Injuries to the meniscus of the knee are a common injury that effect that joint. So what are they, why do they occur and what can be done about them?
Anatomy
Your meniscus (menisci plural) are small disc shape pieces of cartilage that sit between your tibia and your femur (your shin and thigh bones). In each knee joint there are two menisci. Functionally they are as a shock absorber that protect the bony surfaces of a joint.
The medial meniscus is more commonly injured in comparison to the lateral, and is a part of what is known as the ‘terrible triad’, this is where in a bad knee injury the meniscus, Anterior Cruciate Ligament (ACL) and Medial Cruciate Ligament (MCL) can all be damaged in the one incident.
Mechanism of injury
Meniscal injuries are a commonly injured tissue of the knee joint, they are regularly injured in sports requiring agility and power, such as football codes, basketball, netball and tennis. The common mechanism of injury is a rotational force going through a bent knee, so could be landing awkwardly, changing direction or getting caught in a tackle.
However meniscus tears can also happen from getting up from a squat too quickly, especially if there’s weakness or instability.
Clinical features
Most often a case history will give our osteopaths a strong indication of the tissue damaged, so if you remember how it happened that will go a long way! The suspicion can then be supported by orthopedic testing in the clinic.
- As mentioned above landing and twisting or your knee getting ‘caught’ as your body rotates are common mechanisms
- The knee will feel like it’s ‘clicking’ or ‘locking’ within the joint itself
- Pain will vary between person to person, some people may need to be stretchered off the ground, others will be able to walk but feel uncomfortable. This often depends on the location and type of tear.
- A small tear may not be painful for 24 hours
- Knee swelling
- Restricted range of motion
- Tenderness along the joint-line
MRI imaging is often referred for meniscal injuries to assess the type and location of the tear, as well as to rule out the chance of an ACL or other ligamentous damage.
There is of course exceptions to every rule, in the older population meniscal tears are actually incredibly common and you can have them for years without knowing and without them causing pain, this is a normal part of aging. They only become problematic if the minor derangement creates a flap or a large longitudinal tear, this can happen with minor incidents such as just getting up out of a chair off balance or an awkward squat whilst pruning the roses.
Treatment
Treatment often depends on the severity and symptoms of the patient. Small tears will be treated conservatively with relative rest and then progressing to a strengthening and rehabilitation program. Depending on age and aggravating factors, a small tear may be managed within 4-6 weeks.
A severe tear will almost certainly require surgery. This is often done with you being in and out in one day, and you’ll even often be able to walk out. This often involves shaving off the affected piece of cartilage if it is loose or has detached. Some surgeons may try and stitch it together but this unfortunately has a reasonable chance of not holding, due to the very poor blood and therefore healing supply.
Pictured above are the many forms of meniscal tears. Those requiring surgery are often the bucket handle and longitudinal tears, any that have a displaced tear, this are all because they are located in avascular parts of the meniscus, whereas small tears on the periphery have greater blood supply and a higher ability to self-repair.
Some clinical features can indicate the potential need for surgery.
Treatment approach…..which way to go
The more research that is done on injury management, the more it appears that conservative management is often the best way to go. This is definitely the case with meniscal injuries. So below are some rough considerations that should be taken into account when deciding whether conservative or surgical treatment might be the best way to recover from your meniscal injury.
Conservative management
- Symptoms develop 24-48 hours after injury
- The incident was minimal or may not even be able to recall an incident for it to occur
- Minimal swelling
- Full range of motion with minor pain at end range
Potential for surgical consult
- Severe twisting injury rendering athlete not being able to continue
- Locked knee or severe loss of motion
- Palpable clunking on testing
- Little to no improvement after 3 weeks of conservative.