Image of the knee joint, meniscus and kneecap
More Than Just A Tweak
The quiet early symptoms of this injury are actually what make it so easy to ignore. After all, what serious athlete doesn’t experience a tweaked knee from time to time? Unlike ACL injuries, which often result in searing pain, isolated meniscus tears are typically accompanied by a dull ache or a nagging pain around the joint and minor swelling.
“It doesn’t present as something terrible and usually only hurts with activity,” says Levitz, adding that the injury is typically diagnosed upon a physical examination, and then confirmed by an MRI. “Many people walk around with meniscus tears for months. I took care of a professional lacrosse player who played his entire season with a tear. He knew something wasn’t right, but he wasn’t in tremendous pain.”
And in the “no pain, no gain” world of professional sports, ignorance is often bliss, especially for players who will stop at nothing to boost their ERA or gain a playoff berth. Both Rodriguez and Jones played on their meniscus tears for several weeks before consulting a surgeon, and Gonzalez pitched his way through the World Series after tearing his meniscus late in the regular season. And while a cortisone injection can temporarily offset the pain and swelling, Levitz says letting this injury linger is never the ideal approach. The longer it’s left untreated the more limited performance will become.
“Obviously, professional athletes don’t want to miss any games or sacrifice their careers in any way, but I always advise my patients to take care of it early—even if the pain is minor,” he says. “You don’t want to wait until it’s too late.”
To Repair or Remove?
As a rule, athletes never want to hear the word “tear” in a diagnosis, but the good news is that minor meniscus injuries are easily treated without incurring too much time off the field. Tiny tears may not even require surgery—a solid physiotherapy routine concentrating on stretching and strengthening the knee may bring it back to normal function. For more substantial tears, surgeons generally go two routes in terms of treatment: Repair or remove. Both are minimally-invasive arthroscopic repairs. Repairing the meniscus involves sewing the it back together and at least a six-month layoff. Patients are in a brace for the first six weeks and then undergo intense physical therapy in order to regain a full range of motion.
Removal, also known as a meniscectomy or debridement, is the removal of the torn portion of the meniscus, typically resulting in just four-to-six weeks of physical therapy before a return to sports. While this option may seem ideal—it’s what A-Rod and Chipper Jones had done last July—doctors are always concerned that going this route increases chances for developing arthritis or possibly re-tearing further down the road.
“There’s no right or wrong, but there are benefits and drawbacks to each procedure. Having part of your meniscus removed allows you to come back in the same season, but it may not always be best for the long term,” says Levitz.
Which is exactly what happened to Moore. Her injury in January 2010 was actually her second meniscus tear—she originally tore it seven years prior—and then it happened again in mid-2011. After her third meniscectomy in seven years, she has developed arthritis in her knee and now doctors advise her not to quit running.
“After the first two surgeries, it was great to get back out and do everything I wanted so quickly—climbing rocks and hiking in New Zealand, running and swimming,” she says. “I knew there was risk, but didn’t know just how much. Now, I’m missing a fairly large portion of cartilage in my knee and I can’t run. I wasn’t ever aware of how likely I could reinjure it.”
Meredith’s situation is rare, but not entirely unique. Early in his NBA career, Orlando Magic vet Gilbert Arenas had three surgeries on his left lateral meniscus between April, 2007 and September 2008; the ensuing procedures believed to be necessitated by overstrenuous rehabilitation from the first surgery. These cases highlight the importance of cautiously caring for this injury as well as carefully weighing which procedure is best for each individual.
One factor that may prevent future re-tears in the meniscus and possibly even side-step surgery is the use of platelet rich plasma (PRP) Having gained buzz in the sports world over the past few years (Tiger Woods and Phillies’ pitcher Cliff Lee have used PRP to deal with a sore knee and abs, respectively), PRP is the process of centrifuging (spinning) a person’s own blood until it contains a concentrated mix of plasma cells and growth factors. That end product is then injected into the injured tissue. This, doctors say, speeds healing, improves tissue health, and rapidly creates new collagen and blood vessels—although, so far, studies on humans have failed to prove as much.
Dr. Answorth Allen, MD, an associate attending orthopedic surgeon at Hospital for Special Surgery in New York, NY, and a team physician for the New York Knicks, says PRP is especially beneficial for healing meniscal tissue, which naturally has a low blood supply. Because of its success as both a first line treatment for a tear as well as a way to augment meniscal repairs, Allen uses it routinely.
“PRP has made a large difference in meniscal repairs, encouraging healing in an area that only has about a twenty-five percent vascular supply,” says Allen. “There’s no science to prove it yet, but I’ve been impressed with the results. And as time and technology advance, we’ll see more and more ways to approach tears. So even if the rates of these injuries continue to climb, they’ll become that much easier to treat.”