Historically, when you had been diagnosed with a torn meniscus, you would quite quickly be referred to the surgeon for an arthroscopy to remove it, however, as with many things, advice and best practice has moved on. Most meniscus injuries get better with conservative treatment (such as physiotherapy) and in very few instances has surgery been found to provide superior outcomes both in the short and long term. Here we will give you some information on meniscal injuries.
What is the meniscus and what does it do?
The menisci at 2 semi-lunar fibrous structures inside the knee between the tibia and femur. They are important to help load transmission, shock absorption, lubrication and nutrition in the articular cartilage. Approximately 60% of the contact area in the knee is provided by the meniscus, but as you band your knee, such as going into a squat, this percentage decreases, which means more load goes through the articular cartilage.
There are 2 zones to the meniscus – the outer (red zone) which is well vascularised and therefore can heal over time and the inner (white zone) which has much reduced blood supply and can therefore take longer to heal – if it does. It is important at this time to note that meniscal tears do not need to heal to resolve pain and restore function – they just need to settle down.
How would I injure my meniscus?
Meniscal tears can occur spontaneously in older knees, often they do not cause any pain or loss of function, but sometimes they do. As with any imaging, a meniscal tear seen on MRI needs to be put into context. There is suggestion more recently that a \’degenerative\’ meniscal tear is a normal sign of aging – much like wrinkles and grey hair.
It is also possible to suffer a traumatic meniscal tear – one that is a result of a specific event. This usually involves twisting or hyperextending the knee. When this occurs, a pop can sometimes be heard with immediate pain. Swelling often gradually builds up, and is most noticeable the following day (whereas an ACL tear usually presents with sudden swelling).
What symptoms could I expect with an injured meniscus?
If you have injured your meniscus, you may suffer any or all of the following symptoms:
- Pain – usually on the inside or outside of the knee.
- Swelling – as said before, this is normally seen the next day
- Pain on straightening the knee
- Pain with squatting, lunging or similar movements
- In some cases your knee can become locked or pop when moving through a particular range.
How is a meniscal tear diagnosed?
A meniscal tear can usually be diagnosed with clinical history taking and examination combined, and this is considered approximately 80% accurate. A physiotherapist would assess the range of movement in the knee, test the stability by stressing the ligaments, check for tenderness on the joint line and perform orthopaedic clinic tests to guide diagnosis.
If you want to know more about the type of tear that you have, or if your knee is locked in a certain position, then an MRI scan can be ordered to provide more information.
How do I resolve my meniscus pain?
The first place to start is likely to be physiotherapy. This, in combination with time is likely to resolve knee pain caused by a meniscal irritation or tear. Physiotherapy treatment focusses on offloading the knee by making adjustments to your levels of exercise and movement. Hands on, pain relieving treatments may be used such as soft tissue massage, mobilisation or acupuncture to help with the pain in the knee. A personalised home exercise program would also be prescribed. This may start with some range of movement exercises to help with swelling and restore full range and would progress to exercises to started the quadriceps, glutes, hamstrings and calves to strengthen and stabilise the knee.
Rehabilitation for knee pain caused by a meniscal tear may also progress to sport specific or function specific exercises, that may involve using weights or gym equipment. However, in order to prevent recurrence, the level at which an individuals rehab stops would depend on their goals.
What if it doesn\’t get better with time and physio?
The overwhelming majority of meniscus related knee pain will resolve with time and physio. However, if this does not work for you, there are further options including steroid injection, hyaluronic acid injection or surgery.
However, we would always recommend discussing these with an orthopaedic consultant who specialises in knees. Your physiotherapist can help you find a fantastic orthopaedic consultant who would be able to help you.
If you would like to ask any questions on this, or would like further advice, please feel free to contact us.