What is the Meniscus?
The meniscus (plural Menisci) are two pieces of “C” shaped rubbery cartilage in your knee joints. Each knee has a Lateral (outer) and a Medial (inner) meniscus. They provide cushioning between the thigh bone and the shin bone and act as shock absorbers during high impact activities such as running and jumping. Damage to these pieces of cartilage can cause knee pain and instability.
Common causes of tears
Most commonly, meniscal tears are caused by physical trauma or sports injury. An unnatural rotation of the leg can cause the cartilage of either of the menisci to tear. The medial meniscus is attached to the Anterior Cruciate Ligament (ACL) which can also be damaged in these situations. Impact on the side of the knee from a tackle in team sports or over rotation when landing on uneven surfaces are all common causes. Higher incidents of ACL and Meniscal injury are seen in Football (both Soccer and American), Netball, Basketball and Downhill Skiing.
Away from sports, age and occupation can also be risk factors in this type of injury. As we age, Osteoarthritis in the knees becomes more common. This disease can weaken the menisci cartilage and increase the chances of damage. Occupations that require frequent and prolonged squatting such as Plumbing or Carpet laying can also strain the knee joint and lead to an increased risk of meniscal tears.
Symptoms of a meniscal tear
Symptoms of meniscal tears will vary based on the location of the tear, its severity, the overall health of the individual and the time that has elapsed since the injury.
Common symptoms may include:
- Immediate pain after the injury – The sudden tearing of the meniscus is typically accompanied by the feeling of a pop or snap within the leg during an overexerting twisting or stretching motion. Pain will be felt in the immediate area of the tear.
- Slow onset of symptoms – Alternatively,the meniscus can tear without much of a sign or initial pain. This slow onset of symptoms is more common in older individuals and those with damaged knee cartilage from osteoarthritis.
- Pain with movement. The pain will reflect the location of the tear but extend throughout the knee with movement. In the event that the knee has locked, bending it will cause pain to worsen. Pain may lessen with rest but will return when moved again.
- Fluid accumulation within the knee joint. This accumulated fluid will cause the entire area to swell up and reduce mobility.
- Knee locking. If a piece of the meniscus breaks free due to a tear, it may lodge within the joint of the knee itself. This can cause knee locking, in which a person loses the ability to fully straighten the leg when sitting or standing.
It is common for other parts of the knee joint, such as the ACL, to be injured during a traumatic event that causes a meniscal tear. Your doctor (or A&E) will usually check for other injuries during the diagnostic process.
Treatment options
As with all soft tissue injuries, conservative treatments are usually tried before surgery is considered.
The P.R.I.C.E protocol (Protection, Rest, Ice, Compression, Elevation) is often used first with acute injuries (from trauma). This will help to manage the initial pain and swelling but can delay healing due to restriction of blood flow (cold constricts blood vessels). Therefore, it should only be used for a day or so.
Anti – inflammatory medication such as Ibuprofen can help to reduce swelling and may be used for longer. Pain and swelling reduction will encourage movement which can aid healing.
Corticosteroid injections into the knee joint may be considered by your doctor to relieve pain and reduce inflammation. This is likely to be offered to a patient with age or occupation related meniscus tears and Osteoarthritis.
Physical therapy – Massage and/or Physiotherapy can be used to improve blood flow, reduce pain, relax and strengthen the muscles around the joint. This will improve movement and provide support for the joint.
If the tear is severe or the patient has had a number of occasions of damage, surgery may be required. This surgery is often done using key-hole incisions and the surgeon can remove any loose pieces of cartilage and repair the remaining tissues. Surgical success is higher in younger patients and those who have their operations soon after the injury occurs. Sometimes, the meniscus is too badly damaged to repair and it needs to be removed. This procedure increases the risk for future problems in the joint but will be performed if necessary. After surgery, weeks of recovery and rehab will be needed. During this phase, Soft Tissue Therapy will be very useful in helping the patient to maintain their joint flexibility and perform their Physiotherapy exercises.
If you want any discuss how massage and gentle exercise can help you to recover from any surgery or injury, please get in touch.