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The menisci of the knee are two crescent shaped pieces of cartilage that rest on the top of the tibia.
There are two basic reasons why the cartilage in the knee can tear: trauma and degenerative changes.
Typical complaints with cartilage tears involve knee joint pain, swelling, catching or locking of the knee, or a feeling of the knee giving way. It is important to note that even if a cartilage tear is diagnosed via an MRI, it is not an indication that surgery is a must.
In cases in which a tear is present and persistent symptoms occur, surgery is the treatment of choice. In less common situations involving the outer edge of the medial meniscus, a repair of the cartilage may be warranted. However, therapy didn't always help, however and some people wound up having surgery to fix the problem.
Results were published online March 18th in the New England Journal of Medicine and presented Tuesday at an American Academy of Orthopaedic Surgeons conference in Chicago. A meniscus is one of two C-shaped pieces of cartilage that cushion the knee between the shinbone and thighbone, according to the Mayo Clinic.
About one-third of people over 50 have a tear in one, and arthritis makes this more likely. When that happens, it's tough to tell if the pain is from the tear or the arthritis - or whether surgery is needed or will help. Thirty percent of patients assigned to physical therapy wound up having surgery before the six months was up, often because they felt therapy wasn't helping them. However, an Australian preventive medicine expert wrote in an accompanying editorial published in the same journal that that the study's results should change practice.

Surgery costs about $5,000, compared with $1,000 to $2,000 for a typical course of physical therapy, Katz said. One study participant -- Bob O'Keefe, 68, of suburban Boston -- was glad to avoid surgery for his meniscus injury three years ago. An imaging test showed a less severe tear and a different surgeon recommended physical therapy. Fancy living somewhere with low taxes, affordable real estate and a reasonable cost of living? The menisci have a degree of mobility which allows the tibia to roll and glide back on the femur during flexion. Medial tears tend to be related to a stable knee joint, while lateral meniscal tears may be concurrent with damage to the anterior cruciate ligament. The knee may appear swollen, will be painful and there will be limitation of movement in the knee.
Patients may describe a pop or a sensation of tearing when the injury occurs, while swelling may occur one or two days post injury. Patients may experience a clicking feeling in the knee, and locking may occur before completion of the extension movement. Some minors tears are treated using the RICE regime and Non Steroidal ant-Inflammatory drugs, while, depending on the nature and severity, more serious tears may require surgical repair or meniscectomy. A study reported in the New England Journal of Medicine, researchers found that physical therapy was as effective in treating meniscus tears as surgery. Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomised trial.
A new study that compares physical therapy to knee surgery for the common injury finds that therapy can be just as effective -- not to mention cheaper.

But those who stuck with therapy had improved as much six months and one year later as those who were given arthroscopic surgery right away, researchers found. It would be quite reasonable to try physical therapy first because the chances are quite good that you'll do quite well," said one study leader, Dr. Yet they ended up the same as those who got surgery right away, as well as the rest of the physical therapy group who stuck with it and avoided having an operation.
Therapy "is a reasonable first strategy, with surgery reserved for the minority who don't have improvement," wrote Dr. Dvorkin, 56, director of operations at the Coalition for the Homeless in New York City, had surgery followed by physical therapy for a tear in his right knee and said it was months before he felt no pain.
Dvorkin said it worked like a charm - he avoided surgery and recovered faster than from his first injury. Depending upon the size and location of the tear and your activity level, surgery can be avoided. Jeffrey Katz, a joint specialist at Brigham and Women's Hospital and Harvard Medical School. The treatment involved two to three hour-long sessions a week, including strengthening exercises, balancing and massage.
Is arthroscopic surgery beneficial in treating non-traumatic, degenerative medial meniscal tears? The therapy was nine sessions on average plus exercises to do at home, which experts say is key to success.

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