The meniscus is a rubbery-like piece of tissue that resides between the bones in your knee (femur above and tibia below). You have two menisci, one on the medial (inner) side and one on the outer (lateral) side of the knee. The meniscus functions to carry part of your weight, to contribute to knee stability and to help with lubrication of your knee.

The meniscus may tear because of an injury or it may merely "wear out" and begin to break apart as a result of wear and normal aging.

When it tears, pieces of the torn meniscus may get "caught" in the joint between the bones. This may cause Pain, Swelling, Sensations of Instability (the knee may feel like it will 'buckle' or 'give out' when you step on it or twist or turn). Sometimes a piece of meniscus will get caught between the bones causing the knee to "lock" such that it is difficult to bend it or straighten it.

Having a torn meniscus is somewhat like having a piece of gravel in the transmission gears of your car. When the torn piece gets caught in the gears, bad things happen. If the piece drops out of the way and isn't actually caught in the gears, it will feel better. Repeated episodes of catching of the meniscus in your knee will ultimately cause further damage to occur to the delicate surfaces in your knee.

If you ignore a torn meniscus long enough it will cause adjacent joint surfaces to wear out and the joint to fail prematurely.

Symptoms of a torn meniscus may appear suddenly or come on gradually. More often than not, the onset of symptoms is not associated with a specific injury but may have been precipitated by an activity, sport or exercise.

A careful description of the onset, nature and duration of symptoms combined with specific findings on physical exam usually confirms the diagnosis. X-rays are usually normal as x-rays display bones where as the meniscus is soft tissue. MRI studies can demonstrate the meniscus but, unfortunately are not always accurate. The decision to treat a torn meniscus is usually dictated by symptoms and physical findings rather than what one can see on an MRI however an MRI may be useful in confirming a questionable diagnosis.

In most cases, once a meniscus is torn, it stays torn. The following are treatment options that may used to treat a torn meniscus:

1. Rest and altered activity level
   
   • This may temporarily reduce symptoms but probably rarely causes a torn meniscus to heal.
2. Bracing
   • This may help protect the knee and reduce irritation caused by the torn meniscus.
3. Physical therapy
   • Therapy modalities such as heat, ultrasound and massage may temporarily reduce symptoms. Unfortunately they do not cause a torn meniscus to heal.
4. Anti-inflammatory medications
   • Reduces irritation, inflammation and swelling and thus may reduce symptoms caused by the torn meniscus.
5. Cortisone injection
   • Usually dramatically reduces symptoms due to the irritations and inflammation caused by the torn meniscus.
6. Arthroscopic surgery to remove the torn part of the meniscus.
   • This is the only treatment that actually eliminates the cause of the symptoms and protects the mechanical nature of the knee joint from further deterioration as a result of the torn meniscus.

1. First you must schedule the surgery with my office. The best way to do this is to call and ask for Anne (my personal assistant) or Kerry Nye (my surgical scheduler). Kerry will help put your schedule together with mine at a location consistent with the requirements of your insurance company.
2. If you have any significant medical risk factors such as heart disease, a current infection, lung disease or a history of blood clots, such issues may need to be addressed with your internist or primary care doctor prior to proceeding with surgery.

1. Your surgery will be done at a "Same-day-Surgery" facility which means you will go home the same day, usually an hour or two after the procedure is done. I perform these procedures at the Central Utah Surgical Center, Utah Valley Regional Medical Center and Timpanogas Regional Hospital.
2. You will be called the evening before surgery by the facility where your surgery is scheduled. They will ask you some questions and tell you what time to come to the facility the next day. They will want a phone number so they can notify you if the schedule changes.
3. IT will be necessary that you have nothing to eat or drink for 8 hours prior to the planned surgery. Failure to comply with this requirement dramatically increases the risks of anesthesia and will result in delay or cancellation of your surgery.
4. When you come to the facility, initial blood and other tests may be done to verify the status of your medical condition prior to the planned surgery. If you are female, a pregnancy test is routinely performed.
5. An intravenous line will be inserted into a vein in one of your arms. This will be used to administer medication intravenously.
6. You will be placed on a bed and your knee will be shaved. You will be asked to mark a "YES" on the knee that is to receive the surgery.
7. I will come and see you shortly before the surgery, answer any additional questions that you or your family members may have, and I will also put my mark on your leg. I want to take every precaution to make sure that I do the right procedure on the correct knee.
8. The anesthesiologist will come and talk to you about the anticipated procedure and the roll he will play in taking care of you. He also will answer any questions you may have.
9. At the appropriate time you will be moved to the operating room where you will be given an anesthetic and the procedure will be performed.

1. The knee will be painted with antiseptic solution to reduce the risk of infection. You will also be administered antibiotic medication through your intravenous line for the same purpose.
2. I will make three small puncture wounds in the front of your knee.
   • One is for the scope or camera which allows me to see the inside of your knee.
   • One is for the instruments I use to remove the torn part of the meniscus.
   • One is for a small fluid drain tube.
3. I will carefully examine the interior of your knee, define the torn part of the meniscus, using small instruments and remove or repair the torn part.
4. If there are other problems such as an area of arthritis, loose debris or ligament problems I will treat those at the same time UNLESS treating those unanticipated conditions would significantly alter your course of recovery.
5. At the end of the procedure, I will remove the instruments, apply "steri-strips" to the tiny incisions, apply gause pads followed by an Ace bandage. At the end of the procedure but before you wake up I inject a local anesthetic into the knee to reduce pain.
6. You are then moved to the recovery room where you continue to awaken from the effects of the anesthesia. Once you have sufficiently awakened, you will get up, go to the bathroom, eat a snack and drink fluids prior to being released to go home. In most cases, crutches are not necessary.

1. Many patients feel pretty good when they get home. As a result they tend to over do it and then may regret it after the effects of the local anesthetic wear off. Please take it easy. Put ice packs on the knee to help control swelling and limit your activity to household activities.
2. My assistant, Anne, will call you the day after your surgery to make sure you are doing O.K., to make sure your prescriptions are appropriate and to schedule a follow-up appointment in 7 - 10 days.
3. Keep the knee dry. On the 3rd day, remove the bandages but leave the "steri-strips" in place. On the 3rd day it is OK to get the knee wet in the shower but do not soak it in the bath tub. If you wish to take a bath prior to the 3rd day, keep the knee out of the water.
4. It is good to use the knee, gradually work on bending the knee and try to get back to normal. I expect you to limp about for 3-4 days, to be walking normally within a week and to be recovered within a month of the surgery.

1. It is my routine to visit briefly with you and/or your family following your surgery before you go home. I explain what I found and what I did. You will probably not remember any of this but hopefully your family will remind you of what I said.
2. Either I or my P.A. (Doug) will see you in the office about a week following your surgery. We will check your knee, review your surgery including providing you with copies of photos taken of the inside of your knee. I am not the greatest photographer but I try to at least obtain photos that demonstrate what was wrong and what I did (before and after) photos. I will also describe appropriate activities, exercises and rehabilitation efforts that should be performed.

1. Most do not require formal physical therapy following surgical treatment of a torn meniscus. Physical therapy modalities such as heat, ultrasound, massage may offer a temporary "feel good" reaction but usually have no significant impact on your overall recovery. Exercise however is very important. By the time you decide to do surgery on a torn meniscus, chances are you have limped around for quite some time and as such, you muscles are weak and need specific work to regain strength. Physical therapists may teach you what to do but you must do the exercises. Doug, my PA is also a certified Athletic Trainer and educated in teaching you what you can do to facilitate your own recovery. Do not hesitate to ask him for any additional help you may need.