Meniscus injuries are one of the most frequent knee injuries being treated. There are two menisci in each knee, one on the medial side (inside) and one on the lateral side (outside).

The meniscus is a piece of cartilage that provides the cushioning between the bones in your thigh (femur) and the bones in your shin (tibia). It provides stability to the knee joint and act as a shock absorber, with an injury being classified according to how it looks. A tear can be a bucket handle, radial, flap or a degenerative tear.

Types of meniscus tears:

Bucket handle or flap meniscus tears

LEFT: Bucket handle tear RIGHT: Flap tear

Radial and degenerative mensiscus tears

LEFT: Radial tear RIGHT: Degenerative tear

How do meniscus injuries happen?

The injury is caused by a compressive force with rotation. This happens often in sport with a jump or squat and then a twist of the knee. For example, soccer and basketball.

During weight bearing there is more pressure on the inside of your knee and therefore the medial meniscus is more commonly torn then the lateral.

In a more extensive knee injury it is possible to get a “terrible traid” injury. This is from a force to the lateral side of the knee while the foot was planted on the ground.

Unhappy triad of meniscus tears

This injury involves the medical meniscus as well as the anterior cruciate ligament and medial collator ligament of the knee.

Symptoms of a meniscus tear:

  • A tearing sensation at the time of injury or a popping sound.
  • Depending on the severity of the injury the person’s pain may vary.
  • A small meniscus tear may only start to show symptoms and swelling of the knee within 24 hours after injury.
  • A more severe meniscus injury may present with locking of the knee (difficulty straightening the leg). This occurs due to the torn flap impinging between the joints articular surfaces.
  • Pain will be along the joint line. Either on the inside or outside of the knee, depending on how the injury occurred.

Diagnosis for meniscus injuries:

  • Pain with palpation along the joint line.
  • The McMurray test: Your physio will bend your knee and the rotate it as you straighten the knee. This will put stress on the meniscus. A positive test will be pain and a clicking noise.
  • Pain with hyperflexion of the knee such as a squat position.

To rule out fractures you may be referred for an X-ray. However, a meniscus tear will not be visible on an X-ray as it is a soft-tissue structure and will need an ultrasound or MRI to confirm the diagnosis.

How are meniscus injuries treated?

This can be surgical or conservative.

  1. The outer 1/3 of the meniscus has good blood supply and therefore has a good prognosis for healing and it will probably be managed conservatively.
  2. The inner 2/3 of the meniscus has a poor blood supply and therefore has a poor prognosis for healing. These lesions are often managed surgically.
  3. Depending on the severity of the tear, the location and the restrictions it has placed on the person, such as joint locking and the persons ability to bear weight on the leg, will be used to guide the decision for surgical or conservative treatment.

A surgical repair is done through a knee arthroscopy as shown in the picture below.

Surgical repair of a meniscus injury

How can Physio help you?

Physiotherapy starts right at the beginning. If the management is conservative the physiotherapist will manage the acute injury, if the management is surgical the patient will attend Physio for pre-habilitation to strengthen the surrounding muscles pre-operative. This will assist the patient with a faster recovery post-operative. Both of these approaches aim to:

  1. Reduce the pain and swelling through gentle range of motion, manual therapy and electrotherapy modalities.
  2. Give exercises in a pain free range to maintain the strength of the quadriceps, hamstrings, hip abductor and hip extensor muscles.
  3. Protect against further joint damage through the use of assistive devices such as crutches, knee braces and strapping.

If it is managed surgically, the physiotherapist in hospital will help you to move around with crutches and give you a home exercise programme. Thereafter, you will continue physiotherapy as an outpatient, being guided through the rehabilitation process.

As the injury heals, the Physio will progress your strengthening exercises, making sure you have full range of motion of your knee, re-train your balance and teach you to walk again without the crutches.

After a meniscus repair with no other associated injuries and sufficient rehabilitation an athlete may be ready to return to play within 4 weeks.

However, if you return to sports before the knee is properly rehabilitated, then you are at risk of recurrent joint swelling and chronic knee pain. Thus it is important to complete your physiotherapy rehabilitation programme and be cleared by a medical professional before you return to sport.

This article was submitted by Kirsty Mackay one of our Physiotherapists at the Fourways branch of Lamberti Physiotherapy. If you would like to consult Kirsty about any queries or assistance on this topic, please contact her or else use our handy appointment form

References:

  1. Picture 1-4: https://orthoinfo.aaos.org/en/diseases–conditions/meniscus-tears
  2. Picture 5: https://www.epainassist.com/images/Unhappy-Triad.jpg
  3. Picture 6: https://www.indiamart.com/proddetail/arthroscopic-meniscus-repair-surgery-10654215355.html
  4. Clinical Sports Medicine , Brukner & Khan, Fourth Edition, 2014