I am a 57 year old female and I have just found out I have a torn cartilage in my knee. I was told I need surgery as I have fluid around the area and also pain. Do I have to have surgery?

Question

I am a 57 year old female and I have just found out I have a torn cartilage in my knee. I was told I need surgery as I have fluid around the area and also pain. Do I have to have surgery?

Answer

The cartilage that you are referring to is one of the two menisci within the knee. These are easily injured by the force of rotating the knee while bearing weight. A partial or total tear of a meniscus may occur when a person quickly twists or rotates the upper leg while the foot stays still (for example, when dribbling a basketball around an opponent or turning to hit a tennis ball). If the tear is tiny, the meniscus stays connected to the front and back of the knee; if the tear is large, the meniscus may be left hanging by a thread of cartilage. The seriousness of a tear depends on its location and extent.

Generally, when people injure a meniscus, they feel some pain, particularly when the knee is straightened. Severe pain may occur if a fragment of the meniscus catches between the femur and tibia. Swelling may occur soon after injury if blood vessels are disrupted, or several hours later if the joint fills with fluid produced by the joint lining (synovium) as a result of inflammation. If the synovium is injured, it may become inflamed and produce fluid to protect itself. This causes swelling of the knee.

Sometimes, an injury that occurred in the past but was not treated becomes painful months or years later, particularly if the knee is injured a second time.

If the tear is minor and the pain and other symptoms go away, the doctor may recommend a muscle-strengthening program. Exercises for meniscal problems are best performed with initial guidance from a doctor and physical therapist or exercise therapist. The therapist will make sure that the patient does the exercises properly and without risk of new or repeat injury.

If the tear to a meniscus is more extensive, the doctor may perform either arthroscopic surgery or open surgery to see the extent of injury and to repair the tear. The doctor can suture (sew) the meniscus back in place if the patient is relatively young, the injury is in an area with a good blood supply, and the ligaments are intact. If the patient is elderly or the tear is in an area with a poor blood supply, the doctor may cut off a small portion of the meniscus to even the surface. In some cases, the doctor removes the entire meniscus. Degenerative changes, such as osteoarthritis, are more likely to develop in the knee if the meniscus is removed; however, if a torn meniscus goes untreated, flapping around within the joint, this too may result in osteoarthritis.