Knee Meniscal Injury
Each knee joint contains a medial and lateral meniscus (inner and outer meniscus). These are thick ‘rubbery’ pads of cartilage tissue. They are C shaped and act as ‘shock absorbers’ to absorb the impact of the upper leg on the lower leg and also help to improve the movement and stability of the knee. When people talk about a ‘cartilage injury’ to a knee, they usually mean an injury to one of the menisci.
The menisci are commonly injured in sports, such as football. The classic injury is to twist the knee whilst the foot is still on the ground. The meniscus may tear fully or partially. How serious the injury is depends on how much is torn and the exact site of the tear.
Meniscal tears may also occur without a sudden severe injury. In some cases a tear develops due to repeated small injuries to the cartilage or due to degeneration (‘wear and tear’) in older people.
Menisci do not generally heal very well once they are torn. This is mainly because they don’t have a very good blood supply. The outer edge of each meniscus has some blood vessels, but the area in the center has no direct blood supply. This means that although some small outer tears may heal in time, larger tears, or a tear in the middle of a meniscus, are less likely to recover.
What are the symptoms of a meniscus tear?
The pain is often worse when you straighten the leg. If the pain is mild, you may be able to continue to walk. You may have severe pain or twinges if a torn fragment of meniscus catches in the joint.
The knee often swells within a day or two of the injury. Many people notice that slight swelling often persists for several months.
You may be unable to straighten the knee fully. In severe cases you may not be able to walk without a lot of pain. The knee may ‘lock’ from time to time if the torn fragment interferes with normal knee movement. Some people notice a clicking or catching feeling when they walk.
How is a meniscus tear diagnosed?
The history and symptoms are often enough to suggest a meniscal injury, however some features of the clinical examination can assist in the diagnosis. Sometimes a characteristic ‘clunk’ is felt during certain manoeuvers and the joint is often painful when pressed on the side of the tear. The diagnosis can be confirmed by an MRI scan of the knee or by arthroscopy.
What is the treatment for a meniscus tear?
When you first injure your knee the initial treatment should follow the PRICE principle: protect, rest, ice, compression and elevation. This, combined with painkillers, helps to settle the initial pain and swelling. Further treatment may then depend on the size of the tear, the severity of symptoms, how any persisting symptoms are affecting your life, your age and your general health.
Some small tears may heal with time; however the length of time may vary. Typically this can take from 6 – 12 weeks or up to six months for some people. Physiotherapy is often recommended to facilitate this.
Physiotherapy is aimed at strengthening the supporting structures of the knee such as the quadriceps, gluteal and hamstring muscles which will help to stabilize the joint. It is vital to restore any loss of movement and control pain – manual therapy, massage, electrotherapy and acupuncture may help this. The joint must be fully rehabilitated before sporting activity is resumed.
If the injury causes persistent troublesome symptoms then an operation may be advised. Most operations are done by arthroscopy (keyhole surgery) and are typically day cases. The torn meniscus may be repaired and stitched back into place. If repair is not possible a small portion of the meniscus may be trimmed or cut out to even-up the surface
Full recovery following meniscal surgery typically takes around six weeks, however this can vary depending on the operation. Initially the aim is to reduce any pain and swelling, and exercises are often provided to help build up muscle strength and regain full range of knee movement. Physiotherapy is recommended post operatively.
Treatments for Arthritis
There is no full cure for arthritis, but there are many treatments that can help slow down the condition and imporve your quality of life. These include: