Medial Meniscus Tear

A torn meniscus is a tear to the semi circular shock absorbing tissue in the knee joint. It is commonly injured through direct impact in contact sports or twisting but can also occur in older athletes through gradual degeneration.

Symptoms

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. Pain will be felt on the inner surface of the knee along the joint line. Swelling of the knee may occur within 48 hours of injury with the athlete being unable to fully bend knee. If the injury is severe the athlete may be unable to weight bear on the affected leg. The athlete may also complain of the knee locking or giving way.

Cartilage meniscus assessmentMcMurrays test and Apley's test may be used by a therapist to help diagnose a knee cartilage injury. McMurrays test involves rotating the leg with the knee bent. Any pain or clicking indicates a positive result. Apley's test involves compressing the cartilage meniscus with the athlete in a prone position, again pain indicates a positive result.

Medial meniscus tear explained

Bucket handle cartilage tearEach 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.

Longitudinal meniscus tearThe 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.

There are a number of different types of cartilage Radial tearmeniscus injury. A longitudinal tear occurs along the length of the meniscus and can vary in length. A tear from the edge of the cartilage inwards is known as a radial tear. 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.

Degererative cartilage tearMeniscus 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.

Treatment

Cold knee wrapImmediate treatment is to apply the PRICE principles of protection, rest, ice, compression and elevation. Once a cartilage meniscus injury has been diagnosed then the decision to treat it conservatively, meaning without surgery or whether to operate is made.

This will depend on a number of factors including whether the pain is increasing over time, the knee joint locks, has restricted movement, or if there are any other associated injuries such as anterior cruciate ligament sprain. If the patient sees no improvement in symptoms after 3 weeks of conservative treatment then surgery may be a likely option.

Conservative treatment

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.

Knee mobility exercisesAfter 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.

A doctor or sports injury professional can confirm the diagnosis and may refer for an MRI scan. 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.

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.

Surgical 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.

See knee cartilage surgery for more detailed information.