Ask Dr. George: Meniscus Tear

Last week of May '99, Zugspitze, Germany

“As it often happens, my injury occurred on the very last day of the riding season. It was nice and warm, and the pipe was as soft as butter. I tried to stick one of those flips with a spin, but somehow I couldn't complete my rotation properly and hit the pipe wall with my tail. The wall was so soft I ended up sticking in it while still standing on my board. I leaned forward in order to pull off, but then it turned out the wall wasn't as soft as I thought, and the leverage of my body was much stronger. My knee twisted and I felt a sharp pain on the inner side of my left knee joint.

“I decided to rest, and after three days the pain disappeared without medical help. Feeling better, I hit the road for my holidays. While I was surfing, however, my knee began to feel strangely numb.

After my holiday I returned to the snow; the pain in my knee came back and grew stronger. It even hurt at night. I took a break, but the trouble persisted (for instance, I had serious problems kneeling down), and I decided it was time to go see Dr. George.”–Martina Tscharner

Meniscus injuries are among the most frequent knee injuries in snowboarding. The menisci are crescent-shaped cartilaginous disks between the thigh and lower leg bones that act as shock absorbers and stabilizers of the knee joint.

How do meniscus injuries happen?

The consistency of a normal meniscus is pretty much like a Gummi Bear. Its surface is smooth and has a dull milky appearance. If you keep kneading and stretching a Gummi Bear for a while, you will observe very small tears on the surface, which will later be visible inside as well. With a certain number of small tears, even a relatively weak impact is sufficient to twist the Gummi Bear enough to join all the small tears together and turn them into a big one. This is no different than the meniscus.

Meniscus damage usually happens when the athlete's foot is standing firmly on the ground and the upper body is rotating. In these moments, the strain to the meniscus from the pressure and rotation can be strong enough to tear it. Meniscus damage can also happen by overstretching or over-bending the knee joint. In fact, meniscus can be torn in many different ways. This is related to the age of the injured person and the strength and nature of the impact. Generally, the inner meniscus is subject to more injuries than the outer meniscus.

What are the typical symptoms of a medial meniscus injury?

The most typical signs of an inner meniscus tear are:

•Swelling of the knee joint when strained.

•Pain on the inner side of the knee joint right above the joint gap.

•Pain with extreme bending of the knee joint, and increasing pain when twisting the knee joint.

•Pain, stiffness, or tightness in the joint when over-bending or overstretching the knee. This is due to an incarceration of the meniscus tissue–meaning the torn part of the meniscus gets caught between the tibia and femur bones.

•Pain when the knee is straight in a relaxed position with the joints one on top of the other.

How can meniscus damage be diagnosed?

Generally, a clinical examination by an experienced physician will do. But, as some cartilage damages cause similar symptoms, a magnetic resonance tomography (MRI) can be very useful.

What can be done in case of meniscus damage?

There are hardly any blood vessels in the meniscus, which is why meniscus injuries generally don't heal by themselves. As a meniscus tear or a meniscus lobe incarcerated inside the joint leads to recurrent troubles and inflammations, surgery (in most cases) is unavoidable. During the last few years, the choice of therapy has shifted from open surgery to the less-invasive method of arthroscopy. In this case, the surgeon slips an arthroscope (about thhe size of a pencil) with a camera on it into the joint and examines it by watching the transmitted pictures on a monitor screen. Through a second incision (about 0.5 cm wide), they begin to take further examination and therapeutic measures by means of small cutting and pinching tools. The arthroscopy can be done by outpatient treatment or as an inpatient treatment in a hospital.

Acute incarceration of a torn meniscus requires immediate surgery. As the menisci are the most important protection of the cartilage, the surgeon avoids taking away more than is absolutely necessary. In the ideal case, the meniscus can be conserved entirely by means of a simple suture.

After meniscus surgery, the patient should stay away from physical activity for at least one week. Good physiotherapy can do a lot for quick recovery. Generally, you can strap your board back on after a break of three weeks.

Dr. G. Ahlbäumer, better known as Dr. George, is an orthopedic surgeon at the well-known Klinik Gut in St. Moritz, Switzerland. Apart from surgery, he specializes in injury prevention. You can e-mail Dr. George directly at