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Medial Meniscus Tear
A torn meniscus is a tear to the semi circular shock absorbing cartilage in the knee joint causing pain on the inside of the knee. It is commonly injured through direct impact in contact sports or twisting but can also occur in older athletes through gradual degeneration.
Signs and symptoms
- Pain on the inside of the knee which may be of sudden onset but can also occur gradually.
- Pain when fully bending the knee or squatting down.
- Tenderness along the joint line on the inside of the knee.
- There may be swelling present but not always.
- Restricted range of movement in the knee.
- A posivie result for McMurrays test and Apley's test although this is not necessary for a diagnosis of meniscus tear.
A torn meniscus will usually have a history of trauma or twisting of the knee at the time of injury, although they can come on gradually through degeneration or overuse.
If the injury is severe the athlete may be unable to weight bear on the affected leg but a small meniscus tear may have no symptoms at all. The athlete may also complain of the knee locking or giving way.
A doctor or sports injury professional can confirm the diagnosis and may refer for an MRI scan.
Each knee joint has two crescent-shaped cartilage menisci. These lie on the inside and outside of the upper surface of the tibia or shin bone. The cartilage menisci act as shock absorbers and provide support for the knee joint. The medial meniscus on the inside is more prone to injury than the lateral meniscus as it is connected to the medial collateral ligament and the joint capsule making it less mobile.
Types of meniscus tear
There are a number of different types of cartilage meniscus injury.
- A longitudinal tear occurs along the length of the meniscus and can vary in length.
- The bucket handle tear is an exaggerated form of a longitudinal meniscus tear where a portion of the meniscus becomes detached from the tibia forming a flap that looks like a bucket handle.
- A tear from the edge of the cartilage inwards is known as a radial tear.
- Meniscus injury can occur over time due to degenerative changes or wear and tear in the knee joint and is more common in the older athlete. This leads to the edges of the meniscus becoming frayed and jagged, increasing the likelihood of a meniscus tear. Other types of meniscus tear are the flap tear and the horizontal cleavage tear.
The most common cause of cartilage meniscus injury is twisting the knee with the foot planted to the ground either with or without contact from another player. A cartilage injury often occurs in conjunction with injury to other structures in the knee such as an anterior cruciate ligament injury or a medial collateral ligament sprain. They can also come on gradually over time through degeneration, especially in the older patient.
Treatment for a torn meniscus will depend on how bad the injury is. A minor tear or small degenerative condition with no restriction of motion or locking will be treated conservatively or without surgery. More severe injuries may require surgical treatment.
Immediate treatment is to apply the PRICE principles of protection, rest, ice, compression and elevation to reduce pain and reduce swelling.
- Protect the joint from further injury.
- Rest to allow the injured tissues to heal.
- Ice or cold therapy to help reduce pain and swelling. The sooner this is applied the better.
- Compression will help reduce swelling. Professional pitch side physios may apply a compression bandage immediately even before applying ice to restrict swelling althought this should only be for 10 minutes at a time to prevent starving the area of blood.
- Elevating the joint will also help fluid and swelling drain away from the site of injury.
Once a cartilage meniscus injury has been diagnosed then the decision to treat it conservatively, meaning without surgery or whether to operate is made.
Do I need surgery?
This will depend on a number of factors. Surgery may be considered if the following factors a repsent:
- Injury caused by a sudden twisting with the patient unable to continue playing.
- The knee locks or has restricted range of movment.
- Positive McMurrays test with a clunking felt.
- An ACL tear is also present.
- There is little improvement in symptoms after three weeks of non surgical treatment.
Conservative treatment is likely recommened first if:
- Symptoms come on gradually over a couple of days.
- No specific injury caused the pain.
- The patient can weight bear.
- There is little swelling.
- Good or full range of motion with pain only at the extremes.
- Previous history of recovery from a torn meniscus.
- Continue applying the PRICE principles to reduce pain and swelling.
- A knee support will help protect the knee. In the first 24 to 48 hours when complete rest is advised a simple elastic knee sleeve is fine. Later a hinged knee brace is often recommended.
- NSAID's or anti inflammatory drugs such as Ibuprofen may be prescribed in the early stages to help with pain and swelling. Electrotherapy including ultrasound, laser therapy and TENS may also be beneficial in reducing swelling..
- After the initial acute stage mobility exercises and isometric quadriceps exercises will help accelerate rehabilitation.
- A glucosamine or joint healing type supplement may be of benefit in the healing of cartilage injuries.
- Once the initial pain and swelling has gone down then a full rehabilitation program consisting of mobility, strengthening and balance exercises should be completed.
See rehabilitation of medial meniscus injury for more detailed information on treatment.
In the event of more severe meniscus tears such as a bucket handle tear, arthroscopic surgical procedures may be necessary to repair the torn cartilage in the knee. The aim of surgery is to preserve as much of the meniscus cartilage as possible. The procedure will normally involve stitching of the torn cartilage. Following surgery a full rehabilitation and exercise program will be prescribed which will most likely be the same of very similar to the conservative treatment program that someone who has not been operated on would do.
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