A tear in the meniscus refers to an injury sustained by a meniscal cartilage in the knee joint.
The knee is a hinged joint formed by the femur (thighbone), tibia (shinbone) and patella (kneecap). At the inner and outer edges of the knee, between the femur and tibia, are two crescent-shaped pads of tough cartilage that serve as shock absorbers, cushioning the ends of the bones and providing stability by balancing body weight across the joint.
A meniscus tear is a common injury. The cartilage can tear in many different ways, and treatment depends on the type of tear that has been sustained. Parrot-beak, bucket handle, longitudinal and flap are just some of the terms used to describe various meniscal tears.
Normal wear and tear and the aging process causes cartilage to weaken and thin, which leaves it vulnerable to injury. A relatively minor twisting motion might be enough to tear a meniscus.
Another common cause is a sporting injury when an athlete has squatted down and twisted the knee awkwardly.
- A feeling of a ‘pop’ in the knee at the moment of injury
- Pain felt at the center or side of the knee. The pain might be sharp when twisting or squatting.
- Swelling, increasing over two to three days
- Stiffness, increasing over two to three days
- 'Locking’ of the knee
- A feeling of instability in the knee, although it may still be possible to walk
- Loss of full range of motion in the knee
- In severe cases, the knee might ‘give out’ without warning
Your doctor will carefully review with you the circumstances of the injury and the symptoms you are experiencing. Your knee joint will be assessed during a physical examination, which will include observation, palpation (touch) and probably some gentle manipulation to evaluate the stability of the joint, the range of motion of the knee and what movements might cause discomfort.
X-rays will probably be taken and, in some cases, an MRI (magnetic resonance imaging) scan might be needed in order to better view the soft tissues of the knee.
The particular treatment needed will depend on the location, size and type of meniscal tear that you have sustained as well as your general health, level of activity and age.
The outside of each meniscus is richly supplied with blood, so many tears in that area can either heal on their own or be repaired surgically. The inner two-thirds, however, has no blood supply, so tears have to be cut away. Sometimes a piece of meniscus can be completely torn off and float freely in the knee joint, causing ongoing painful symptoms that would need surgery to relieve.
Initial treatment after diagnosis would include:
Physiotherapy to restore full range of motion to the joint will be an important part of the recovery process. You will be taught certain exercises to perform, at first under supervision and then at home.
- Resting the joint
- Applying ice, crushed in a bag and wrapped in a towel, to the knee for 15 minutes at a time, several times a day
- Wearing a compression bandage on the knee
- Elevating the knee above heart level, whenever possible
- Wearing a knee brace and possibly using crutches for a time
- Taking NSAIDs (non-steroidal anti-inflammatory drugs) to reduce pain and swelling
If surgery is deemed to be the best option for you, based on factors such as the location and extent of the injury, and your age and activity levels, one of three options will be chosen.
Arthroscopy is the preferred surgical technique. Very small incisions are made around the knee, through which instruments, including the arthroscope (a soft, flexible tube with a camera on the end) can be passed in order to perform the surgery.
- Repair: The pieces of torn cartilage are sewn back together.
- Partial meniscectomy: This procedure surgically removes part of the torn cartilage, trimming it back to a smooth shape.
- Total meniscectomy: This entails the surgical removal of the entire meniscus. This option is the least desirable due to the risk of developing arthritis in the knee.
There is an experimental treatment, meniscal transplant, that some people may be able to have, depending on factors such as age, weight, the failure of previous treatment, and whether the knee has correct alignment.
Rehabilitation after surgery will include many of the same features as for a less severe injury, but the time it takes for complete recovery will necessarily be longer and will also depend on your age and general level of fitness.
Sitting on the floor with your injured leg straight out in front of you and the unaffected leg bent with the foot on the floor, contract the thigh muscles of the injured leg (the quadriceps) by pressing the knee towards the floor. Hold the position for 5-10 seconds then relax. Repeat 10 times, 3 times a day.
Straight leg raise:
Lying on your back on the floor, bend your unaffected knee and rest the foot on the floor. Keeping the knee of the injured leg straight, contract the thigh muscles and lift the leg up until the heel is about 6 inches off the ground. Hold for 5-10 seconds then relax. Repeat 10 times, 3 times a day.
Lying on your stomach on the floor, and with your legs straight out behind you, bend the injured knee and move your foot towards the buttocks as far as it will go without producing any pain. Repeat 10 times, 3 times a day.
Standing with your feet shoulder width apart, and holding on to the back of a chair for support, slowly lift your heels off the ground as far as you can. Hold the position for 5-10 seconds then slowly lower your heels back to the ground.
The best brace for you will depend on the cause of your meniscal tear. Any brace will provide support and a degree of pain relief, but there are braces available that offer different levels of reinforcement. A hinged knee brace might be appropriate if you need significant support after a severe tear, or surgery to repair the injury. A degenerative meniscal tear might be better served by a brace that gently compresses the joint. Your health care provider can help you make the right choice.