I have been thinking about meniscus tears recently.

I had a patient yesterday who presented with a locked knee. In his case, he was unable to straighten his knee or even contract his quads (they were grossly inhibited).  This has happened before, on and off over 5 years, once in the past year. When I saw him earlier in the year, he presented the same way, and while examining the knee, there was an audible and palpable “click”, and the knee was suddenly able to straighten fully, and the quads were able to generate a full contraction painlessly.

In trying to figure out why this happens, two thoughts went through my mind. The first was that he had suffered bucket handle meniscus tear, where the tear had flipped up and over and was logged beneath the ACL/PCL. The second is that he has a loose body in the joint, probably a piece of articular cartilage that had dislodged and was interfering with the function of the knee.

My sense is that in his case, the issue is the meniscus tear. I say this because the movement that seemed to be most comfortable involved a varus stress, gapping the lateral compartment of the knee. In addition, his pain is along the lateral joint line. I was unable to resolve the locking manually this time, and sent him to an orthopedic surgeon for further more aggressive investigation and care. I suspect that his MRI will demonstrate the meniscus tear, and he will have arthroscopic surgery to resolve the problem. In the best of all worlds, he will be back training for his sport in short order.

How can you tell if you have a meniscus tear?

Well, for one, you will often have either locking, or giving way episodes. In the case of locking, the knee will not straighten all the way, or it might not bend all the way. Often trying to make it straight is painful, sometimes not. In the case of giving way episodes, the knee literally gives out unexpectedly where you are bending over and literally find yourself sitting on your butt on the floor wandering what happened.

In the end, if you believe your meniscus is torn, the question becomes how to treat your meniscus tear? While many meniscus tears can be treated on-surgically, more often than not a simple arthroscopic surgery is the solution. When I tore my meniscus, a scope cleaned my knee up and I was back at it in a couple of weeks. In this case, the strategy was removal of the torn bits. On the other hand, when my son had his surgery, because of his age (14) and the nature of the tear (starting near the blood supply), the surgeon decided to repair the meniscus. In adults, this is uncommon though, because meniscus tears often fail, especially in adults. My only regret about my surgery is that I did not have access to the Alter G when I had my surgery. Now, a year and a half later, with the help of the Alter G, I am once again, back running again pain free!