Meniscus Tear/Injury

What is a Meniscus Tear/Injury?

Overview of Meniscus Injuries

Meniscus Injury Description

• A meniscal injury refers to damage or tearing of the meniscus, which is a piece of fibrocartilage in the located on the medial and lateral aspect of the knee joint. The menisci are two wedge-shaped pieces of tough, rubbery discs that act as shock absorbers between the thighbone (femur) and shinbone (tibia). They help stabilise the knee joint and distribute weight evenly across the joint surfaces.

• A meniscus tear or ruptured can occur to the medial and lateral meniscus with medial meniscus tears being more common.

• Also, knee osteoarthritis can also lead to a spontaneous meniscal tear through wear-and-tear of the meniscal structure.

Meniscus Injury/Tear Symptoms

Meniscus Injury Presentation/Characteristics

• Mechanism of injury:

  • The most common – a sudden twisting or rotating movement of the knee with the foot anchored on the ground, often seen in sports activities.

  • The twisting component may be of comparatively slow speed. This type of injury is commonly seen in football and basketball players.

  • They can also occur gradually over time due to wear and tear, particularly in older individuals.

• The degree of pain associated with an acute meniscal injury varies considerably. Some people may describe a tearing sensation at the time of injury.

• A small meniscal tear may cause no immediate symptoms, it may become painful and cause knee swelling over 24hrs

• Small tears may also occur with minimal trauma in the older athlete as a result of degenerative change of the meniscus.

• Pain is usually present during squatting movements.

• People with more severe meniscal injuries experience:

  • Difficulty fully extending the knee.

  • Stiffness, pain and restriction of range of knee movement soon after injury.

  • Intermittent locking or catching sensation in the knee due to a meniscal ‘bucket handle’ tear impinging within the joint. This may unlock spontaneously with a clicking sensation.

  • Severe Meniscus injuries often occur in association with ACL tears.

• MRI examination is the investigation of choice for suspected severe meniscus injuries as it can aid management if findings show either a complex tear or damage.

Meniscus Injury/Tear Treatment

Managing your Meniscus Injury

• The management of meniscal injuries varies depending on the severity of the tear and the individual's activity level and overall health. Treatment may include:

  • Rest, ice, compression, and elevation (RICE protocol) to reduce acute symptoms

  • Physiotherapy focussing on strengthening exercises of the surrounding musculature

  • Activity modification to minimise aggravating activities

  • And in some cases, surgery may be necessary to repair or remove the torn portion of the meniscus.

• Small tears and degenerative meniscus injuries should initially be treated conservatively.

• Large painful ‘bucket handle’ tears, causing a locked knee, requires immediate arthroscopic surgery.

• Surgical management:

  • Aim: preserve as much of the meniscus as possible.

  • Some meniscal lesions are suitable for repair by meniscal suture. The factors affecting the decision to attempt meniscal repair is based on the acuity of the tear, persons age, stability of the knee and tear location.

  • The outer one-third of the meniscus rim has a blood supply and tears in this region can heal.

  • Partial tears may require removal of the damaged meniscal flap.

• Rehabilitation after meniscal surgery:

  • Prior to surgery the aim is to:

    • Reduce pain and swelling

    • Maintain quadricep, hamstring and hip strength

    • Protect against further damage – using crutches

    • Have a good understanding of the surgical procedure and post-operative rehabilitation program.

  • Rehabilitation principles after surgery:

    • Control pain and swelling

    • Regain pain-free active knee movement

    • Progress weight-bearing

    • Progressive strengthening within the available range of movement

    • Progressive balance, proprioceptive and coordination exercises

    • Return to functional activities.

• Conservative management of meniscal injuries
  Conservative management of relatively minor meniscal injuries will often be successful, particularly in the athlete whose sporting activity does not involve twisting activities.

Prognosis

• Factors that may indicate that conservative treatment is likely to be successful:

  • Symptoms develop over 24-48 hours after injury

  • Injury is minimal or no recall of specific injury

  • Able to weight-bear

  • Minimal swelling

• Factors that may indicate that surgery will be required:

  • Severe twisting injury

  • Athlete is unable to continue playing

  • Locked knee or severely restricted knee movement

  • Associated ACL tear

  • Little improvement of clinical features after 3 weeks of conservative treatment.

Some athletes with a small isolated medial meniscal tear are ready to return to sport after four weeks of rehabilitation. The rehabilitation process usually takes longer if there has been a more complicated tear of the meniscus, especially if the lateral meniscus is injured. The presence of associated abnormalities, such as articular cartilage damage or ligament (MCL, ACL) tears, will necessarily slow down the rehabilitation process.

If you are experiencing symptoms of a meniscus injury and need help managing this injury and its symptoms, come and see us at Brisbane Physiotherapy.