Among Athletes)

Non-Surgical Treatments For Meniscus Tears

When addressing meniscus tears, non-surgical treatments are often the initial step, particularly for less severe tears or in situations where surgery might not be ideal. These conservative methods aim to alleviate pain, minimise inflammation, and restore the knee’s functionality.

One of the foundational steps in treating a meniscus tear is RICE — rest, ice, compression, elevation. Rest and refrain from activities that might exacerbate the injury or put undue stress on the knee. Using crutches can also help in avoiding weight-bearing on the affected knee. Regularly applying ice or cold packs, especially during the initial 48 hours post-injury, can significantly reduce swelling and alleviate pain. Apply ice in intervals, typically 20 minutes on followed by 20 minutes off.

Additionally, wearing a knee brace or elastic compression bandage can support the injured knee, reduce swelling, and prevent further injury. These can be particularly useful when you need to be mobile. Finally, keeping the affected leg elevated, preferably at a level higher than the heart, also helps reduce swelling by facilitating the drainage of excess fluids away from the injured site.

Medication is another standard non-surgical treatment for meniscus tears. Over-the-counter pain relievers and anti-inflammatory drugs, such as ibuprofen or naproxen, can effectively manage pain and reduce inflammation. In some cases, corticosteroid injections may be recommended to reduce inflammation and pain. However, consulting with a healthcare professional before starting any medication regimen is vital.

What’s more, engaging in physical therapy and rehabilitation programs under the guidance of a physical therapist can strengthen the muscles around the knee, enhancing stability and promoting healing. Physical therapy can also help restore the range of motion and prevent stiffness.

Adapting your lifestyle or sports activities can help prevent further strain on the injured knee. It might involve switching to low-impact exercises or altering techniques to reduce knee stress. Finally, maintaining a healthy weight can significantly reduce the pressure exerted on the knee, facilitating healing and preventing future injuries.

READ: Meniscus Tears Occurence In Singapore

Surgical Treatments For Meniscus Tears

The type of surgery that your doctor may recommend typically depends on where the tear is located, its severity, and the tear pattern in the meniscus. A patient may have recourse to surgery if the knee still hurts even after exhausting non-surgical treatments.

Likewise, surgery is recommended if a tear occurs in the inner part of the meniscus — blood can’t reach this inner part due to the absence of blood vessels. There are three main methods of surgical management of meniscus tears: arthroscopic partial meniscectomy, meniscal repair with or without augmentation, and meniscal reconstruction.

Meniscectomy, the removal of the damaged meniscus tissue, has good short-term results but may lead to the development of arthritis 10 to 20 years later. Meniscal repair is attempted when the tear is repairable, and surgery aims to preserve a healthy meniscus.

Knee arthroscopy, also known as keyhole surgery, allows doctors to see inside the knee joint without making a large cut, making it a minimally invasive option. It is a surgical approach that trims the meniscus in a partial meniscectomy procedure. It is often preferred over open surgery because it requires only small cuts instead of large incisions. It usually means less pain and stiffness for the patient and quicker recovery so that they can return to their normal activities sooner.

On the other hand, meniscal reconstruction is a less common procedure involving replacing the damaged meniscus with a graft, which can be taken from the patient’s body or a donor. This procedure is typically reserved for patients with a previous meniscectomy or a significant loss of meniscal tissue that cannot be repaired.

Words to the wise: the most appropriate treatment for a given patient depends on individual factors, such as age and comorbidities, and tear characteristics, such as the location of the tear and reducibility of the tear. Hence, consulting a trusted orthopaedic surgeon should be your first course of action.

Comparative Table of Meniscus Tear Surgical Options

PROCEDURE
INVASIVENESS
RECOMMENDED FOR

ESTIMATED RECOVERY TIME

Arthroscopic Surgery
Minimally invasive; uses small incisions
Based on individual factors and findings post consultation
Around 6 to 8 weeks
Meniscal Repair
Involves suturing the torn meniscus
Typically younger patients; for tears in outer third with good blood supply
Around 3 to 6 months
Meniscectomy
Removal of torn meniscus portion
Typically older patients; for tears in inner two-thirds with poor blood supply
Around 3 to 4 weeks

Making Informed Decisions On Meniscus Tear Treatment

The information we provide, however medically factual and vetted by a doctor, should never replace a medical consultation. Choosing the right doctor is crucial as it directly impacts the success of the procedure and your overall recovery. With a trained and experienced orthopaedic surgeon, you can rest assured that proper surgical techniques are employed, minimising potential complications and reducing re-injury risks.

With a medical practice dating back to 1996, A/Professor Dutton completed his subspecialty in hip and knee surgery at Massachusetts General Hospital and Harvard Medical School before opening his clinic in Singapore. Please call (+65) 6836 8000 to schedule an appointment or send a message through the inquiry form.

We partner with a wide range of insurance providers in Singapore to offer you access to the quality healthcare you deserve. To aid in the expenses that you may incur, we accept many corporate and international insurance. If you have any of the insurance plans below, please let us know when you book an appointment with us.

A/Professor Andrew Quoc Dutton Orthopaedic & Sports Clinic Insurance

The A/Professor Andrew Quoc Dutton Orthopaedic & Sports Clinic offers minimally invasive and surgical treatments for sports-related injuries and orthopaedic conditions.

To aid in the expenses that you may incur, we accept a number of corporate and international insurance. If you have any of the insurance plans below, please let us know when you book an appointment with us. If you need further assistance, you may drop us an e-mail at info@eliteortho.com.sg or call us at (+65) 6836 8000.

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About A/Professor Andrew Quoc Dutton

A/Professor Dutton, also known as, has been in clinical practice since 1996 after graduating from Marist College, Canberra and the University of New South Wales, Sydney, Australia. A/Professor Dutton has worked at the Prince of Wales Hospital, Sydney, and the St. George Hospital, Sydney, before completing his orthopaedic surgery training in Singapore. He is currently an associate professor of orthopaedic surgery at the National University of Singapore (NUS).

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