The skinny on meniscus tears
The Boston Celtics were dealt a late-season blow this week when the center of their defense, Robert Williams, was announced to have a meniscus tear that will require surgery. I got a lot of questions about meniscus tears from the Boston sports media, so I’m going to share what I told them with you.
A simple knee drawing highlighting the two types of cartilage - articular cartilage (blue) and meniscus (pink)
The knee has 2 types of cartilage - one type is like a thick, shiny lacquer paint that coats the bones (the articular cartilage) and the other are two discs of cartilage that sort of feel like they’re made of silicone (you have two of them - the medial and lateral meniscus). The articular cartilage can thin and become rough with age or mileage and we call that osteoarthritis. The meniscus can tear because of an actual injury or from wear and tear over time.
A meniscus tear will not heal by itself. That being said, many patients can live with meniscus tears. In fact, in MRI studies of patients with NO knee pain at all, 30-40% had meniscus tears and had no idea. A meniscus tear warrants treatment if it is causing symptoms that are bothersome to the patient. These can range from pain and swelling, to mechanical symptoms where a fragment of the torn meniscus can flip into the wrong place and act like a door jam, causing the knee to lock up.
When an athlete has knee pain or swelling and the MRI shows a meniscus tear, the options for how to treat it depend on a lot of things - type of tear, symptoms, other issues in the knee (arthritis is a big one), timing in the season, age of the athlete, and more. Many athletes try to rehab through a meniscus tear if they’re not having mechanical symptoms. While the meniscus tear doesn’t truly “heal,” sometimes the rehab quiets down the tear and either allows them to finish the season or, sometimes, to avoid surgery altogether.
In the case of Robert Williams, the team announced that he will be having surgery. The options will be a partial meniscectomy, where the torn part of the meniscus is trimmed away, or a meniscal repair, where the tear is stitched back together by the surgeon. That decision will be made by the surgeon and patient and may not be final until the surgeon actually scopes his knee and is able to fully evaluate the tear. The blood supply to the meniscus is poor and wanes with age. If the surgeon stitches together a part of the meniscus that doesn’t have good blood supply, it will never heal and will just fall apart when the stitches absorb/give way. While we always prefer to repair a torn meniscus to preserve the “cushion” and support that it gives to the joint, sometimes it’s just not possible. In those cases, the surgeon trims away the part of the meniscus that is torn and re-contours it so that it’s less likely to tear again.
If surgeons are able to repair the meniscus, recovery is 6+ months. It takes a while for the meniscus to heal. Athletes who undergo partial meniscectomy, where the meniscus is trimmed, are often able return to sports much more quickly, at around 3-6 weeks.
Long-term, if a meniscus tear can be repaired, it’s usually best for the knee. Having a full and functioning meniscus is likely protective against early-onset arthritis. That being said, some professional athletes who are candidates for meniscus repair opt instead for the quicker healing time associated with trimming the meniscus instead. It is a personal decision that takes into account more than just the athlete’s knee, including things like sport, position, timing in the season, contract and career considerations, and sometimes other injuries.