The most common cause of surgical knee pain in the country in today’s day in age is from a structure called the meniscus. The meniscus is a piece of tissue that is situated in the middle of the knee and is composed of cartilage, like the tip of one’s nose. The primary function of the meniscus is to provide a buffer between the thigh bone (femur) and the shin bone (tibia) to spread the force of weight bearing over a larger area and protect the knee from early degeneration or arthritis.
Patients of all ages can sustain a tear in the meniscus and the cause of the tear is usually related to age and activity level. This is a very common injury to sustain to the knee for athletes of all ages, but particularly in middle aged and older patients who sustain a “minor” injury to the knee. The symptoms that are typical of a tear of the meniscus are pain on the side of the knee and a sense of popping/clicking/catching that people will commonly describe as their knee “popping out of joint.” What is actually happening is that the torn piece of tissue is getting caught between the femur and tibia and will hurt and then will pop back in to place.
Often times, diagnostic imagery such as an MRI is required to diagnose a meniscus tear and is what is typically recommended when this diagnosis is suspected. Since the meniscus is made of a soft cartilage material, it does not show up on xray and therefore an xray is of little use to determine if the meniscus is torn.
The treatment for a torn meniscus is typically surgical. The reason for this is that the meniscus lacks sufficient blood supply to heal on its own, so once it’s torn, it stays torn. More often than not, the meniscus tears in such a way that even if the surgeon were to stitch the tear back together, the tear itself would not predictably heal (again, owing to the blood supply). So, what is done from a surgical standpoint is to remove the portion of the meniscus that is torn and thus remove a pain generator from the knee. The typical surgery leaves a large majority of the meniscus intact.
The results of the surgery can be quite dramatic as patients typically start experiencing pain quite quickly, although sometimes having associated arthritis can make the results slightly less predictable. With modern surgical techniques, this procedure is always done using an arthroscopic, minimally invasive, surgical technique which leads to much quicker recovery, usually on the order of weeks to a few months for complete recovery. Being a fellowship trained arthroscopic surgeon I feel as though I am on the cutting edge of the most novel arthroscopic techniques for many causes of pain, not just in the knee but anywhere in the body. I am excited to be able to offer these procedures to my patients.