Injuries to the meniscus cartilage of the knee are common. So what are they, why do they occur and what can be done about them?
Anatomy of the knee Your meniscus (menisci plural) are small disc shape pieces of cartilage that sit between your tibia and your femur (your shin and thigh bones). In each knee joint there are two menisci. Functionally they act as a shock absorber to protect the bony surfaces of a joint.
Mechanism of injury for meniscal injuries Meniscal injuries are a commonly injured tissue of the knee joint. They are regularly injured in sports requiring agility and power, such as football codes, basketball, netball and tennis. The common mechanism of injury is a rotational force going through a bent knee, so could be landing awkwardly, changing direction or getting caught in a tackle. However meniscus tears can also happen from getting up from a squat too quickly, especially if there’s weakness or instability.
Clinical features of meniscal injuries As mentioned above landing and twisting or your knee getting ‘caught’ as your body rotates are common mechanisms. The knee will feel like it’s ‘clicking’ or ‘locking’ within the joint itself. Pain will vary from person to person - some athletes may need to be stretchered off the ground, others will be able to walk but feel uncomfortable. This often depends on the location and type of tear. A small tear may not be painful for 24 hours. Knee swelling. Restricted range of motion. Tenderness along the joint-line.
MRI imaging is often requested for meniscal injuries to assess the type and location of the tear, as well as to rule out the chance of an ACL or other ligament damage.
There is of course exceptions to every rule, and in the older population meniscal tears are quite common and may be present for years without knowing and without them causing pain. They only become problematic if the minor derangement creates a flap or a large longitudinal tear, this can happen with minor incidents such as just getting up out of a chair off balance, or an awkward squat whilst working in the garden.
Meniscal injury treatment Treatment depends on severity and symptoms of the person. Small tears will be treated conservatively with relative rest and then progressing to a strengthening and rehabilitation program. Depending on age and aggravating factors, a small tear may be managed within 3-4 weeks. A severe tear will almost certainly require surgery. This is often done with you being in and out in one day, and you’ll even often be able to walk out. This often involves shaving off the affected piece of cartilage if it is loose or has detached.
Treatment approach The more research that is done on injury management, the more it appears that conservative management is often the best way to go. This is definitely the case with meniscal injuries. So below are some considerations that should be taken into account when deciding whether conservative or surgical treatment might be the best way to recover from your meniscal injury.
Conservative management Symptoms develop 24-48 hours after injury The incident was minimal or may not even be able to recall an incident for it to occur Minimal swelling Full range of motion with minor pain at end range
Surgery Severe twisting injury rendering athlete not being able to continue Locked knee or severe loss of motion Palpable clunking on testing Little to no improvement after 3 weeks of conservative management