Meniscus Injuries: Symptoms, causes, diagnosis and treatment.

The meniscus is a type of C-shaped cartilage found in the knee joint between the femur and the tibia. Each knee joint has two mensis: one on the outside of the knee (called the lateral meniscus) and one on the inside of the knee (called the medical meniscus).

The medial and lateral menisci act as shock absorbers and also provide shock absorption and stability for the knee, so any tear or injury to the meniscus results in pain, swelling, and sometimes a feeling that the knee is giving up. Although athletes often experience knee meniscus tears , older adults are also at risk.

To diagnose a meniscus tear, your healthcare provider will take a history, a physical exam, and order one or more imaging tests.

Once a diagnosis is made, your healthcare provider will help you choose the best treatment plan, which often includes non-surgical options such as anti-inflammatory medications and physical therapy . If your symptoms persist despite conservative measures, your doctor may recommend surgery.

Illustration by Alexandra Gordon, Get Meds Info

Symptoms

A meniscus tear causes pain in the front of the knee, either in the middle of the knee (due to a medial meniscus tear, which is more common) or on the side of the knee (due to a meniscus tear side). Interestingly, as is often the case with a torn meniscus, a person can still walk and even continue playing sports immediately after an injury. However, within a day or two, the knee becomes unpleasantly swollen and stiff .

In addition to pain, swelling, and stiffness, depending on the type and severity of the injury, other symptoms may include:

  • Gripping or snapping sensation when walking.
  • Inability to fully bend or extend the knee.
  • Knee flexion sensation (knee instability )

Causes

Most of the time, a meniscus tear occurs as a result of an acute knee injury, often as a result of sudden knee rotation while squatting while playing a sport. Examples of sports that increase the risk of a meniscus tear include:

  • Football
  • Football
  • Basketball
  • Baseball
  • Ski
  • Struggle

But meniscus tears can also occur due to age-related degenerative changes (wear and tear) ( osteoarthritis of the knee joint ). With age, the menisci weaken, become more fragile, and prone to damage. Daily movement, such as not getting up properly from a chair, may be enough to cause a meniscus to tear .

Diagnostics

Diagnosis of a torn meniscus requires history, physical examination, and imaging.

History of the disease

During your doctor's appointment, you will be asked a few questions about knee pain. Examples of such questions include:

  • Where exactly is knee pain located?
  • Does the knee swelling appear suddenly or has it developed gradually over several days?
  • Are you experiencing symptoms other than pain and swelling, such as a weakened knee or an inability to bend or extend the knee?
  • Have you had a knee injury or injury?
  • Do you have a history of knee osteoarthritis?

Physical exam

After gathering your medical history, your doctor will perform a physical exam during which he or she will examine, press, and move the knee joint to assess swelling, pain, range of motion, and clicks within the joint. Your healthcare provider will also assess the strength of your leg muscles and assess your gait and your ability to fully extend or bend your knee on your own.

A classic test used to assess meniscus damage is called the McMurray test.

Display

Even if your doctor suspects a meniscus tear, they may first order an X- ray of your knee to evaluate any accompanying bone fractures or other signs of knee pain, such as osteoarthritis.

However, in general, magnetic resonance imaging (MRI) of the knee is the gold standard or the main test for diagnosing and evaluating a meniscus tear.

Differential diagnosis

Other diagnoses involving the knee can cause pain and symptoms that mimic a tear in the meniscus. Two classic examples include:

Anterior cruciate ligament injury

An anterior cruciate ligament (ACL) tear can occur when an athlete suddenly changes direction or lands incorrectly after a jump. Sometimes an ACL tear occurs along with a medial meniscus tear.

These injuries can often be distinguished by a good history. A torn ACL can cause a popping sound or sensation and often causes immediate swelling. In contrast, a tumor from an isolated medial meniscus tear tends to develop gradually over a day or two. MRI can confirm one or both diagnoses.

Collateral Ligament Injury

Collateral ligament injuries can also cause knee pain and swelling, as can meniscal tears. They may involve the medial collateral ligament (located on the inside of the knee) or the lateral collateral ligament (located on the outside of the knee).

Ligament injuries are usually the result of a direct blow to the knee (for example, during a soccer grip) and, like an anterior cruciate ligament tear, can occur in conjunction with a meniscus tear .

A detailed physical examination can help distinguish between knee ligament injuries and meniscus injuries. For example, pain with medial or lateral collateral ligament damage is felt directly over the affected ligament, and with a torn meniscus, pain is felt along the plane of the knee joint, medially or laterally. Also, when the meniscus is torn, the pain usually increases significantly with full extension or flexion of the knee.

As with a torn ACL, MRI can distinguish a collateral ligament from a meniscus injury.

Watch out

While you may assume that surgery is required to heal a torn meniscus , this is generally not the case. In most cases, nonsurgical treatments are all that is needed for a meniscus to heal.

Non-surgical options

The initial treatment for a meniscus tear is the RICE protocol :

  • Relax with disturbed activities.
  • Apply ice or a cold pack to your knee for 15-20 minute sessions several times a day.
  • Tighten the knee with a brace or knee sleeve to prevent additional swelling.
  • Raise your leg over your heart during icing or during rest or relaxation.

To further reduce pain and swelling, your healthcare provider may also recommend an oral nonsteroidal anti-inflammatory drug (NSAID) . Sometimes a steroid (cortisone) is injected into the knee joint to reduce inflammation and relieve pain.

Physical therapy is usually followed by a RICE protocol and a correct diagnosis by your healthcare provider.

If you are still in pain after four to six weeks of disturbed exercise and physical therapy and / or you are still unable to return to your pre-injury activities, surgery may be recommended.

However, keep in mind that non-surgical treatments are almost always the ideal option for treating meniscus tears that result from degenerative changes. This is because research has shown that long-term results do not improve with surgery in people with degenerative meniscus tear.

For example, one study found that there were no clinically significant differences between those who underwent a 12-week supervised exercise therapy program and those who underwent surgery for a degenerative medial meniscus tear. In fact , participants in the physical therapy program had improved thigh muscle strength compared to those who underwent surgery, a positive result.

Operation

Surgery works best when the main symptoms of a meniscus tear are mechanical. This means that a tear in the meniscus causes a pinching or locking sensation in the knee. In other words, when a meniscus tear only causes pain, the results of the surgery may not be as reliable.

Three types of surgeries are used to treat a meniscus tear:

Arthroscopic meniscectomy

A meniscectomy is a procedure to remove a torn part of the meniscus. This procedure is done much more often than meniscus repair . A meniscectomy is performed to remove the damaged part of the meniscus, leaving as much of the healthy meniscus as possible. Meniscectomy usually heals quickly and allows for a quick resumption of activity .

Meniscus repair

Meniscus repair is a surgical procedure done to repair a damaged meniscus. Meniscus repair can restore normal knee anatomy and has a better long-term prognosis if successful. However, meniscus repair is a more serious operation, recovery takes longer, and due to the limited blood supply to the meniscus, it is not always possible .

Meniscus transplant

Meniscus transplantation involves placing a meniscus from a deceased donor patient to a person who has had a meniscus removed . The ideal patient for a meniscus transplant is someone who had their meniscus removed and subsequently developed knee pain.

Meniscus transplantation is not done with an acute meniscus tear, but if the removal of the entire meniscus has caused persistent knee pain.

Long-term forecast

When the meniscus of the knee breaks, the cushioning capacity of the joint is compromised. This increases the risk of developing damage to the cartilaginous surface of the knee joint. Loss of the meniscus puts a lot of pressure on the cartilaginous surfaces of the joint and they are more likely to develop wasting arthritis .

The good news is that you can make lifestyle changes to reduce your risk of developing arthritis after a meniscus tear. Some of these preventive lifestyle strategies include:

Get the word of drug information

Not all meniscus tears are the same, and not all meniscus tears require the same treatment. Also, meniscus tears are common, so try not to get upset if yours is injured. With proper physical therapy and care, most people recover well and return to their desired sports and activities.

Read more about meniscus cysts .

Related Articles