A torn meniscus is a very common knee injury and is one of the top reasons to see an orthopedic surgeon. This type of injury can put a serious cramp in your sports training and game schedule. Plus, it might be leaving you with a lot of pain, loss of function, anxiety and questions about the healing process.
What is a meniscus and how does it tear?
The meniscus is a “C” shaped piece of cartilage in your knee that is designed to absorb the forces you put it through every day. This absorption is critical since the knee joint is an area of high impact, providing adequate cushion and movement between the two largest bones in your body: the thigh and shin.
The menisci are categorized into four different zones in each knee. They are at highest risk for injury with twisting motions, especially when the foot is planted. Direct trauma, such as getting hit in the knee during a sport, is also a common cause for a meniscus tear. Ball sports tend to be high risk for knee injuries since they involve pivots and rapid changes in direction.
How much time does my knee need to heal?
You want to get better, but you also want to give your meniscus time to heal. One of the biggest questions on your mind is probably about when you can return to your sport.
Does your knee need time to heal or can you continue until the end of the week, month, season, or tournament without any serious consequences? The key is to find balance between rest and movement that works best for your specific symptoms, activity level, and sport.
Weighing the options following knee injury.
There are three options following a meniscus tear: conservative treatment, removal of the damaged meniscus (meniscectomy) or meniscus repair. Meniscus removal is most common with athlete’s over 20 years of age, big tears, or tears in specific areas of the meniscus that have the least amount of blood flow and are not likely to heal.
Meniscus repair is a great option for younger athletes or small tears that have a higher chance of healing. No matter what, conservative treatment should always be the first line of defense to manage initial symptoms and get insight into how the knee is healing and coping.
However, if symptoms persist and are affecting your ability to compete, you will be faced with these two surgical options.
Specifically for athletes (especially young athletes), research indicates that a meniscus repair is likely a better option since it will help maintain optimal knee mechanics and decreases the risk of future knee problems, such as arthritis.1 Yet, there is a 23% risk of re-tearing the meniscus within the first 5 years of repair, so discuss your options thoroughly with your surgeon.2
Assess your knee’s function and start a therapy program prior to returning to your sport.
With the help of a physical therapist, you can receive a full assessment of your knee to determine what loss of function your injury has caused. Typical problems include loss of knee range of motion, muscle guarding and pain, swelling, loss of strength around the joint and poor awareness of where the joint is in space (called proprioception).
Thus no matter what your sport, the best type of treatment promotes blood flow for healing while maintaining strength, flexibility and balance mechanisms in the knee. With effective treatment, you should notice a gradual decrease in pain and any perpetual swelling, returning strength and full knee motion.
With quick initiation of treatment and making the right decision about your activity level, you may be able to return to your sport relatively quickly and even avoid surgery altogether.
So can I keep playing my sport on my knee or will I cause further damage?
Ideally, the meniscus will heal completely without surgery and you can return fully to your sport. However, the healing process takes time and you may be trying to reach a specific goal or finish out a season.
Unfortunately, a meniscus has very little to blood flow to it, which can limit its ability to heal correctly. This is where you need to stop and take inventory of your ability to compete (your therapist can help you with this).
If you find you are still able to participate with minimal pain, leg weakness or feelings of instability in the knee, you may decide you can continue your sport and delay time for surgery or adequate rest for the healing process until later.
However, if you continue to do sports on your injured knee, there is always a small potential risk of further tearing the meniscus.3 This can lead to a more extensive surgery that requires removal of a larger portion of the meniscus.
Ultimately, it comes down to your comfort level with competing on your knee. The type of sport you play will also determine your risk of further injury. If your sport involves a lot of high impact, planting and twisting motions, you may want to think twice before playing.
How do I know if I’m able to keep playing?
The biggest issue you will encounter with continuing to play is a decline in your abilities, leaving you far from the top of your game. You may find you just can’t run as fast, have as much power or keep having a painful, catching, or locking knee. These are all signs that you may need to take some time to heal.
However, if after a full assessment you feel comfortable using your knee without any locking, clicking, sharp pain or any similar symptoms, you can give your sport a try and see what happens.
Your therapist can help gauge your readiness for playing your sport by assessing movements specific to your sport. This way there will be no surprises and you will feel strong and confident in your return.
It’s all about listening to your body.
It all depends on you. If your symptoms are well managed and not limiting your ability to complete your sport, a delayed surgery, or even no surgery at all, may be okay.
It ultimately depends on the type of activities your sport requires. It also depends on your age, since young athletes may be at a higher risk than adults to worsen the tear (due to the laxity of their connective tissue).
Talk to your therapist and/or orthopedic doctor and make a decision that you are happy and comfortable with. Continuing to play has its benefits since there are downsides to being sedentary for too long too.
The take away.
- There is no black and white answer for any type of joint injury for whether you can continue to play.
- Talk to your therapist and orthopedist and work together to make a plan.
- Assess your knee’s function and symptoms to decide what’s right for you.
- Consider the sport and what type of movement is required of you.
- Consider your age and attachment to the sport. Is your sport of choice something you are passionate about or something you could easily exchange for a different once? This may seem like a trivial question but really take some time to reflect to consider the best options for you! Any surgery should be taken seriously since it compromises your joint integrity.
Keep playing if you’re comfortable.
It is completely plausible to continue your sport and delay or even avoid surgery for a torn meniscus. As long as it doesn’t aggravate it, keeping active is probably the best thing you can do for your injured knee, entire body and overall well-being and health.