Dear Dr. Garner,
I am 62 years old and am very active. I run around Prospect Park each day, and I play golf at least once a week, especially now that the weather is getting better.
Everything was fine until I started to get pain in my knee. It swells up a little, and sometimes I think it feels somewhat unsteady.
My doctor ordered an MRI and found a tear in my cartilage. He said it was involving the meniscus on the inner side of the knee.
I figured that this meant surgery. Instead, my doctor suggested physical therapy to build up my leg muscles. He says surgery may not be necessary.
Does this make any sense to you? I want to get back to running and golf as soon as possible.
Knee KO’d
In Kensington
Dear Knee KO’d,
Before discussing your torn meniscus, I would like to acknowledge loyal Tablet reader Joan Williams. It was a pleasure to meet you.
Now, back to the question. Torn cartilage in the knee is very common. About 40 percent of people have a torn meniscus, and about 70 percent of people don’t even know it, as it is not symptomatic. Therefore, we have to be very careful when diagnosing the condition because the tear we see on an MRI may not be causing the problem you are having.
The tear can occur from degenerative disease, which means the cartilage has worn down over time from the pounding it has taken. As we age, the meniscus gets worn, making it easier to tear. Another way to get a tear is through sports or trauma where the knee is bent and then twists.
No matter how the tear occurs, it can lead to pain, swelling, locking of the knee joint, an unstable or wobbly feeling in the knee and difficulty straightening the joint.
A meniscus is a rubbery material called cartilage, which acts as a shock absorber, and prevents damage to the bones of the knee by keeping the joint steady.
The menisci are ‘C’ shaped and sit in between the shin bone and the thigh bone, one on the inner part, and one on the outer part of the knee.
When they tear, they lose their effectiveness, and then pain and swelling occur. You might experience a sharp pain when squatting, or you may not be able to straighten the knee. People particularly feel much pain when exiting a car as their knee may lock.
The symptoms often subside on their own in two or three weeks or may require further action, such as physical therapy, or if not successful, surgery.
There are ways to prevent the meniscus from tearing due to sports.
1. Use proper athletic shoes, such as cleats when playing football. One wrong step can tear the meniscus.
2. It is imperative to warm up, stretch and cool down when exercising.
3. Practice proper technique in your sport. If you are playing golf, make sure that your swing motion is proper. Lessons may be of help.
4. Schedule regular days off from exercise. If you feel fatigue, soreness or pain, it is good to rest a day or two.
Your doctor can evaluate your meniscus by doing a physical exam or an MRI. This can pinpoint the injury and determine the treatment options.
Some tears do need surgery, particularly if the knee is locking.
On the other hand, a major study was just published last week in the prestigious New England Journal of Medicine, which looked at the results of one group with torn menisci who had surgery, versus a second group with torn menisci who had just physical therapy.
Surprisingly, whether a patient had surgery or had the more conservative physical therapy, there was no difference in the outcome or time to return to sports or work.
If it is possible to get the same results from physical therapy as surgery, I am sure most patients would prefer this option. Of course, each tear is different so it is important to have a discussion with your doctor and avoid a “knee jerk” (couldn’t resist) response to automatically having surgery.[hr] Dr. Steven Garner is a Fidelis Care provider who is affiliated with New York Methodist Hospital, Park Slope. He also hosts “Ask the Doctor” on NET, Tuesdays at 8 p.m. on Ch. 97 Time Warner and Ch. 30 Cablevision.