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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. We look at meniscus tear symptoms, types of injury and treatment options.
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 joint along the joint line. Swelling of the knee may happen within 48 hours of injury. Inability to bend knee fully- this may be associated with pain or a clicking noise.
A positive sign (pain and/or clicking noise) during a "McMurrays test" which a therapist or trainer may use to diagnose a meniscus tear. Pain would also be felt with Apley's test which involves rotating and pressing down on the knee in prone position. The athlete may complain of the knee locking or giving way. If the injury is severe the athlete may be unable to weight bear on the affected side.
What is a Medial Meniscus Tear?
Each knee joint has two crescent-shaped cartilage menisci. These lie on the medial (inside) and lateral (outside) of the upper surface of the tibia (shin) bone. They are essential components of the knee, acting as shock absorbers as well as allowing for the proper interaction and weight distribution between the tibia and the femur (thigh bone). As a result, injury to either meniscus can lead to critical impairment of the knee itself.
A torn 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 and so is less mobile. Hence, any forces impacting from the outer surface of the knee, such as a rugby tackle, can severely damage the medial meniscus and lead to a torn meniscus. In addition, medial meniscal injuries are often also associated with injuries to the anterior cruciate ligament (ACL) and the Medial collateral ligament (MCL).
Other mechanisms of medial meniscus tear may be twisting the knee or degenerative changes that are associated with age. Any of these circumstances may lead to tearing of the medial meniscus, which in serious cases may require surgical intervention.
Types of Meniscus Tear
- Longitudinal Tears: This is a meniscus tear that occurs along the length of the meniscus and can vary in length
- Radial Tears: These tear from the edge of the cartilage inwards.
- Bucket-Handle Tears: This 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
- Degenerative Changes: This may lead to edges of the meniscus becoming frayed and jagged, increasing the likelihood of a meniscus tear
Torn Meniscus Treatment
Treatment for a torn medial meniscus can be either conservative which means not having surgery or if the injury is severe or does not respond to conservative treatment then meniscus tear surgery is an option which is usually very successful.
What can the athlete do?
- Apply RICE (rest, ice, compress and elevate) to the injured knee. This will reduce pain and swelling and accelerate the healing process.
- Wear a knee support. 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 knee ligament and cartilage.
- Try to keep the knee moving using our mobility exercises for a torn meniscus.
- Gentle exercises to maintain quadriceps strength, although care should be taken not to aggravate the symptoms.
- A glucosamine or joint healing type supplement may be of benefit in the healing of cartilage injuries.
- Consult a Sports Injury Professional who can advise on torn meniscus rehab.
What can a Sports Injury Professional do?
- Assess the knee to confirm the injury.
- Refer you for an MRI scan.
- Decide if conservative treatment will be effective or if surgery may be required.
1. Conservative Treatment
This may be indicated in the case of a small tear or a degenerative meniscus and may involve:
- Ice, compression and recommendation of NSAID's e.g. Ibuprofen.
- Electrotherapy i.e. ultrasound, laser therapy and TENS.
- Massage to decrease swelling and relax surrounding muscular tension.
- Manual therapy
Once pain has subsided, exercises to restore the range of movement, improve balance and maintain quadriceps strength may be prescribed. These may include: squatting, single calf raises and wobble-board techniques.
2. Torn meniscus surgery
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. The procedure itself will normally involve stitching of the torn cartilage. The success of the surgery depends not only on the severity of the tear but also on the age and physical condition of the patient. Younger and fitter patients are known to have better outcomes.
Following surgery a rehab and exercise program will be outlined for the patient which may include mobility, strengthening and balance training. Full co-operation with the rehabilitative technique will be necessary to maximise recovery.
