Firstly a little anatomical education.
What is a meniscus? We have two menisci in each knee. These moon shaped cartilages sit on the upper surface of the tibia (shin bone). They serve as the ‘shock absorbers’ which essentially absorb most of the daily impact that we place through our knees from general activities such as walking up stairs or bending to tie your shoelace to higher intensity forces such as running or jumping.
These structures, like most in the human body, can be vulnerable to injury. The most common mechanism of injury is a twisting injury when the foot is planted, often seen in sports such as basketball or rugby. As we get older our menisci weaken and become thinner, in this population degenerative meniscal tears can occur without an acute incident and also without symptoms.
The signs & symptoms of a meniscal injury will vary significantly depending on the severity of the damage.
- An inflamed or irrtated meniscus will present with joint line tenderness, discomfort at end of range extension (straightening the knee) and a reprucudton of pain at end of range flexion (bending). There may be a small amount of swelling present.
- More severe meniscal injuries where there is a tear in the cartulage will have swelling, joint line tenderness and potentially an inability to move the knee through full range of motion due to pain. In cases where the tear is large you may experience spontaneous locking of the knee in certain positions. This often occurs in association with damage to other structures inside the knee such as at torn ACL.
- A Baker’s cyst which is a pocket of swelling directly behind the knee may be present & can be an indication of a tear in the meniscus
A diagnosis can often be made by a skilled physiotherapist based on your history & thorough knee examination. There are a few special tests that can assess the integrity of the meniscus however if further investigation is warranted the an MRI is the scan of choice. This can be used to confirm the diagnosis, assess the extent of the damage and assist in decision making regarding management options for your injury. Larger tears of the meniscus will often require surgical intervention.
What can be done?
Treatment of a meniscal injury will again depend on the severity. A small or degenerative meniscal tear will often be initially treated conservatively with physiotherapy and a progressive strengthening program. These can often take 4- 6 weeks to heal. At the other end of the spectrum a large tear of the meniscus where knee function is impaired will require surgical intervention.
The inner two thirds of the meniscus lacks a blood supply, without receiving fresh nutrients from blood tears in this area will not heal & is referred to as the ‘white zone’. The outer third has a rich blood supply so tears in this area can often heal without the need for surgery. This is known as the ‘red zone’.
Physiotherapy plays a vital role in the conservative management of meniscal injuries. Treatment will usually involve a combination of the following;
- Soft tissue massage to tight, overactive muscles (calf, hamstring, quadriceps and popliteus)
- Dry needling to assist with swelling control as well as reduce muscle spasm and pain.
- Exercise prescription. Your physio should guide you through a progressive strengthening and mobility program. The program should incorporate elements of motor control training, proprioceptive training, and in the later stages sport specific and agility drills.
- Advice regarding activity modification, return to running and eventually return to sport
If surgical intervention is required your physiotherapist will prepare you for surgery and also be able to assist you with the post surgery rehabilitation.
The ‘prehabilitation’ phase prior to surgery is very important. The better the condition of the knee before surgery the better the outcome after surgery. Prehab physio should focus on reducing swelling, maintaining strength and mobility and education regarding the surgical procedure and post op rehabilitation.
As always our advice is ff you are struggling with pain in the knee get it checked out. We need our knees so look after them.