What are your treatment options?
These will vary depending on how much trouble you are having, your age, health, activity level, desires, and so forth. In general, cartilage tears will not heal by themselves. They may become less symptomatic with rest, crutches, and medication, but the symptoms usually recur with resumption of normal activity. One option, therefore, is to rest, (usually with crutches) do some exercises and try to maintain good muscle tone, and take an anti-inflammatory medication.
For most, the symptoms either are or have been severe enough to warrant having something further done. In my opinion, the best way to establish a diagnosis with 100% certainty, and to do something about it, is to arthroscope the knee. An arthroscope is a small telescope which allows me to see inside the knee after inserting it through a small, approximately 5 mm puncture wound. This is done as an outpatient at the hospital or surgery center. Anesthetic is required and the anesthesiologist will discuss the kind of anesthetic with you after you are admitted to the hospital. Most patients have a general anesthetic (go to sleep), but it can be done with a spinal epidural or a local anesthetic. The type of anesthetic used will be determined by your desires, other medical conditions, your anxiety level, and other factors.
Once the arthroscope is in the knee, the entire internal portion or intra-articular portions of the knee can be examined and the cartilage tear can be found. Some cartilage tears are not repairable. In that case, one or more small instruments are inserted through other small puncture wounds, and the torn part of the cartilage is removed. The unaffected portion of the cartilage is left intact. The damaged part is usually about a sixth or a third of the total volume of cartilage. It can be substantially more or less.
Some other cartilage tears may be considered to be repairable. In these, stitches or sutures can be placed cross the torn part of the cartilage with arthroscopic control. If this is done, sometimes a small incision may be necessary on the back or the side of the knee to tie the stitches. Most often today, the repairs can be made totally within the knee without the need of making external incisions. Even though repair seems like more surgery, patients can still go home on the same day.
The main difference between taking out the torn meniscus and repairing the tear is that, if the torn part is removed, your time on crutches will be about a week or so and you will be able to put all your weight on your knee fairly quickly. However, if the tear is repaired with sutures, as described above, sometimes (rarely) hinged-brace is needed to restrict some of the knee motion for a total of six weeks. Crutches are also needed for six weeks as you can only put some weight on that side (partial weight bearing).
After that, the recovery is pretty much standard, with full resumption of sports and activities without restrictions occurring three months from the time of repair. There is a chance (approximately 20% to 30%) that the cartilage will re-tear. The decision to attempt repair depends on the type of the tear, the age of the patient, and other factors. In general, the younger the patient and larger the tear, the stronger I feel about trying to repair it. The specifics of your case will be discussed with you.
Patients that work for themselves or have a sedentary or office type job, can go back to work within the next few days following surgery, if they feel like it. Labor and most athletic activities require about three to six weeks, depending on several variable factors, such as type of surgery, age, desire, motivation, and so forth.