The treatment of a meniscus tear depends on its severity, location, and underlying disease within the knee joint. Patient circumstances also may affect the treatment options. Some meniscus tears can be treated conservatively with anti-inflammatory medications and rehabilitation to strengthen muscles around the knee to prevent joint instability. Patients involved in athletics or whose work is demanding may opt for immediate surgery. Most patients fall in between and the decision to treat the injury conservatively or operative needs to be individualized.
Torn meniscus due to injury
Initial therapy after the acute injury usually includes rest, ice, compression, and elevation (RICE). This may be helpful in easing the inflammation that occurs with a torn meniscus. Anti-inflammatory medications, such as ibuprofen (Advil), may help relieve pain and inflammation. It is important to remember that over-the-counter medications can have side effects and interactions with prescription medications. It is reasonable to ask a health-care professional or pharmacist for directions as to which over-the-counter medication might be best.
Many patients choose initial conservative or nonsurgical treatment for a meniscus tear. Once the initial injury symptoms have calmed, exercise programs may be recommended to strengthen the muscles surrounding the knee and add to the stability of the joint. Maintaining an ideal body weight will also help lessen the forces that can stress the knee joint. Orthotics may be useful to distribute the forces generated by walking and running.
If conservative therapy fails, surgery may be a consideration. Knee arthroscopy allows the orthopedic surgeon to assess the tear within the meniscus and repair it. Options include sewing the torn edges together or trimming the torn area and smoothing the injury site.
Degenerative joint disease
In older patients with degenerative joint disease (also known as osteoarthritis), where the cartilage wears out, treatment options may be considered over a longer timetable.
Exercise and muscle strengthening may be an option to protect the joint and maintain range of motion. As well, anti-inflammatory medications may be considered to decrease swelling and pain arising from the knee joint.
Cortisone medication injections into the knee joint may be a consideration to decrease joint inflammation and to bring temporary symptom relief that can last weeks or months. A variety of Hyaluronan preparations are approved for mild to moderate knee arthritis and include Synvisc and Orthovisc.
The use of dietary supplements including chondroitin and glucosamine have yet to have their effectiveness proven, but many people find relief with their use.
As a last resort, joint replacement may be an option with substantial degeneration of the knee if conservative measures fail and symptoms of pain and decreasing joint range of motion progress.
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