The knee is known as a hinge joint and is where your shin bone (tibia) meets your thigh bone (femur). The knee joints bends and straightens, and has to take some considerable levels of force during activities such as walking, stair climbing and running. The menisci are two c-shaped pads of cartilage that are positioned at the top of the tibia. The best way to think of the menisci is as shock absorbers; they are made of a particular type of cartilage that gives them a tough, car-tyre like consistency that is resistant to stress and strain.
A meniscus tear can occur after trauma (such as twisting and falling during running or playing sport) but can also be the result of the ageing process. Over time, the menisci are subjected to significant forces and this can lead to degenerative or age-related tears of the cartilage material. This can result in knee joint pain without any obvious cause or trauma.
A meniscus tear can cause pain in the knee and it is often felt more on the inside of the knee (where the medial meniscus is located). However, the pain can be quite diffuse and some people report that the whole knee region feels painful. A meniscal tear can be accompanied by mechanical symptoms, particularly if an acute injury has led to a larger or more traumatic tear. Some of these symptoms include locking (where the knee gets stuck in a certain position during movement) or giving way (where the knee buckles under load).
There may be the presence of crepitus, which is the sensation of grinding or catching from within the knee joint during movement or activity.
Your Physiotherapist can usually make a diagnosis of a meniscal tear from your history of pain and also from a physical examination. The Physiotherapist will ask you to do certain movements and tests that can help identify a meniscal tear. If the Physiotherapist suspects that this is a large or more traumatic tear, they may refer you for an MRI scan to evaluate the knee and aid in decision making.
Physiotherapy has very good evidence for the management of meniscal tears. Recent studies have shown that surgery for meniscal tears is very rarely needed, and should only be undertaken for very specific cases. Pain killers can be provided to help manage your pain whilst you engage with any exercises given to you by your clinician.
Physiotherapy for meniscal tears may include education and advice on how to manage your knee pain, advice on losing weight to decrease the load on the joint and specific exercises to strengthen and mobilise the structures around the knee joint. This in turn will help reduce load on the knee joint and allow the meniscal tear to settle over time.
On the patient resources section of website, our Physiotherapists have worked in collaboration to produce a series of recommended exercises to increase knee strength and stability.
There are no quick fixes for the treatment of a meniscal tear. With appropriate adherence to rehabilitation you can expect to see improvements in 3 – 6 months and improvements can continue beyond this. As has been said, surgery is very rarely needed and only if there are significant mechanical symptoms from the joint. The surgical team will try and remove as little of the meniscus as possible as this could lead to earlier onset osteoarthritis.