A medial meniscus tear or torn meniscus is a tear of the semi-circular 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. Treatment depends on how bad the injury is and may require surgery
- Symptoms & diagnosis
- Causes & anatomy
Medial meniscus tear symptoms & diagnosis
Symptoms include pain on the inside of the knee which may be of sudden onset but can also occur gradually. The patient will usually experience pain when fully bending the knee or squatting down. There may be swelling present but not always and the patient may also complain of the knee locking or giving way.
There will be tenderness along the joint line on the inside of the knee and range of motion is likely to be restricted. A doctor or sports injury professional can confirm the diagnosis with the aid of specific assessment tests including McMurray's test (play video) and Apley's test (play video) and may refer to an MRI scan.
McMurrays test is often used to indicate cartilage injuries. With the patient laying on their back the therapist holds the knee with the upper hand and the heel with the lower hand. The therapist then applies a valgus (inward) stress to the knee whilst the other hand rotates the leg externally (outwards) and extends the knee. Pain and/or an audible click while performing this maneuver can indicate a torn medial meniscus.
Apley's test is also used in cases of suspected meniscal tears. The patient is positioned on their front with the knee bent. The therapist grasps the heel and ankle and applies a compressive force through the lower leg. At the same time, they rotate the lower leg. Any reproduction of symptoms, pain or clicking is a positive response, suggesting a torn meniscus.
Torn meniscus causes & anatomy
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.
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 and act as shock absorbers for the knee. Twisting and compression of the cartilage can cause it to tear. There are different ways in which the cartilage can tear including longitudinal, bucket handle tears, radial tear and degenerative.
Medial meniscus treatment
What can the athlete do?
Immediate first aid after any knee joint injury is to apply the PRICE principles of protection, rest, ice, compression, and elevation. Apply ice or cold therapy and compression to reduce pain, swelling, and inflammation. Apply ice wrapped in a wet tea towel to avoid ice burns on the skin or better still a specialist cold compression wrap will apply both cold and compression to the knee joint.
Rest is important to allow the injured tissues to heal. This is often overlooked but is essential for the injury to heal.
Protect the joint from further injury by taping/strapping the knee joint, or wearing
What can a professional do?
Expert interview: Sports Physiotherapist Neal Reynolds (play video) explains knee cartilage injuries and treatment options. A professional therapist will undertake a thorough assessment and make an accurate diagnosis to confirm cartilage meniscus injury and they may undertake an MRI scan to determine the extent of the injury.
Then the decision to treat it conservatively, meaning without surgery or whether to operate is made. The decision of whether to operate will depend on a number of factors. 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.
Medial meniscus tear surgery
Orthopaedic Surgeon Mr Richard Villar (play video) explains meniscus tear surgery, surgical techniques and recovery times.
An MRI scan is often used to confirm the diagnosis and then an arthroscopy performed to either repair or remove the torn cartilage. Repairing the cartilage is a good thing but the surgeon must be sure that it's going to heal. Tears near to the blood supply on the outside of the cartilage are more likely to heal well. Tears in the body of the cartilage where the blood supply is less will not heal as well and so repairs are less likely to work and removing the torn cartilage is the better option. Removal is also more commonly performed in degenerative cases.
After surgery treatment may vary depending on the symptoms and the surgeon. Crutches may be used to slow the patient down and ensure at least partial rest for the first few days. Mr. Richard Villar recommends at least 2 weeks off work initially. After this time, Physiotherapy is very useful. It could then be up to 6 months before the athlete feels ready to compete in contact sports. Non-contact sports will probably allow a more rapid return.