Basketball phenomenon Jeremy Lin of the New York Knicks had to sit out part of the season because of a common knee injury—a torn meniscus. This can cause pain, swelling and a loss of motion. But you can have a torn meniscus even if you’re not active or don’t recall a recent injury.

Unfortunately, many people get surgery who don’t need it. Here’s why surgery should be your last resort and effective treatments to try first…

CARTILAGE WEARS OUT

The menisci are small pieces (about one inch by two inches) of cartilage. They act as shock absorbers between the bones that meet in the knee. The twisting, turning and sudden stops and acceleration that occur in sports can cause the cartilage to rip. This also can happen gradually, due to the age-related degeneration of cartilage, and is common after age 40.

The classic symptom is a “popping” sensation in the knee, followed by pain and swelling. The knee might briefly—and repeatedly—lock in position. The popping/locking occurs when a loose piece of cartilage causes the knee to “catch” during its normal movements.

You might notice intermittent pain and stiffness in the knee. It feels similar to arthritis—in fact, it might be arthritis, which often accompanies, or follows, a torn meniscus.

But not everyone with a torn meniscus has symptoms. In one study, researchers randomly chose nearly 1,000 people to have a knee MRI. They found that 30% of women and 42% of men had some meniscal damage—but 61% of these patients had little or no discomfort.

SIMPLE TREATMENTS

If your symptoms are mild and/or intermittent and there isn’t swelling or a loss of mobility, you probably can get by with an occasional ibuprofen or other type of painkiller. You also will want to strengthen the muscles that support the knee.

If the pain and stiffness are severe, you will need to be evaluated by a doctor.

In my experience, about 90% of patients who are middle-aged and older can treat a torn meniscus without surgery. (About half of younger adults, who are more likely to have a trauma-related injury, will need surgery.) Damage to the cartilage rarely heals, because only the outer 20% to 25% of the meniscus has a blood supply.

But with treatment, symptoms usually diminish or disappear…

Cortisone. This steroid can dampen flare-ups, especially if there is arthritis. A single injection of a corticosteroid into the knee quickly reduces inflammation as well as pain.

Most patients need just one injection—if one shot isn’t effective, subsequent injections are unlikely to help. If the injection does work, you can get subsequent injections, about six to 12 months apart, if you are having flare-ups.

Exercise and/or physical therapy. Strengthening the muscles around the knee reduces stress on the cartilage, improves mobility and reduces discomfort. Patients who haven’t exercised in the past might want to work with a trainer or physical therapist. You also can do exercises on your own.

Example #1: Straight-leg raises. Lie on your back with your good knee bent and the injured leg extended on the floor. Without bending the knee, raise the injured leg to about a 45? angle, then lower it back down. Do it 10 times, then repeat on the other side so that both legs are equally strong. If 10 reps are easy for you, add ankle weights.

Example #2: Ride a stationary bike, maintaining a slow-to-moderate pace. I recommend this because it increases flexibility as well as strength.

Glucosamine/chondroitin. These over-the-counter supplements can decrease the symptoms related to early arthritis. The typical dose is 1,500 milligrams (mg) of glucosamine and 1,200 mg of chondroitin daily. If you notice an improvement—for example, less pain and stiffness—keep taking them. If nothing changes after about three months, they probably won’t help.

Caution: Glucosamine and chondroitin may interact with blood thinners, such as warfarin, and cause bleeding problems. Don’t use glucosamine if you are allergic to shellfish.

Hyaluronic acid. This substance lubricates the knee, reduces inflammation and may slow cartilage breakdown. It won’t help if you have only a torn meniscus, but it’s effective for patients with a torn meniscus who also have knee arthritis. Patients are given three injections, one week apart. The injections are effective for about six months—the series can be repeated as needed.

SURGERY

If your doctor recommends surgery, get a second opinion because surgery often is not necessary for a torn meniscus. No one should agree to surgery before trying everything else.

The operation is done arthroscopically, through one or more tiny incisions in the knee. It’s a simple, outpatient procedure that typically takes 30 minutes or less. Main approaches…

Partial meniscectomy. This is the most common procedure. Only the damaged part of the meniscus is removed. Most patients regain all or most of their normal range of motion.

Total meniscectomy. It might be necessary to remove the entire meniscus when the damage is severe. Your knee will work well after the procedure, and you might not have any pain or stiffness. But without the cushion of cartilage, you are almost certain to develop knee arthritis at some point.

Meniscal repair. You often read about athletes who have had their menisci repaired, but this usually is just a partial meniscectomy. Repair rarely is done, because the tear is rarely in a vascular, or repairable, zone.

Meniscus transplant. Some patients continue to have pain after the meniscus is removed. One option is a transplant procedure in which a meniscus from a cadaver is used to replace the original cartilage. This works only when the procedure is done before a patient has developed arthritis. It can reduce or eliminate pain, but the transplanted material may need to be replaced at some point.

At our hospital, we do less than 50 of these transplant procedures a year. And these usually are in young patients who have lost their entire meniscus due to multiple surgeries and who have pain but not arthritis.