What is a meniscal tear and how is it treated?
Figure 1: Knee Pain - Meniscal Injuries - Physio Frenchs Forest, Physio Macquarie Park
What is a Meniscus?
The meniscus is the layer of fibrocartilage that sits between the two main bones of the knee joint, acting to absorb some of the forces that the knee joint is exposed to throughout everyday life. The meniscus is divided into two main areas, the medial and lateral components, and are found on the inside and outside of the knee respectively. Both the medial and lateral menisci are “C” shaped, and fit between the two bones of the knee joint (the femur and tibia) snuggly.
Figure 2: Knee Pain - Meniscal Injuries - Physio Frenchs Forest, Physio Macquarie Park
How do I injure my Meniscus?
There are two main categories of meniscal tears - traumatic, or degenerative. Traumatic injuries to the meniscus usually involve a particular incident, for example a sporting accident. Most commonly, the knee twists while in a slightly bent position, causing immediate pain or discomfort.
The meniscus can also become injured due to performing repetitive movements over a number of years. In this case, the cartilage deteriorates to an extent - these are classified as degenerative injuries.
Figure 3: Knee Pain - Meniscal Injuries - Physio Frenchs Forest, Physio Macquarie Park
Classic Presentation:
After injuring your meniscus, it is common for you to have pain and/or tenderness around the inside or outside of your knee, especially close to the gap between the bones of the knee joint. Some swelling may also be present, and can act to limit the range of motion at the knee joint. While bending your knee, you may experience the joint clicking, locking up or even giving way while you are walking - all of these are common acute complaints after a meniscus injury. Pain can also be worse while climbing up/down stairs, or squatting.
How are meniscal tears diagnosed?
A meniscal tear can be diagnosed by your physiotherapist or doctor. Your health professional will take into account the location and characteristics of your pain, as well as what you were doing at the time of your injury. They will then run you through a series of physical tests to confirm your diagnosis. Imaging, such as MRI, is not always needed, although in certain cases can be used to examine the exact nature and extent of your injury.
Figure 4: Knee Pain - Meniscal Injuries - Physio Frenchs Forest, Physio Macquarie Park
What are my treatment options?
There are a number of different treatment options available for meniscal injuries. The first step is to have the suspected meniscal injury assessed by a physiotherapist. They will assess the nature/extent of your injury, decide if any further examinations are necessary and educate you on short term pain management strategies. There is also good evidence for the effectiveness of exercise therapy in treating meniscal tears, with the aim to recover any lost range of motion, and then slowly build surrounding muscle strength as your symptoms improve.
The only meniscal tears that require immediate surgical intervention are bucket handle tears (image 3). Should your injury be of a more traumatic nature, causing locking/giving way of the knee joint or not improving with conservative management, your physiotherapist may suggest a consultation with a knee specialist. If indicated, they can perform an arthroscopic surgery, where the surgeon makes a small incision and places a fibre optic camera into the joint, to assess the full extent of the damage to your meniscus. Using the same incision, loose or obstructive pieces of meniscus can be removed from the knee joint. Following this minor surgery, physiotherapy is required to regain range of motion and return you to your pre-injury activity levels.
Frequently Asked Questions:
Will I be able to return to my pre-injury activities after a meniscal injury/tear?
There is a high likelihood that you will be able to return to your chosen sport/hobby after a meniscus injury, providing you are diligent with your rehabilitation and do not progress back to activity too quickly.
How long will my symptoms take to settle after a meniscal injury/tear?
There is no “one size fits all” answer to this question, as it depends on the severity and type of injury to the cartilage. But most symptoms begin to settle with physiotherapy input after 2-4 weeks, and complete resolution of symptoms can be expected between 4-12 weeks after the initial injury.
My knee is clicking when I walk, and sometimes gives way from under me - will this ever stop happening?
As the inflammation within the knee joint reduces, the sensation of clicking and locking will reduce also. Should this not be the case, your physiotherapist will refer you to a knee specialist, for a detailed assessment of your knee symptoms.
See our expert Physiotherapy team at Frenchs Forest and Macquarie Park!