Meniscus Tear

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What is it?

A meniscal injury refers to damage to one of the two C-shaped cartilages which separate the knee joint. Note figure 1 (a) and figure 1 (b) which shows and x-ray view of a damaged Meniscus. These cartilages act as shock absorbers within the knee to assist in cushioning forces.

How did I get it?

The menisci in the knee are most commonly injured when the knee is twisted. This often occurs when changing direction quickly whilst the foot is fixed on the ground. It may also occur if a fellow competitor hits your knee causing it to twist or buckle.

How is a diagnosis made?

A diagnosis is made on the history of the injury and examination findings. Occasionally x-rays and/or an MRI are ordered to rule out other injuries.

What are the symptoms?

The first sensation felt when a meniscus is injured is pain within the knee joint. This may be associated with a sensation of something tearing. Depending on the severity of the injury, the knee may swell and you may have difficulty walking due to pain. Swelling may be immediate or occur over a period of hours. The knee may also feel weak and ‘unstable’, and may produce clicking noises, lock or give way.

What should I do?

To limit the severity of this injury it is advisable to stop your activity immediately and start initial treatment. The most important time in the treatment of any injury is the first 24—48 hours. Swelling is a necessary step in the healing process, however too much swelling can delay healing and cause further tissue damage. To control the amount of swelling and limit the degree of damage to the knee, the RICE regime should be commenced (Rest, Ice, Compression, Elevation). This will help to reduce blood flow to the injured area, thereby reducing the extent of swelling and tissue damage. Rest involves ceasing your activity or sport and limiting the amount of weight you put through your leg. Crutches may be required if you are having difficulty walking. Ice should be applied to the injured site for 15—20 minutes every 1—2 hours. Ideally, it should be applied using crushed ice wrapped in a moist cloth or towel. Compression involves the application of a firm elastic bandage around your knee. It should be firm but not tight enough to cause pain.

Elevation involves lying with your knee resting comfortably on a chair or pillows so that it is above the level of your heart. You should continue the RICE regime until you consult a sports medicine professional preferably within two days of the initial injury.

Following injury to a meniscus, you should NOT undertake activities which increase blood flow to the injured area. These include hot showers, heat rubs, the consumption of alcohol and excessive activity. These may increase the bleeding and swelling within the knee and potentially prolong your recovery.

Because the menisci in the knee have a poor blood supply when they are injured, they are unable to heal by themselves. This can result in ongoing problems depending on the severity of the injury. These problems include persistent knee swelling, clicking, locking and giving way. To limit these surgery is often performed lo remove the damaged portion of the meniscus. Recovery from surgery normally takes a number of weeks. In some situations this may be prolonged if, at the time of the injury, other structures within the knee were also injured.

What does rehab involve?

Most meniscus tears will not heal. Fortunately the meniscus does not always need to heal. Often the meniscus will settle by itself, stop causing pain and the knee will be pain free and function normally. Surgery is a predictable and efficient method of relieving a meniscus tear but does have some drawbacks including anaesthetic, small risk of infection and financial burden. Whether to pursue surgery or physical rehab is largely dependent on how quickly you need to return to activity and your current level of disability. There are other variables that need to be considered when making a decision on surgery. These include the timing of the operation and an assessment on the benefits against the risks of delaying it. From a recreational activity perspective it may be advantageous to wait and see if the meniscus becomes pain free by itself first before considering surgery. How long you wait is largely dependent on your lifestyle and the severity of the symptoms. Physiotherapy has been shown to be helpful for the non-operative management of meniscus tears. Strengthening exercises that do not provoke the injury will be helpful.


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