Treatments for Meniscus (knee) tears in Children

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Boston Children's Hospital's Orthopedic Center provides patients with comprehensive care—including evaluation, diagnosis, consultation, non-surgical therapies, surgery and follow-up care.

Initial self-aid for a torn meniscus usually involves “R.I.C.E.” (rest, ice, compression and elevation), as well as medications to help control pain and swelling:

  • rest: Make sure your child doesn't exert in any way that involves the injured knee; he can use crutches or a cane, if it helps.
  • ice: Wrap a towel around ice cubes, or use a bag of frozen vegetables, to ice the area at two-hour intervals, for 20 minutes each time.
  • compression: Wrap a bandage or soft brace (from the drugstore) around his injury.
  • elevation: Your child should remain seated or reclining, with his leg elevated, as often as possible before and after seeing the doctor.

Non-operative treatment

If your child's knee is stable and does not lock, the R.I.C.E. formula combined with nonsteroidal anti-inflammatory pain medication may be all that's needed to treat his torn meniscus. Blood vessels feed the outer edges of the meniscus, giving that part the potential to heal on its own. So, small tears on the outer edges often heal themselves with rest.

Additional measures to support this conservative approach to treatment can be:

  • crutches to take pressure off the knee
  • exercises to strengthen and stabilize the muscles around the knee
  • arch supports or other shoe inserts to redistribute weight while walking

Surgical repair

If your child's meniscus tear doesn't heal on its own and his knee becomes painful, stiff or locked, it may need surgical repair. The goal of meniscal surgery is to obtain a stable, smooth rim of meniscal tissue that doesn't rub abnormally on the cartilage surfaces of the knee. (Patients may still have an increased risk of arthritis in the knee after a meniscal tear, even if surgery is performed.)

Depending on …

  • the type of meniscal tear
  • whether your child also has an injured ACL
  • your child's age, general health and other variables

… the surgeon may recommend surgery using an arthroscope to:

  • place sutures to repair the meniscus, or
  • use small instruments to trim off damaged pieces of meniscal cartilage

Arthroscopic surgical techniques

Children's orthopedic surgeons have spent many years developing highly specialized arthroscopic techniques to repair meniscus tears. Our deep experience allows us to repair not only small “simple” tears—but also complex, multi-component tears, which most physicians elect to remove.

 

 

Arthroscopic treatment of meniscal tears

 [photo courtesy of the American Academy of Orthopaedic Surgeons]

Because many of our patients are young, we emphasize trying to repair not only small meniscal tears, but also large, complex tears. Although the success rate is lower for complex tears (80 percent) compared to simple tears (98 percent), we feel that it's worth the time and effort to try to save the meniscus—in order to keep as much of the normal shock absorber in the knee as possible.

In some cases, the torn part of the meniscus is either so small that it's impractical to repair, or so damaged that the repair is likely to fail. In these cases, this tissue is simply trimmed out to leave a stable rim of meniscus and to minimize further damage within the knee.

Alternatives to surgery

Surgical treatment is usually advised for patients with symptoms of unstable meniscal tears, including pain, locking, giving way or catching in the knee. But non-operative management of isolated meniscal tears may be indicated for patients:

  • with small, stable tears located in the outer one-third of the meniscus
  • with low-demand lifestyles
  • with no effusion (“water on the knee”) or swelling of the knee and no symptoms of locking or catching in the knee

Care before surgery

If your child is to have arthroscopic surgery to treat his meniscal tear, he may need a complete physical with his pediatrician before surgery to assess his health and rule out any conditions that could interfere with his surgery.

Before surgery, tell your child's doctor about any medications that he's taking. You will be informed which medications he should stop taking before surgery. This typically includes aspirin and anti-inflammatory medications, which should be stopped 10 days before surgery.

Your doctor may also order tests, such as blood samples or an echocardiogram, to help prepare for your child's procedure.

Care after surgery

After surgery, you and your child will be given written instructions, pictures of his surgery, a prescription for therapy and a copy of our rehabilitation guidelines. A cast or brace will immobilize the knee for a period of time after surgery, and your child will use crutches for four to six weeks.

Your child will need to complete a course of rehabilitation exercises before gradually resuming his activity. He'll meet with the physical therapist, who will instruct your child in exercises, wound care and how much weight he should place on the operated knee. The therapist will work with your child to help set goals for rehabilitation; the entire rehab process will probably take four to six months.

Throughout the rehab period, your Children's team will be available for questions, concerns and help.

Caring for your child after treatment or surgery

Your child's doctor will give you guidance regarding how long your child's knee should be rested in order for it to heal. The good news is that 98 percent of patients with simple meniscus tears are able to return to sports and regular activities without knee instability.

After your child's knee has healed, and after his strength and stability have returned through physical therapy, he should be able to return to his previous sports and activities—usually within six months. (But his doctor may recommend lifestyle changes for him if he has joint changes such as arthritis or instability that couldn't be corrected even with surgery.)

Your child's rehab team will help him relearn normal movements and pain-free activities. After he has successfully eliminated most of his discomfort and has returned to his normal routine, it's important for him to continue to be involved in some form of orthopedic fitness to ensure continued good physical health and well-being.

Coping and support

At Boston Children's Hospital, we understand that a hospital visit can be difficult, and sometimes overwhelming. So, we offer many amenities to make your child's—and your own—hospital experience as pleasant as possible. Our Center for Families staff will give you all the information you need regarding:

  • getting to Children's
  • accommodations
  • navigating the hospital experience
  • resources that are available for your family

In particular, we understand that you may have a lot of questions when your child is diagnosed with a meniscal tear. Will this affect my child long term? When can he return to his sports and activities? Children's can connect you with extensive resources to help you and your family through this stressful time, including:

  • patient education: From the first doctor's appointment to treatment and recovery, our staff will be on hand to walk you through your child's treatment and help answer questions you may have—How long will his recovery take? Will he need home exercises and physical therapy? We'll help you coordinate and continue the care and support your child received while at Children's.
  • parent-to-parent: Want to talk with someone whose child has been treated for a meniscus tear? We can often put you in touch with other families who've been through the same process that you and your child are facing, and who will share their experience at Children's.
  • faith-based support: If you're in need of spiritual support, we'll connect you with the Children's chaplaincy. Our program includes nearly a dozen clergy— representing Protestant, Jewish, Muslim, Roman Catholic and other faith traditions—who will listen to you, pray with you and help you observe your own faith practices during your Children's experience.
  • social work: Our clinical social workers have helped many families in your situation. Your Children's social worker can offer counseling and assistance with issues such as coping with your child's diagnosis, stresses relating to dealing with a child's injury, changing family dynamics and financial issues.
A Long Line of Orthopedic Firsts

With a long history of excellence and innovation and a team of clinicians and researchers at the forefront of orthopedic research and care, Children's is home to many treatment breakthroughs:

  • advanced techniques and microsurgery care for complex fractures and soft tissue injuries to the hand and upper extremity
  • one of the first pediatric sports medicine clinics in the nation
  • a hip program that has performed more than 7,000 periacetabular osteotomies
  • advances in our spinal program, such as video-assisted thorascopic surgery

We are also:

  • the oldest and largest comprehensive center for the care of spina bifida
  • one of the first scoliosis clinics in the nation
  • one of the first centers in the nation to use adjuvant chemotherapy and perform limb salvage surgery for patients with osteosarcoma

 

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The Division of Sports Medicine has provided care to thousands of young athletes and is the health care choice of world-renowned dancers and professional athletes. We are the orthopedic caregivers for the Boston Ballet and the Boston Marathon.
We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the third year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.”
- Sandra L. Fenwick, President and CEO

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