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Meniscus Injury

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Introduction

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.

Information Video

Signs & Symptoms

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.

Causes

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.

 

Acute

  • More common in younger patients under the age of 40.
  • Usually associated with a twisting injury.
  • Localised knee pain.
  • Often result in “mechanical” symptoms such as locking (where the knee joint gets stuck during certain movements) and giving way (where the knee buckles from under you).

 

Degenerative 

  • More often seen in middle aged or older patients.
  • No obvious injury or incident.
  • They come on gradually and can wax and wane over time.
  • The knee pain can often be difficult to pinpoint and mechanical symptoms are rare.

Assessment & Diagnosis

a physiotherapist giving a patient with ACL injuries treatmentYour 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. With a diagnosis in place, there will be a discussion regarding the most appropriate treatment and you will be given advice and education to help you make an informed decision on how to manage going forward. 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.

 

Your Physio will like to ask about your usual activities so they can understand your limitations and will work with you to develop a set of personalised goals. You will be regularly assessed so progress can be monitored and for any changes in your treatment to be made.

Self-Management

Your Physiotherapist will educate you on meniscal tears and offer you advice on how to manage your knee pain and how losing weight can decrease the load on the joint. Pain killers can be provided/recommended to help manage your pain whilst you engage with any exercises given to you by your clinician.

Physiotherapy

Physiotherapy has very good evidence for the management of meniscal tears. Based on your individual goals, your Physio will prescribe 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. Throughout your Physiotherapy, you will be given ongoing support and advice so that you can continue to manage your symptoms independently and mitigate the likelihood of re-injury.

Escalation of Treatment

Recent studies have shown that surgery for meniscal tears is very rarely needed, and should only be undertaken for very specific cases where 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.

 

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