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.

Medial meniscus tear symptoms

Symptoms of a torn meniscus will include a history of trauma or twisting of the knee. Pain will be felt on the inner surface of the knee along the joint line. Swelling of the knee may happen within 48 hours of injury and the athlete will be unable to fully bend knee. If the injury is severe the athlete may be unable to weight bear on the affected side.

Cartilage meniscus assessmentTests a therapist may use to help diagnose a cartilage injury include McMurrays test and Apley's test. McMurrays test involves rotating the leg with the knee bent. 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. The athlete may complain of the knee locking or giving way.

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 anterior cruciate ligament injury and the 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.

Torn meniscus treatment

Cold knee wrapImmediate treatment of any knee joint injury 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 an operation to remove or repair the injured meniscus is required needs to be made.

The decision on whether to operate or not will depend on a number of factors including whether the patient has ever increasing pain, the knee joint locks or has restricted movement, or if there are any other associated injuries such as anterior cruciate ligament sprain. Also, 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. Do no apply ice directly to the skin but use a wet tea towel or specialist cold therapy knee what which can provide both cold and compression to help 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 as the athlete starts to walk then most physiotherapists will recommend a hinged knee brace or at least a strong stabilizing brace to protect the medial knee ligament and cartilage.

Knee mobility exercisesAfter the initial acute stage aim to try to keep the knee mobile with mobility exercises. Static or isometric quadriceps exercises can help maintain muscle bulk. 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 may be prescribed in the early stages to help with pain and swelling for example Ibuprofen. Electrotherapy including ultrasound, laser therapy and TENS may also be beneficial in managing pain and swelling.

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 conservative rehabilitation of medial meniscus injury for more detailed information on treatment.

Surgical treatment

In the event of more severe meniscal 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 and procedure itself will normally involve stitching of the torn cartilage.

Following surgery a full rehabilitation and exercise program will be outlined for the patient which may include mobility, strengthening and balance training.